中性粒细胞与淋巴细胞比值在有机磷农药中毒急性肾损伤中的诊断价值
Value of neutrophil to lymphocyte ratio in diagnosis of acute renal injury after organophosphorus pesticide poisoning
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摘要:
背景 急性有机磷中毒（AOPP）多发于农村，医疗管理困难，常造成多系统功能损害。其中肾脏是其损伤的重要靶器官之一，主要表现为急性肾损伤（AKI），但AOPP致AKI的机制尚不明确，且目前AKI诊断缺乏特异、灵敏且方便易测的血清学标志。
目的 探讨中性粒细胞与淋巴细胞比值（NLR）在诊断急性AOPP伴发AKI中的临床应用价值，为临床早期干预治疗及评价预后提供依据。
方法 纳入灌云县人民医院2016年1月至2018年12月共56例重度AOPP患者，根据AKI诊断标准，将研究对象分为AOPP伴发AKI组和AOPP未伴发AKI组，于接触毒物24 h时检测血常规指标并计算NLR，检测胆碱酯酶（ChE）、血肌酐（Scr）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C（Cys-C）等血清学指标。使用t检验、Spearman相关分析和受试者工作特征曲线（ROC）对两组数据进行统计学分析。
结果 在重度AOPP患者中，AKI的发生率为69.6%，NLR与Scr、NGAL以及Cys-C均呈正相关（r分别为0.358、0450、0.340，均P < 0.05），同时NLR值在AOPP并发AKI患者（21.78±5.80）中高于未发生AKI患者（17.19±3.88），差异具有统计学意义（P < 0.05）。NLR诊断AOPP所致AKI的截断值（cut-off）为18.4，其敏感性和特异性分别为84.6%和64.7%，ROC曲线下面积（AUC）及其95% CI为0.775（0.640~0.912），与Cys-C、NGAL和Scr等指标的AUC结果差异无统计学意义（P>0.05）。
结论 NLR可以作为重度AOPP患者发生AKI的一个诊断指标，具有较好的特异性与敏感性且简便，获得性好。
Abstract:Background Acute organophosphorus pesticide poisoning (AOPP) is common in rural areas where it is difficult to manage medical treatment, and it often causes injury in multiple systems and organs. The kidney is one of the important target organs of the injury. Acute kidney injury (AKI) is a main clinical presentation, but the mechanism between AOPP and AKI is not clear yet, and there remains significant unmet need for specific and sensitive serological markers for AKI diagnosis.
Objective This study explores the clinical value of neutrophil to lymphocyte ratio (NLR) in the diagnosis of AKI caused by AOPP, and provide a basis for clinical intervention, treatment, and evaluation of prognosis.
Methods A total of 56 patients diagnosed with severe AOPP were enrolled in the study from Guanyun People's Hospital from January 2016 to December 2018. According to AKI diagnostic criteria, the participants were divided into AOPP with AKI group and AOPP without AKI group. Blood routine tests were performed after 24 hours of exposure to toxicants, and the value of NLR was calculated. Other serum variables such as acetyl cholinesterase (ChE), serum creatinine (Scr), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C (Cys-C) were also detected. All the data were analyzed by t test, Spearman correlation analysis, and receiver operating characteristic (ROC) curve.
Results The incidence rate of AKI in patients with severe AOPP was 69.6%. NLR was positively correlated with Scr, NGAL, and Cys-C (r=0.358, 0.450, and 0.340, respectively, all Ps < 0.05), and was higher in the patients with AOPP complicated with AKI (21.78±5.80) than in those without AKI (17.19±3.88) (P < 0.05). The cut-off value of NLR for identifying AKI caused by AOPP was 18.4, with a sensitivity of 84.6% and a specificity of 64.7%. The area under curve (AUC) of NLR was 0.775 (95% CI:0.640-0.912), and not different from the results of Cys-C, NGAL, and Scr (P>0.05).
Conclusion NLR can be used to diagnose AKI in patients with severe AOPP because it has good specificity and sensitivity, and is easy to obtain.
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