外周血细胞计数及其比值预测百日咳患者疾病严重程度的分析

Peripheral blood cells count and their ratio in predicting the severity of pertussis

摘要:

目的： 评估外周血细胞计数［白细胞（white blood cell，WBC）、淋巴细胞绝对值、血小板（platelet，PLT）］及其相关比率，即中性粒细胞/淋巴细胞比率（neutrophil to lymphocyte ratio，NLR）、淋巴细胞与单核细胞比（lymphocyte to monocyte ratio，LMR）、血小板与淋巴细胞比率（platelet to lymphocyte ratio，PLR）、血小板计数与平均血小板体积（platelet count to mean platelet volume ratio，PLT/MPV）在预测百日咳患者合并呼吸道感染严重程度的价值。方法： 回顾性分析1 129例百日咳患者资料，分组对比外周血WBC、PLT、NLR、PLR、LMR、PLT/MPV差异。结果： 共1 129例患者纳入研究。重症肺炎组分别与3个非重症肺炎组（上呼吸道感染组、支气管炎组、肺炎组）WBC计数水平有统计学差异（P=0.000、0.041、0.000），重症肺炎组WBC计数水平明显高于非重症肺炎的3组患者，WBC计数越高，越容易发生重症肺炎，提示外周血细胞WBC计数值可以作为预测重症肺炎及非重症肺炎的指标。重症肺炎组分别与3个非重症肺炎组NLR具有组间统计学差异（P=0.000、0.014、0.037），肺炎组与非肺炎组NLR具有组间统计学差异（P=0.043）。重症肺炎组NLR明显高于非重症肺炎的3组患者，肺炎组NLR明显高于非肺炎百日咳患者，说明NLR随着呼吸道感染程度加重，值越高，尤其是在发生重症肺炎时，NLR显著高于非重症肺炎的3组患者。NLR是一个有效预测呼吸道感染严重程度的指标，比值越高提示呼吸道感染程度可能越重。LMR在上呼吸道感染组与其他3组对比具有统计学差异（P=0.001、0.000、0.001），统计发现呼吸道感染程度越重，值越低，可能作为预测呼吸道感染严重程度的指标之一。除上述3项指标外，淋巴细胞绝对值、PLT、PLT/MPV在预测不同呼吸道感染程度中作用有限。结论： WBC、NLR对重症肺炎预测具有临床意义；NLR对肺炎预测具有临床意义。WBC越大，NLR越大，其预测重症肺炎发生的概率增高，呼吸道感染可能越严重。

Abstract:

Objective: To evaluate peripheral blood cells count［white blood cell (WBC), lymphocyte absolute value, platelet (PLT) ］and their related ratios (i.e. neutrophil to lymphocyte ratio, NLR; lymphocyte to monocyte ratio, LMR; platelet to lymphocyte ratio, PLR; platelet count to mean platelet volume ratio, PLT/MPV) in predicting the severity of respiratory infections in patients with pertussis. Methods: The data of 1 129 patients with pertussis were analyzed retrospectively, and the differences of WBC, PLT, NLR, PLR, LMR and PLT/MPV in peripheral blood were evaluated statistically in different respiratory tract infection groups. Results: A total of 1 129 patients were included in the study. There were statistically significant differences in WBC count levels between the severe pneumonia group and the three non-severe pneumonia groups (the upper respiratory tract infection group, the bronchitis group, and the pneumonia group) (P=0.000, 0.041, 0.000) . The WBC count level in the severe pneumonia group was significantly higher than that in the three non-severe pneumonia groups. The higher the WBC count, the more likely it was to develop severe pneumonia, suggesting that the WBC count of peripheral blood cells can be used as an index to predict severe pneumonia and non-severe pneumonia. There were significant differences in NLR between the severe pneumonia group and the three non-severe pneumonia groups respectively (P=0.000, 0.014, 0.037), between the pneumonia group and the non-pneumonia group (P=0.043) . The NLR of the severe pneumonia group was significantly higher than that of the three non-severe pneumonia groups, and the NLR of the pneumonia group was significantly higher than that of the non-pneumonia group, indicating that the NLR increased with the severity increasing of respiratory tract infection. Especially when severe pneumonia occurred, NLR was significantly higher than the three non-severe pneumonia groups. NLR is an effective index to predict the severity of respiratory tract infection. The higher the NLR, the more severe the respiratory tract infection could be. LMR was statistically higher in the upper respiratory tract infection group than the other three groups (P=0.001, 0.000, 0.001) . The statistics found that the more severe the respiratory tract infection, the lower the LMR, which may be one of the indicators to predict the severity of respiratory tract infection. In addition to the above three indicators, the lymphocytes absolute value, PLT, and PLT/MPV had limited roles in predicting the severity of different respiratory tract infections. Conclusion: WBC and NLR are good independent predictors of severe pneumonia. NLR has a role in predicting pneumonia. The larger the WBC or NLR, the higher the probability of predicting severe pneumonia and the more serious the respiratory infection being.