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心力衰竭是由心脏结构重塑和功能受损引起的临床症状,全球约有4千万人患有心力衰竭[1]。肺循环淤血是心力衰竭的主要症状之一,故易引发肺部感染。同时,肺部感染又增加了心脏负担。研究指出,感染是影响心力衰竭患者预后的危险因素[2]。但是在临床工作中,鉴别老年心力衰竭患者合并肺部感染较为困难,常常延误治疗,导致预后不佳,因此其早期诊断就显得尤为重要。目前,我们受益于一系列对心力衰竭患者具有预后价值的生物标志物,其中研究最多的是B型利钠肽(BNP),实践指南不仅推荐其用于心力衰竭的阳性诊断,还被用于预后和治疗监测[3]。而中性粒细胞与淋巴细胞比值(NLR) 检测可反映肺部感染的严重程度,对感染的临床鉴别诊断具有重要的意义[4]。并且NLR也被应用于心脑血管病等发病、严重程度及预后的预测[5]。因此,本研究将BNP和NLR指标联合,探讨其在老年心衰合并肺部感染病人中的预测价值。
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对照组与感染组在年龄、高血压史、吸烟史、心功能分级、卧床时间、慢性阻塞性肺疾病(COPD)史、中性粒细胞计数、BNP和NLR的差异有统计学意义(P<0.05);两组在性别构成、BMI、糖尿病史和淋巴细胞计数的比较,差异无统计学意义(P>0.05),具体见表1。
表 1 两组临床相关指标比较
项目 对照组(n=86) 感染组(n=92) t/χ2 P 年龄(岁) 63.48±7.12 65.77±6.70 2.215 0.028 男性(%) 54(62.8) 64(69.6) 0.913 0.339 BMI(kg/m2) 22.57±2.97 22.81±2.93 0.547 0.585 高血压史(%) 50(58.1) 71(77.2) 7.398 0.007 糖尿病史(%) 21(24.4) 31(33.7) 1.850 0.174 吸烟史(%) 31(36.0) 58(63.0) 12.959 <0.001 心功能分级(%) Ⅱ 22(25.6) 11(12.0) 6.984 0.030 Ⅲ 39(45.3) 41(44.6) Ⅳ 25(29.1) 40(43.5) 卧床时间(%) ≤7 d 47(54.7) 33(35.9) 6.337 0.012 >7 d 39(45.3) 59(64.1) 慢性阻塞性肺疾病史 13(15.1) 27(29.3) 5.167 0.023 BNP(ng/L) 654.67±529.64 1072.45±674.87 4.573 <0.001 中性粒细胞计数
(×109/L)3.07±1.09 4.76±1.03 10.635 <0.001 淋巴细胞计数
(×109/L)1.36±0.83 1.15±0.77 1.751 0.082 NLR 2.26±1.10 4.14±1.75 8.539 <0.001 -
结果显示,心力衰竭合并肺部感染患者中BNP水平与NLR水平呈正相关(r=0.400, P<0.001)。具体见图1。
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结果显示,NLR、BNP和二者联合对预测心力衰竭患者伴发肺部感染的 ROC的曲线下面积分别为0.810(95% CI 0.743~0.877)、0.756(95% CI 0.680~0.832)、0.838(95% CI 0.777~0.898),P<0.001;灵敏度分别为0.641、0.772和0.826,特异度分别为0.965、0.767、0.733,见图2。其中,NLR、BNP的最佳诊断界值分别为3.81和804.5 ng/L,见图1。
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以是否伴发肺部感染为因变量(0=对照组,1=感染组),以单因素分析中P<0.1的变量纳入多因素分析中,纳入连续性变量:年龄和分类变量:高血压史、吸烟史、慢性阻塞性肺疾病史、卧床时间以及NLR(低组≤3.81,高组>3.81)、BNP(低组≤804.5 ng/L,高组>804.5 ng/L)、心功能分级为自变量,进行多因素Logistic回归分析。结果显示, 吸烟史、NLR和BNP高组、慢性阻塞性肺疾病史是心力衰竭患者伴发肺部感染的危险因素,具体见表2。
表 2 心力衰竭患者伴发肺部感染的多因素logistic回归分析
自变量 B值 SE waldχ2 P值 OR值 95%CI 年龄 0.149 0.094 2.513 0.113 1.161 0.965~1.395 高血压史 −0.230 0.550 0.121 0.727 0.793 0.218~2.895 吸烟史 1.005 0.565 3.167 0.075 2.733 0.903~8.272 心功能分级 0.531 0.322 2.719 0.099 1.701 0.905~3.196 卧床时间 0.056 0.549 0.010 0.918 1.058 0.360~3.105 COPD 1.108 0.636 3.030 0.082 3.027 0.870~10.537 NLR分组 2.029 0.454 19.952 <0.001 7.606 3.123~18.526 BNP分组 1.450 0.475 9.334 0.002 4.264 1.682~10.811 常量 −4.973 1.654 9.040 0.003
Predictive value of neutrophil to lymphocyte ratio combined with BNP in elderly patients with heart failure complicated with pulmonary infection
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摘要:
目的 评估中性粒细胞和淋巴细胞比值(NLR)联合B型利钠肽(BNP)对老年心力衰竭合并肺部感染病人中的预测价值。 方法 收集2018年6月至2020年5月我院就诊的老年心力衰竭病人178例,其中合并肺部感染组92例,无肺部感染组86例。比较两组NLR和BNP水平以及其他临床指标的差异,采用Logistic分析NLR和BNP水平对心力衰竭伴发肺部感染的影响,ROC曲线分析NLR联合BNP对老年心力衰竭合并肺部感染的预测价值。 结果 Logistic回归分析显示NLR(OR=7.606,95%CI: 3.123~18.526)和BNP(OR=4.264,95%CI: 1.682~10.811)是老年心力衰竭合并肺部感染的独立危险因素。Pearson相关分析显示BNP水平与NLR水平呈正相关(r=0.400, P<0.001)。NLR、BNP和NLR+BNP联合预测老年心力衰竭合并肺部感染ROC曲线下面积分别为0.810、0.756和0.838。 结论 BNP和NLR是老年心力衰竭合并肺部感染的独立危险因素,联合检测对其发生有较好的预测价值。 -
关键词:
- 心力衰竭 /
- 肺部感染 /
- 中性粒细胞和淋巴细胞比值 /
- B型利钠肽
Abstract:Objective To evaluate the predictive value of neutrophil to lymphocyte ratio(NLR) and B-type natriuretic peptide (BNP) in elderly patients with heart failure complicated with pulmonary infection. Methods 178 heart failure patients in our hospital from June 2018 to May 2020 were selected as the research objects, and they were divided into pulmonary infection group (n=92) and non-pulmonary infection group (n=86) according to whether they were complicated with pulmonary infection. The differences of NLR and BNP levels and other clinical indicators between the two groups were compared. Univariate and multivariate Cox regression were used to analyze the influence of NLR and BNP levels on heart failure complicated with pulmonary infection. The predictive value of NLR combined with BNP on heart failure complicated with pulmonary infection was analyzed by receiver operating characteristic (ROC) curve. Results Multivariate logistic regression analysis showed that NLR (OR=7.606, 95% CI: 3.123-18.526) and BNP (OR=4.264, 95% CI: 1.682-10.811) were independent risk factors of elderly heart failure complicated with pulmonary infection after adjusting for other related variables. Pearson correlation analysis showed that BNP level was positively correlated with NLR level (r=0.400, P<0.001). The area under ROC curve of NLR, BNP and NLR+BNP in predicting pulmonary infection in elderly patients with heart failure was 0.810, 0.756 and 0.838, respectively. Conclusion BNP and NLR are independent risk factors of elderly patients of heart failure with pulmonary infection .The combined detection of BNP and NLR has predictive value for those patients. -
Key words:
- heart failure /
- pulmonary infection /
- NLR /
- BNP
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表 1 两组临床相关指标比较
项目 对照组(n=86) 感染组(n=92) t/χ2 P 年龄(岁) 63.48±7.12 65.77±6.70 2.215 0.028 男性(%) 54(62.8) 64(69.6) 0.913 0.339 BMI(kg/m2) 22.57±2.97 22.81±2.93 0.547 0.585 高血压史(%) 50(58.1) 71(77.2) 7.398 0.007 糖尿病史(%) 21(24.4) 31(33.7) 1.850 0.174 吸烟史(%) 31(36.0) 58(63.0) 12.959 <0.001 心功能分级(%) Ⅱ 22(25.6) 11(12.0) 6.984 0.030 Ⅲ 39(45.3) 41(44.6) Ⅳ 25(29.1) 40(43.5) 卧床时间(%) ≤7 d 47(54.7) 33(35.9) 6.337 0.012 >7 d 39(45.3) 59(64.1) 慢性阻塞性肺疾病史 13(15.1) 27(29.3) 5.167 0.023 BNP(ng/L) 654.67±529.64 1072.45±674.87 4.573 <0.001 中性粒细胞计数
(×109/L)3.07±1.09 4.76±1.03 10.635 <0.001 淋巴细胞计数
(×109/L)1.36±0.83 1.15±0.77 1.751 0.082 NLR 2.26±1.10 4.14±1.75 8.539 <0.001 表 2 心力衰竭患者伴发肺部感染的多因素logistic回归分析
自变量 B值 SE waldχ2 P值 OR值 95%CI 年龄 0.149 0.094 2.513 0.113 1.161 0.965~1.395 高血压史 −0.230 0.550 0.121 0.727 0.793 0.218~2.895 吸烟史 1.005 0.565 3.167 0.075 2.733 0.903~8.272 心功能分级 0.531 0.322 2.719 0.099 1.701 0.905~3.196 卧床时间 0.056 0.549 0.010 0.918 1.058 0.360~3.105 COPD 1.108 0.636 3.030 0.082 3.027 0.870~10.537 NLR分组 2.029 0.454 19.952 <0.001 7.606 3.123~18.526 BNP分组 1.450 0.475 9.334 0.002 4.264 1.682~10.811 常量 −4.973 1.654 9.040 0.003 -
[1] BAMAN J R, AHMAD F S. Heart Failure [J]. JAMA. 2020, 324(10): 1015. [2] 任莉霞, 贾旭, 王志浩, 等. 基层医院慢性心力衰竭治疗转归的影响因素研究[J]. 中国全科医学, 2021, 24(14):1769-1775. [3] PONIKOWSKI P, VOORS A A, ANKER S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J]. Eur J Heart Fail,2016,18(8):891-975. doi: 10.1002/ejhf.592 [4] 刘伟平, 毛小倩. Hs-CRP、PCT、IL-6和NLR对肺部细菌及肺炎支原体感染的诊断价值[J]. 医学研究杂志, 2021, 50(12):64-67+135. [5] DELCEA C, BUZEA C A, DAN G A. The neutrophil to lymphocyte ratio in heart failure: a comprehensive review[J]. Rom J Intern Med,2019,57(4):296-314. [6] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789. [7] 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南 [J]. 现代临床医学, 2018, 41(4): 255-280. [8] 张绍江, 祁庆, 税小波. 老年心力衰竭患者合并肺部感染及预后影响因素[J]. 中华医院感染学杂志, 2021, 31(02):203-207. [9] Kounis N G, Soufras G D, Tsigkas G, et al. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease[J]. Clin Appl Thromb Hemost,2015,21(2):139-143. doi: 10.1177/1076029614531449 [10] Boralkar K A, Kobayashi Y, Amsallem M, et al. Value of Neutrophil to Lymphocyte Ratio and its Trajectory in Patients Hospitalized With Acute Heart Failure and Preserved Ejection Fraction[J]. Am J Cardiol,2020,125(2):229-235. doi: 10.1016/j.amjcard.2019.10.020 [11] Cho J H, Cho H J, Lee H Y, et al. Neutrophil-Lymphocyte Ratio in Patients with Acute Heart Failure Predicts In-Hospital and Long- Term Mortality [J], J Clin Med. 2020, 9(2): 557. [12] 顾辨辨, 何媛媛, 李静, 等. 炎性指标对高龄脑卒中患者肺部感染的早期预测价值[J]. 中国临床保健杂志, 2020, 23(6):766-769. doi: 10.3969/J.issn.1672-6790.2020.06.010 [13] SUDOH T, KANGAWA K, MINAMINO N, et al. A new natriuretic peptide in porcine brain[J]. Nature,1988,332(6159):78-81. doi: 10.1038/332078a0 [14] Egom E E. BNP and Heart Failure: Preclinical and Clinical Trial Data[J]. J Cardiovasc Transl Res,2015,8(3):149-157. doi: 10.1007/s12265-015-9619-3 [15] 王大强, 王革新, 张庆远, 等. 血清TNF-α与IL-6和BNP指标在检测心力衰竭合并感染患者中的应用价值分析[J]. 中华医院感染学杂志, 2018, 28(21):3219-3221+3225. [16] 许抗抗, 杨国爱, 陈晓琳, 等. NLR、MPV、脑钠肽评估心力衰竭病人预后的临床价值及其相关性分析[J]. 中西医结合心脑血管病杂志, 2021, 19(17):2970-2973. doi: 10.12102/j.issn.1672-1349.2021.17.020 [17] 黎晨辉, 杨少芬, 卢庆莉, 等. 系统免疫炎症指数与慢性心力衰竭急性发作患者院内死亡的相关性研究[J]. 心肺血管病杂志, 2021, 40(07):658-662. doi: 10.3969/j.issn.1007-5062.2021.07.003 [18] 张毅, 刘亚伟, 段振乾, 等. 重症肺部感染患者血清S-ChE、BNP、NLR水平与患者预后的关系[J]. 热带医学杂志, 2021, 21(9):1172-1174+1221. doi: 10.3969/j.issn.1672-3619.2021.09.019