Value of serum hemoglobin scavenger receptor soluble CD163 combined with neutrophil to lymphocyte ratio in predicting prognosis of patients with stroke-related pneumonia
-
摘要:目的 探讨血清血红蛋白清道夫受体可溶性CD163(sCD163)联合中性粒细胞与淋巴细胞比值(NLR)预测卒中相关性肺炎(SAP)患者预后的价值。方法 回顾性分析2019年4月—2020年12月90例SAP患者的临床资料，根据改良Rankin量表(mRS)评分分为预后良好组(n=58)与预后不良组(n=32)。分析预后不良的相关影响因素，评估sCD163、NLR与肺炎严重指数(PSI)分级、美国国立卫生研究院卒中量表(NIHSS)评分、临床肺部感染评分(CPIS)、肺部感染严重程度(CURB-65)评分、C反应蛋白(CRP)、白细胞(WBC)计数的相关性。比较2组血清sCD163水平及NLR, 评估sCD163、NLR单独预测及联合预测SAP患者预后不良的价值。结果 单因素分析结果显示，预后不良组与预后良好组在年龄、PSI评分分级、NIHSS评分、CPIS评分、CURB-65评分、CRP、WBC方面比较，差异有统计学意义(P < 0.001)。二分类Logistic回归分析显示, PSI评分分级为Ⅳ~Ⅴ级、NIHSS评分≥20分、CPIS评分≥6分、CURB-65评分≥3分及CRP、WBC高表达是SAP患者预后不良的独立危险因素(P < 0.05)。预后不良组的血清sCD163、NLR高于预后良好组，差异有统计学意义(P < 0.001)。Spearman相关性分析结果显示, sCD163、NLR与PSI评分分级、NIHSS评分、CPIS评分、CURB-65评分呈显著正相关(P < 0.05或P < 0.01)。Pearson相关性分析结果显示, sCD163、NLR与CRP、WBC呈显著正相关(P < 0.001)。受试者工作特征(ROC)曲线显示, sCD163、NLR单独预测及联合预测SAP患者预后不良的曲线下面积(AUC)分别为0.910、0.867、0.915, P均 < 0.05。结论 SAP患者血清sCD163、NLR显著升高，尤其在预后不良患者中升高更为显著, sCD163与NLR联合检测预测SAP患者预后不良的价值较高。
-
关键词:
- 血红蛋白清道夫受体可溶性CD163 /
- 中性粒细胞与淋巴细胞比值 /
- 卒中相关性肺炎 /
- 预后 /
- C反应蛋白 /
- 白细胞计数
Abstract:Objective To explore the value of serum hemoglobin scavenger receptor soluble CD163 (sCD163) combined with neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients with stroke-related pneumonia (SAP).Methods The clinical materials of 90 SAP patients from April 2019 to December 2020 were analyzed retrospectively, and they were divided into good prognosis group (n=58) and poor prognosis group (n=32) according to the score of modified Rankin Scale (mRS). The related factors of poor prognosis were analyzed, and correlations between sCD163, NLR and Pneumonia Severity Index (PSI) classification, the National Institutes of Health Stroke Scale (NIHSS) score, Clinical Pulmonary Infection Score (CPIS), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65) score, C-reactive protein (CRP) as well as white blood cell (WBC) count were evaluated. Serum sCD163 level and NLR were compared between the two groups, and the values of sCD163 alone, NLR alone and their combination in predicting the poor prognosis of SAP patients were evaluated. Univariate analysis showed that there were significant differences in age, PSI score and classification, NIHSS score, CPIS score, CURB-65 score, CRP and WBC between the poor prognosis group and the good prognosis group (P < 0.001). Binary Logistic regression analysis showed that PSI score and classification of grade Ⅳ to Ⅴ, NIHSS ≥20 scores, CPIS ≥6 scores, CURB-65 ≥3 scores and high expression of CRP and WBC were independent factors for poor prognosis in SAP patients (P < 0.05). The serum sCD163 and NLR in the poor prognosis group were significantly higher than those in the good prognosis group (P < 0.001). Spearman correlation analysis showed that sCD163 and NLR were significantly positively correlated with PSI score, NIHSS score, CPIS score and CURB-65 score (P < 0.05 or P < 0.01). Pearson correlation analysis showed that sCD163 and NLR were significantly positively correlated with CRP and WBC (P < 0.001). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of sCD163 alone, NLR alone and their combination in predicting the poor prognosis of SAP patients were 0.910, 0.867 and 0.915 respectively, and their P values were less than 0.05.Conclusion Serum sCD163 and NLR increase obviously in SAP patients, especially significant in patients with poor prognosis. Combined detection of sCD163 and NLR has a high value in predicting poor prognosis of SAP patients. -
-
表 1 SAP患者预后不良的单因素分析(x±s)[n(%)]
指标 预后不良组
(n=32)预后良好组
(n=58)性别 男 17(53.12) 27(46.55) 女 15(46.88) 31(53.45) 年龄 ≥60岁 19(59.38) 12(20.69)** < 60岁 13(40.62) 46(79.31)** 脑卒中类型 脑梗死 26(81.25) 54(93.10) 脑出血 6(18.75) 4(6.90) PSI评分分级 Ⅳ~Ⅴ级 18(56.25) 7(12.07)** Ⅰ~Ⅲ级 14(43.75) 51(87.93)** NIHSS评分 ≥20分 17(53.12) 8(13.79)** < 20分 15(46.88) 50(86.21)** CPIS评分 ≥6分 15(46.88) 4(6.90)** < 6分 17(53.12) 54(93.10)** CURB-65评分 ≥3分 19(59.38) 6(10.34)** 0~2分 13(40.62) 52(89.66)** CRP/(mg/L) 84.52±15.65 55.25±10.65** WBC/(×109/L) 17.23±2.52 11.02±1.98** PSI: 肺炎严重指数; NIHSS: 美国国立卫生研究院卒中量表;
CPIS: 临床肺部感染评分; CURB-65: 肺部感染严重程度;
CRP: C反应蛋白; WBC: 白细胞。
与预后不良组比较, * * P < 0.01。
下载: 导出CSV
表 2 SAP患者预后不良的二分类Logistic回归分析
因素 B S. E. Wald 自由度 P OR 95%CI 下限 上限 年龄≥60岁 0.696 0.777 0.802 1 0.370 2.006 0.437 9.196 PSI评分分级为Ⅳ~Ⅴ级 2.237 0.802 7.775 1 0.005 9.362 1.944 45.098 NIHSS评分≥20分 1.527 0.766 3.980 1 0.046 4.606 1.027 20.657 CPIS评分≥6分 2.878 0.896 10.310 1 0.001 17.779 3.069 103.005 CURB-65评分≥3分 3.182 0.864 13.563 1 < 0.001 24.098 4.431 131.052 CRP 0.188 0.041 21.473 1 < 0.001 1.207 1.115 1.307 WBC 1.153 0.251 21.020 1 < 0.001 3.167 1.935 5.185
下载: 导出CSV
表 3 2组血清sCD163与NLR指标比较(x±s)
组别 n sCD163/(mg/L) NLR 预后不良组 32 45.32±8.62 2.68±1.02 预后良好组 58 30.95±6.45** 1.35±0.65** sCD163: 血红蛋白清道夫受体可溶性CD163; NLR: 中性粒细胞与淋巴细胞比值。与预后不良组比较, **P < 0.01。
下载: 导出CSV
表 4 sCD163、NLR与评估指标的相关性分析
指标 PSI评分分级 NIHSS评分 CPIS评分 CURB-65评分 CRP WBC sCD163 r 0.360 216.000 0.329 0.355 0.851 0.839 P < 0.001 0.041 0.002 < 0.001 < 0.001 < 0.001 NLR r 0.310 205.000 0.317 0.264 0.739 0.730 P 0.003 0.053 0.002 0.012 < 0.001 < 0.001
下载: 导出CSV
表 5 sCD163、NLR及两项联合的预测效能分析
检验结果变量 AUC 标准错误 P 渐近95%CI cut-off值 约登指数 敏感度/% 特异度/% 下限值 上限值 sCD163 0.910 0.033 < 0.001 0.846 0.974 37.995 0.741 84.40 89.70 NLR 0.867 0.038 < 0.001 0.792 0.943 1.665 0.561 90.60 65.50 两项联合 0.915 0.034 < 0.001 0.848 0.982 50.816 0.751 90.60 84.50 将sCD163、NLR纳入Logistic回归分析，根据回归结果中的回归系数值拟合两项联合诊断的数值计算公式:
两项联合=sCD163+(-2.241/-0.269)×NLR。
下载: 导出CSV
-
[1] NIELSEN M C, ANDERSEN M N, RITTIG N, et al. The macrophage-related biomarkers sCD163 and sCD206 are released by different shedding mechanisms[J]. J Leukoc Biol, 2019, 106(5): 1129-1138. doi: 10.1002/JLB.3A1218-500R
[2] 许墨菊, 孙向军. 血清PCT和CRP/ALB比值在卒中相关性肺炎患者的病原学分类的诊断价值分析[J]. 河北医学, 2020, 26(8): 1329-1333. doi: 10.3969/j.issn.1006-6233.2020.08.023 [3] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 [4] 王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019更新版)[J]. 中国急救医学, 2019, 39(12): 1135-1143. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY201912002.htm [5] 郑娜敏, 顾乐, 吕建农. PSI评分对呼吸机相关性肺炎患者预后价值的评估[J]. 中国急救复苏与灾害医学杂志, 2019, 14(4): 323-327. doi: 10.3969/j.issn.1673-6966.2019.04.006 [6] 汤锦丽, 顾艳, 费雅雅, 等. 基于NIHSS评分的干预模式对重型颅脑损伤术后患者的影响[J]. 中国医药导报, 2020, 17(14): 69-72, 77. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202014018.htm [7] 何荣香, 俞丹, 何英, 等. CPIS评分联合CURB-65评分系统在医院获得性肺炎评价中的作用及价值研究[J]. 中华医院感染学杂志, 2019, 29(2): 300-304. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201902035.htm [8] 谭伟, 田辉, 袁强, 等. 外周血NLR和CRP/ALB值对获得性败血症预后评估的临床价值[J]. 现代医学, 2020, 48(6): 699-704. doi: 10.3969/j.issn.1671-7562.2020.06.004 [9] 赵鲁新, 仝冰云, 姜宁. 肺炎患儿血清s TREM-1、sCD163、SP-A、LP(a)的变化及其意义[J]. 四川医学, 2019, 40(1): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX201901020.htm [10] 王磊, 夏云峰, 李良, 等. 心房颤动病人血清sCD14、sCD163的表达及临床意义[J]. 中西医结合心脑血管病杂志, 2019, 17(15): 2348-2351. doi: 10.12102/j.issn.1672-1349.2019.15.028 [11] 庞苏迎, 童天夫, 李美, 等. NLR、PLR及CRP/ALB对老年脑卒中相关性肺炎的诊断和预后评估价值[J]. 国际检验医学杂志, 2020, 41(21): 2599-2603. doi: 10.3969/j.issn.1673-4130.2020.21.009 [12] 陈永海, 方凤, 范美花, 等. 血清可溶性清道夫受体CD163在慢性阻塞性肺疾病急性加重期中的临床意义[J]. 临床肺科杂志, 2019, 24(8): 1429-1432. doi: 10.3969/j.issn.1009-6663.2019.08.018 [13] 葛学茹, 陆友金. NLR、PLR、APACHEⅡ评分对AECOPD患者预后的评估价值[J]. 临床肺科杂志, 2020, 25(4): 541-545. doi: 10.3969/j.issn.1009-6663.2020.04.013 [14] RUSSELL C D, PARAJULI A, GALE H J, et al. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: a systematic review and meta-analysis[J]. J Infect, 2019, 78(5): 339-348. doi: 10.1016/j.jinf.2019.02.006
[15] 浦晋军, 罗家祺, 周丹丹, 等. 血清肾上腺髓质素前体对急性脑梗死并发卒中相关性肺炎的预测价值[J]. 实用临床医药杂志, 2020, 24(5): 47-52. doi: 10.7619/jcmp.202005013 [16] 湛栖睿, 卢宣霖. 外周血中性粒细胞与淋巴细胞比值评估脑卒中相关性肺炎患者预后的价值分析[J]. 检验医学与临床, 2020, 17(22): 3339-3341. doi: 10.3969/j.issn.1672-9455.2020.22.035 [17] 张花平, 宋贺, 张博, 等. 外周血NLR、sTREM-1、PCT水平对老年卒中患者相关性肺炎的诊断价值[J]. 解放军医药杂志, 2020, 32(4): 72-75. doi: 10.3969/j.issn.2095-140X.2020.04.018 [18] 薛笑甜, 陈明伟. 清肺十八味丸联合桉柠蒎对老年COPD合并PTB患者肺功能及炎性因子水平的影响[J]. 西部中医药, 2020, 33(9): 85-88. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZY202009024.htm -
期刊类型引用(2)
1. 曾林，史易晗，孙荣鑫，张磊，高健，姜侃. 深静脉血栓形成的多组学研究进展. 骨科临床与研究杂志. 2024(02): 125-128 . 
百度学术
2. 乔琛琛，梁云龙. ABO血型对达比加群酯治疗非瓣膜性房颤效果的影响. 实用临床医药杂志. 2023(23): 63-67 . 本站查看
其他类型引用(0)
计量
- 文章访问数:
- HTML全文浏览量:
- PDF下载量:
- 被引次数: 2
苏公网安备 32100302010246号