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2019年12月以来,中国湖北省武汉市出现了新型冠状病毒感染的肺炎病人,并迅速蔓延到我国其他地区。2020年1月12日,WHO正式将引起肺炎疫情的新型冠状病毒命名为2019新型冠状病毒(2019 new coronavirus,2019-nCoV),属于β属冠状病毒,其基因组和蝙蝠SARS样冠状病毒(bat-SL-CoVZC45)高度同源,相似度85%以上[1];由其感染引起的肺炎称之为新型冠状病毒肺炎(COVID-19)。临床表现主要有发热、干咳、乏力,重症病人多在发病1周后出现呼吸困难和/或低氧血症,严重者快速进展为急性呼吸窘迫综合征、脓毒症休克、代谢性酸中毒等,实验室检查可出现多种指标的变化,主要表现为发病早期外周血白细胞总数正常或降低,淋巴细胞计数绝对值减少,C反应蛋白(CRP)升高,重症病人常有炎症因子升高并伴有外周血淋巴细胞进行性减少[2]。所以实验室检查对COVID-19的早期筛查和治疗,提高COVID-19的治愈率非常重要。CRP是机体在应激状态下由肝脏合成的一种急性时相反应蛋白,升高常见于细菌感染,在病毒感染时一般不升高或仅有轻微升高。当机体受到感染后,其升高的幅度与感染的程度呈正相关并可早于白细胞升高,故其有较高的敏感性[3]。中性粒细胞淋巴细胞比值(NLR)作为机体炎症反应的生物标志物,可直观地反映机体的炎症状态和全身免疫系统状态,越来越受到炎症相关研究的极大重视。本文旨在研究淋巴细胞(LY)、CRP联合NLR检测在COVID-19早期诊断中的临床应用价值。现作报道。
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COVID-19组NLR、CRP水平均高于对照组,LY水平低于对照组(P < 0.01)(见表 1)。
分组 n NLR LY/(×109/L) CRP/(mg/L) 对照组 90 3.20±1.60 1.80±0.94 6.96±10.93 COVID-19组 53 6.40±7.16 1.21±0.56 57.93±66.47 t — 3.21 4.70 5.54 P — < 0.01 < 0.01 < 0.01 表 1 2组间各指标检测结果比较(x±s)
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以2019-nCoV核酸检测结果作为金标准,评价NLR、LY、CRP对COVID-19诊断的价值。NLR、LY、CRP单独及NLR+LY+CRP联合用于诊断COVID-19曲线下面积(AUC)依次为:0.610、0.705、0.833、0.817,最佳截断界值(cut-off值)分别为6.23、1.41、11.80,灵敏度分别为31.0%、69.8%、67.9%、58.5%,特异度分别为96.7%、62.2%、80.0%、92.2%,NLR+LY+CRP联合诊断价值高于单独诊断价值(见表 2、图 1)。
指标 AUC cut-off值 灵敏度/% 特异度/% SE P 95%CI NLR 0.610 6.23 34.0 96.7 3.210 < 0.01 0.552~0.712 LY 0.705 1.41 69.8 62.2 4.700 < 0.01 0.625~0.777 CRP 0.833 11.80 67.9 80.0 5.540 < 0.01 0.420~0.590 NLR+LY+CRP 0.817 — 58.5 92.2 — — 0.644~0.790 表 2 各指标对COVID-19诊断价值分析
淋巴细胞、C反应蛋白联合外周血中性粒细胞淋巴细胞比值检测在新型冠状病毒肺炎早期诊断中的应用价值
Value of lymphocyte, C reactive protein combined with peripheral blood neutrophil to lymphocyte ratio in the early diagnosis of COVID-19
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摘要:
目的探讨中性粒细胞淋巴细胞比值(NLR)、淋巴细胞(LY)和C反应蛋白(CRP)单独与联合检测在新型冠状病毒肺炎(COVID-19)早期诊断中的临床应用价值。 方法选取对53例COVID-19病人(COVID-19组)以及同期90例其他呼吸系统疾病病人(对照组),回顾性分析和比较2组病人中性粒细胞淋巴细胞比值(NLR)、淋巴细胞(LY)和C反应蛋白(CRP)的表达水平。并利用ROC曲线分析NLR、LY、CRP单独以及NLR+LY+CRP联合检测对COVID-19的早期诊断价值。 结果COVID-19组NLR、CRP水平均高于对照组,LY水平低于对照组(P < 0.01)。NLR、LY、CRP单独及联合用于COVID-19感染诊断的ROC曲线下面积分别为0.610、0.705、0.833、0.817;灵敏度分别为31.0%、69.8%、67.9%、58.5%;特异度分别为96.7%、62.2%、80.0%、92.2%,NLR+LY+CRP联合诊断的价值高于单独诊断价值。 结论NLR、LY、CRP联合诊断可以提高COVID-19早期诊断的特异度和灵敏度,从而指导临床尽早采取合理治疗措施,提高COVID-19的治愈率。 -
关键词:
- 新型冠状病毒肺炎 /
- 淋巴细胞 /
- 中性粒细胞淋巴细胞比值 /
- C反应蛋白 /
- ROC曲线
Abstract:ObjectiveTo investigate the clinical application value of the single and combined detection of the neutrophil to lymphocyte ratio(NLR), lymphocyte(LY) and C reactive protein(CRP) in the early diagnosis of corona virus disease 2019(COVID-19). MethodsFifty-three patients with COVID-19 and 90 patients with other respiratory diseases were divided into the COVID-19 group and control group, respectively.The levels of NLR, LY and CRP between two groups were retrospectively analyzed and compared.The ROC curve was used to analyze the application value of the single and combined detection of NLR, LY and CRP in the early diagnosis of COVID-19. ResultsThe levels of NLR and CRP in COVID-19 group were higher than those in control group, and the level of LY in COVID-19 group was significantly lower than that in control group(P < 0.01).The area under the ROC curve of the single and combined detection of NLR, LY and CRP in the diagnosis of COVID-19 were 0.610, 0.705, 0.833 and 0.817, respectively.The sensitivities and specificities of the single and combined detection of NLR, LY and CRP in the diagnosis of COVID-19 were 31.0%, 69.8%, 67.9%, 58.5% and 96.7%, 62.2%, 80.0%, 92.2%, respectively.The diagnosis value of the combined detection of NLR, LY and CRP were higher than that of the single detection of NLR, LY and CRP. ConclusionsThe combined detection of NLR, LY and CRP can increase the specificity and sensitivity of early diagnosis of COVID-19, which can guide the clinical treatment as soon as possible, and improve the cure rate of COVID-19. -
Key words:
- corona virus disease 2019 /
- lymphocyte /
- neutrophil to lymphocyte ratio /
- C reactive protein /
- ROC curve
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表 1 2组间各指标检测结果比较(x±s)
分组 n NLR LY/(×109/L) CRP/(mg/L) 对照组 90 3.20±1.60 1.80±0.94 6.96±10.93 COVID-19组 53 6.40±7.16 1.21±0.56 57.93±66.47 t — 3.21 4.70 5.54 P — < 0.01 < 0.01 < 0.01 表 2 各指标对COVID-19诊断价值分析
指标 AUC cut-off值 灵敏度/% 特异度/% SE P 95%CI NLR 0.610 6.23 34.0 96.7 3.210 < 0.01 0.552~0.712 LY 0.705 1.41 69.8 62.2 4.700 < 0.01 0.625~0.777 CRP 0.833 11.80 67.9 80.0 5.540 < 0.01 0.420~0.590 NLR+LY+CRP 0.817 — 58.5 92.2 — — 0.644~0.790 -
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