摘要
目的 探讨纤维蛋白降解产物与白蛋白比值(fibrin degradation product to albumin ratio,FDP/ALB)、中性粒细胞与淋巴细胞及血小板比值(neutrophil to lymphocyte and platelet ratio,NLPR)对老年社区获得性肺炎(community-acquired pneumonia,CAP)严重程度的预测价值。方法 选取2021年3月至2023年3月于承德医学院附属医院呼吸与危重症医学科住院的147例老年CAP患者,根据病情严重程度分为非重症肺炎组(n=94)和重症肺炎组(n=53)。记录两组患者的一般资料和临床资料,计算两组患者的中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、C反应蛋白(C-reactive protein,CRP)与白蛋白比值(CRP to albumin ratio,CAR)、FDP/ALB、NLPR、氧合指数,并进行比较分析;比较FDP/ALB、NLPR与其他传统炎症指标对老年CAP严重程度的预测价值。结果 重症肺炎组患者的CRP、降钙素原(procalcitonin,PCT)、白细胞(white blood cells,WBC)、中性粒细胞(neutrophil,NEU)、纤维蛋白降解产物(fibrin degradation product,FDP)、NLR、CAR、CURB-65评分、FDP/ALB、NLPR明显高于非重症肺炎组,淋巴细胞(lymphocyte,LYM)、血小板(platelet,PLT)、白蛋白(albumin,ALB)明显低于非重症肺炎组(P<0.05);两组患者的年龄、性别、吸烟史、基础疾病、PLR比较,差异均无统计学意义(P>0.05)。Spearman相关性分析显示FDP/ALB、NLPR与CRP、PCT、WBC、NLR、CAR、CURB-65评分呈正相关性,与氧合指数呈负相关(P<0.05)。多因素Logistic回归分析显示FDP/ALB、NLPR是老年重症CAP的独立危险因素(P<0.05)。受试者工作特征曲线分析显示FDP/ALB、NLPR、NLR、CAR、PCT、NEU、CURB-65评分、CRP、WBC预测老年CAP严重程度的能力逐渐减低(P<0.05)。结论 FDP/ALB、NLPR对老年CAP严重程度的预测价值明显优于传统炎症指标(CRP、PCT、WBC、NEU、NLR、CAR、CURB-65评分),应引起临床重视。
Objective To explore the predictive value of fibrin degradation product to albumin ratio(FDP/ALB),neutrophil to lymphocyte and platelet ratio(NLPR)for the severity of elderly community-acquired pneumonia(CAP).Methods 147 elderly CAP patients hospitalized in the Department of Respiratory and Critical Care,Affiliated Hospital of Chengde Medical University from March 2021 to March 2023 were selected and divided into non severe CAP group(n=94)and severe CAP group(n=53)according to the severity of the disease.The general and clinical data of two groups of patients were recorded,and calculated neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),C-reactive protein(CRP)to albumin ratio(CAR),FDP/ALB,NLPR,and oxygenation index,the differences between two groups of the above indicators were compared and correlation analysis were conducted;The predictive value of FDP/ALB,NLPR,and other traditional inflammatory indicators on the severity of elderly CAP were compared.Results CRP,procalcitonin(PCT),white blood cells(WBC),neutrophil(NEU),fibrin degradation product(FDP),NLR,CAR,CURB-65 scores,FDP/ALB,and NLPR in severe CAP group were significantly higher than those in non severe CAP group,while lymphocyte(LYM),platelet(PLT)and albumin(ALB)were significantly lower than those in non severe CAP group(P<0.05);There were no statistically significant differences in age,gender,smoking history,underlying diseases,and PLR between two groups(P>0.05).Spearman correlation analysis showed a positive correlation between FDP/ALB,NLPR and CRP,PCT,WBC,NLR,CAR CURB-65 scores,while a negative correlation with oxygenation index(P<0.05).Multivariate Logistic regression analysis showed that FDP/ALB and NLPR were independent risk factors for severe CAP in the elderly(P<0.05).The analysis of receiver operating characteristic curve showed that the ability of FDP/ALB,NLPR,NLR,CAR,PCT,NEU,CURB-65 score,CRP,and WBC to predict the severity of elderly CAP gradually decreased(P<0.05).Conclusion The predictive value of FDP/ALB and NLPR for the severity of elderly CAP is significantly better than traditional inflammatory indicators(CRP,PCT,WBC,NEU,NLR,CAR,CURB-65 scores),which should be taken seriously by clinical workers.
作者
姚泓哲
郭鑫龙
杨林瀛
YAO Hongzhe;GUO Xinlong;YANG linying(Graduate School of Chengde Medical University,Chengde 067000,Hebei,China;Department of Respiratory and Critical Care,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China)
出处
《中国现代医生》
2025年第6期50-54,86,共6页
China Modern Doctor
