中性粒细胞与淋巴细胞比值对失代偿期肝硬化患者预后的评估价值

梁利民; 徐鹤翔; 郑吉顺; 章媛媛

doi:10.3969/j.issn.1001-5256.2019.04.017

中性粒细胞与淋巴细胞比值对失代偿期肝硬化患者预后的评估价值

DOI: 10.3969/j.issn.1001-5256.2019.04.017

1. 安徽医科大学第三附属医院暨合肥市第一人民医院感染性疾病科
2. 安徽省中西医结合医院

基金项目:

中国肝炎防治基金会天晴肝病研究基金(TQGB20180226)；合肥市卫生计生委应用医学研究重点项目(hwk2016zd003)；

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中图分类号: R575.2
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出版历程
- 收稿日期: 2018-10-09
- 出版日期: 2019-04-20

Value of neutrophil-lymphocyte ratio in predicting the prognosis of patients with decompensated cirrhosis

Department of Infectious Diseases, The Third Affiliated Hospital of Anhui Medical University & The First People′s Hospital of Hefei

Research funding:

摘要

摘要: 目的探讨中性粒细胞与淋巴细胞比值（NLR）评估失代偿期肝硬化患者预后的价值。方法回顾性分析2013年1月-2016年12月安徽医科大学第三附属医院确诊的173例失代偿期肝硬化患者的临床资料,包括性别、年龄、病因、病史、入院后首次的实验室检查等资料。以死亡为终点事件,根据随访1年的疾病转归情况将所纳入的患者分为生存组（n=123）和死亡组（n=50）。分析影响预后的相关因素,并评估NLR对失代偿期肝硬化患者预后的预测价值。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ2检验。采用Spearman相关分析评估两变量间的相关性。对相关变量行Cox单因素分析,采用多因素Cox风险比例模型（enter法）分析独立影响因素。绘制受试者工作特征曲线（ROC曲线）,计算ROC曲线下面积（AUC）,并根据约登指数确定最佳临界值。运用Kaplan-Meier生存曲线分析不同NLR患者的1年生存率,并采用log-rank检验进行比较。结果死亡组患者的NLR、Child-Turcotte-Pugh（CT...
- 肝硬化 /
- 中性白细胞 /
- 淋巴细胞 /
- 预后
Abstract: Objective To investigate the value of neutrophil-lymphocyte ratio ( NLR) in predicting the prognosis of patients with decompensated cirrhosis. Methods A retrospective analysis was performed for the clinical data of 173 patients who were diagnosed with decompensated cirrhosis in The Third Affiliated Hospital of Anhui Medical University from January 2013 to December 2016, including sex, age, etiology, medical history, and first laboratory examination after admission. With death as the outcome event, these patients were divided into survival group and death group according to the outcome of the disease at 1-year follow-up. The influencing factors for prognosis were analyzed, and the value of NLR in predicting the prognosis of patients with decompensated cirrhosis were evaluated. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed to investigate the correlation between two variables. A univariate Cox analysis was performed for related variables, and the multivariate Cox proportional hazards model was used to identify independent influencing factors.The receiver operating characteristic ( ROC) curve was plotted and the area under the ROC curve ( AUC) was calculated; the optimal cut-off value was determined according to the optimal Youden index. The Kaplan-Meier survival analysis was performed to compare the 1-year survival rate of patients with different NLR values, and the log-rank test was used for comparison. Results Of all 173 patients, 50 died and 123 survived within the 1-year follow-up. The death group had significantly higher NLR, Child-Turcotte-Pugh ( CTP) score, and Model for End-Stage Liver Disease ( MELD) score than the survival group ( U = 4660. 0, 4994. 5, and t =-9. 209, all P < 0. 001) .NLR was positively correlated with CTP score and MELD score ( r = 0. 363 and 0. 410, both P < 0. 001) . The optimal cut-off values of NLR and MELD score in predicting 1-year prognosis were 3. 52 and 14. 26, respectively, with AUCs of 0. 758 and 0. 854, respectively;the combination of NLR and MELD score had an increased AUC of 0. 863. The survival analysis showed that the high-NLR group ( NLR≥3. 52) had a significantly lower survival rate than the low-NLR group ( NLR < 3. 52) ( χ2= 36. 602, P < 0. 001) . The multivariate Cox regression analysis showed that NLR≥3. 52 was an independent risk factor for death within 1 year. Conclusion NLR has a good value in predicting the 1-year prognosis of patients with decompensated cirrhosis.
- liver cirrhosis /
- neutrophils /
- lymphocytes /
- prognosis

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