| 中性粒细胞与血小板比值对脓毒症急性肾损伤发生的预测价值 |
| 投稿时间：2024-12-25 修订日期：2025-01-14 点此下载全文 |
| 引用本文：黄超,谷柳莹,伊尔潘江·阿不杜克然木,马骏麒,姜雯娟.中性粒细胞与血小板比值对脓毒症急性肾损伤发生的预测价值[J].医学研究杂志,2025,54(6):103-108 |
| DOI：
10.11969/j.issn.1673-548X.2025.06.019 |
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| 基金项目:新疆维吾尔自治区自然科学基金资助项目(2022D01C544) |
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| 中文摘要:目的 探讨中性粒细胞与血小板比值(neutrophil to platelet ratio,NPR)对脓毒症急性肾损伤(acute kidney injury, AKI)发生的预测价值。方法 回顾性分析2023年2月～2024年5月新疆维吾尔自治区人民医院急诊重症监护室收治的脓毒症患者,根据2012年改善全球肾脏病预后组织指南将脓毒症患者分为AKI组及非AKI组。记录入院时的临床基本资料,包括年龄、合并症、28天预后情况和入住重症监护室24h内首次检测的中性粒细胞计数、血小板计数、降钙素原、乳酸、NPR等,比较两组临床资料。通过Logistic回归分析筛选影响脓毒症AKI发生的危险因素,采用受试者操作特征(receiver operator characteristic,ROC)曲线评价NPR对脓毒症AKI发生的诊断效能；采用Spearman相关分析NPR与脓毒症AKI分期的相关性。结果 最终纳入脓毒症患者159例,其中AKI组87例,非AKI组72例,AKI发生率为54.7%。与脓毒症非AKI组比较,脓毒症AKI组降钙素原、白介素-6、乳酸、D-二聚体、尿酸、NPR、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、中性粒细胞与淋巴细胞和血小板比值(neutrophil to lymphocyte and platelet ratio,N/LPR)高于脓毒症非AKI组,血小板计数、淋巴细胞计数低于脓毒症非AKI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示, NPR、乳酸、尿酸升高及淋巴细胞计数降低是脓毒症AKI发生的独立危险因素。ROC曲线分析显示,NPR对预测脓毒症AKI发生有较好的临床价值,曲线下面积(area under the curve,AUC)达0.731,且优于NLR,但低于N/LPR,N/LPR预测效能还高于NPR与NLR两者联合时。Spearman相关性分析显示,脓毒症AKI患者的NPR、N/LPR与AKI的分期呈正相关。结论 入院NPR的升高是脓毒症AKI的独立危险因素,且高NPR与脓毒症患者严重的AKI发生风险密切相关。NPR可在一定程度上预测脓毒症AKI发生。 |
| 中文关键词:脓毒症 急性肾损伤 中性粒细胞与淋巴细胞比值 预测 |
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| Value of the Ratio of Neutrophil Count to Platelet Count in Predicting the Occurrence of Acute Kidney Injury in Sepsis. |
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| Abstract:Objective To explore the predictive value of neutrophil to platelet ratio (NPR) in acute renal injury (AKI) in sepsis. Methods Patients with sepsis admitted to the emergency intensive care unit of Xinjiang Uygur Autonomous Region People′s Hospital from February 2023 to May 2024 were retrospectively analyzed. According to the guidelines of the Global Organization for Improving the Prognosis of Nephropathy (KDIGO) in 2012, septic patients were divided into acute renal injury group (AKI group) and non-acute renal injury group (non-AKI group). The basic clinical data on admission, including age, complications, 28-day prognosis and the first neutrophil count, platelet count, procalcitonin, lactic acid and NPR within 24hours after admission were recorded and compared between the two groups. The risk factors of septic AKI were screened by Logistic regression analysis, the diagnostic efficacy of NPR in septic AKI was evaluated by receiver operating characteristic (ROC) curve, and the correlation between NPR and AKI stage of sepsis was analyzed by Spearman. Results Finally, 159 patients with sepsis were included, including 87 patients in AKI group and 72 patients in non-AKI group. The incidence of AKI was 54.7%. Compared with non-AKI group, procalcitonin, IL-6, lactic acid, D-dimer, uric acid, NPR, neutrophil to lymphocyte ratio (NLR), neutrophil to lymphocyte and platelet ratio (N/LPR) in septic AKI group were significantly higher than those in septic non-AKI group, while the platelet count and lymphocyte count in sepsis group were significantly lower than those in non-AKI group(P<0.05). Multivariate Logistic regression analysis showed that the increase of NPR, lactic acid, uric acid and the decrease of lymphocyte count were the independent risk factors of septic AKI. ROC curve analysis showed that NPR had good clinical value in predicting the occurrence of septic AKI. The area under the curve (AUC) was 0.731, which was better than that of NLR, but lower than N/LPR, and the predictive efficacy of N/LPR was also higher than that of the combination of NPR and NLR. Spearman correlation analysis showed that there was a positive correlation between NPR, N/LPR and AKI stage in patients with sepsis AKI. ConclusionThe increase of admission NPR is an independent risk factor for septic AKI, which has a good predictive value, and high NPR is more closely related to the risk of severe AKI in septic AKI patients. NPR can predict the occurrence of septic AKI to some extent. |
| keywords:Sepsis Acute kidney injury Neutrophil to lymphocyte ratio Prediction |
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