NLR联合D-二聚体、C反应蛋白等指标快速筛选急性主动脉夹层的临床观察

李末寒; 陆士奇; 吴云

doi:10.13201/j.issn.1009-5918.2019.09.013

NLR联合D-二聚体、C反应蛋白等指标快速筛选急性主动脉夹层的临床观察

- 苏州大学附属第一医院重症医学科(江苏苏州,215006)

详细信息

通讯作者: 吴云,E-mail:shui.ru.yun@163.com

中图分类号: R543.3

收稿日期: 2019-07-30

Rapid screening of acute aortic dissection by NLR combined with D-dimer, C-reactive protein and other indicators

- Department of ICU, the First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu, 215006, China

More Information

Corresponding author: WU Yun, E-mail: shui.ru.yun@163.com

Received Date: 30 July 2019

摘要

摘要: 目的: 探讨联合NLR、D-二聚体、CRP、ALT、AST、年龄、SBP、PLR等指标从急性胸痛患者中筛选出急性主动脉夹层患者的作用。方法: 回顾性收集166例急性心肌梗死患者(AMI组)、87例急性肺栓塞患者(APE组)和208例急性主动脉夹层患者(AAD组),收集患者的基线资料以及入院后即刻测定的各项指标,包括白细胞计数、淋巴细胞计数、中性粒细胞计数、谷丙转氨酶、谷草转氨酶、C反应蛋白、肌酐等。使用SPSS 21.0进行统计学分析,并使用SPSS Modeler建立诊断流程。结果: AAD患者以男性居多(占85.1%),发病年轻化,发病年龄中位数为52岁,院前收缩压、舒张压较高,心率明显增快,D-二聚体升高,炎症指标(WBC、NLR、PLR、CRP)升高明显。经过logistic多项回归后发现NLR、D-二聚体、CRP、ALT、AST、年龄、SBP、PLR可以用于从三组患者中筛选出AAD患者。分别绘制单项指标的ROC曲线和联合各项指标诊断的ROC曲线,发现联合诊断的准确性强(AUC=0.880,P<0.01,95%置信区间为0.845~0.916)。结论: 联合NLR、PLR、年龄、入院时收缩压、ALT、AST、D-二聚体、C反应蛋白可以从急性胸痛患者中快速筛选出疑似AAD的患者,诊断的准确性较高,并且本研究在进行了logistic多项回归后,筛选出有效的指标进行了诊断流程模型的建立,可以应用于临床工作中。
- 急性主动脉夹层 /
- 急性胸痛 /
- 中性粒细胞/淋巴细胞比值
Abstract: Objective: To investigate the role of combining NLR, D-dimer, CRP, ALT, AST, age, SBP and PLR in the screening of patients with acute aortic dissection from patients with acute chest pain. Method: This retrospective study included 166 patients with acute myocardial infarction(AMI), 87 patients with acute pulmonary embolism(APE group) and 208 patients with acute aortic dissection(AAD group). Baseline data of these patients and various indicators immediately detected after admission including white blood cell count, lymphocyte count, neutrophil count, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, creatinine were collected. Statistical analysis was performed by SPSS 21.0 and the diagnostic procedure was established by SPSS Modeler. Result: AAD patients were mostly male(85.1%), younger(median age of onset was 52 years old) with higher pre-hospital systolic and diastolic blood pressure, faster heart rate and significantly increased level of D-dimer and inflammation index(WBC, NLR, PLR, CRP). After logistic multiple regression, NLR, D-dimer, CRP, ALT, AST, age, SBP, and PLR were picked up to screen AAD patients out of three groups of patients. The ROC curves of the individual indicators and the ROC curve of the combined indicators were drawn respectively. Combined indicators are found to be more accurate(AUC=0.880, P<0.01, 95% confidence interval(0.845, 0.916)).Conclusion: Combination of NLR, PLR, age, systolic blood pressure at admission, ALT, AST, D-dimer, and C-reactive protein can rapidly screen patients with suspected AAD out of patients with acute chest pain, and the diagnostic accuracy is relatively high. After the logistic multiple regression, the effective indicators were screened out and the diagnostic process model was established, which can be applied in clinical work.
- acute aortic dissection /
- acute chest pain /
- neutrophil to lymphocyte ratio

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