中性粒细胞与淋巴细胞比值辅助诊断老年社区获得性尿路感染的研究

裴倩倩; 高云; 王春梅

doi:10.16766/j.cnki.issn.1674-4152.003595

中性粒细胞与淋巴细胞比值辅助诊断老年社区获得性尿路感染的研究

doi: 10.16766/j.cnki.issn.1674-4152.003595

1.
航天中心医院全科医学科，北京 100049
2.
首都医科大学宣武医院重症医学科，北京 100053

基金项目:

国家重点研发计划项目 2020YFC2005403

国家重点研发计划项目 2020YFC2005406

首都全科医学研究专项项目 21QK08

详细信息

通讯作者:
王春梅，E-mail：drwangchunmei@sina.com

中图分类号: R691.3 R446
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- 文章访问数: 141
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-07
- 网络出版日期: 2024-09-05

Diagnostic value of neutrophil-to-lymphocyte ratio in elderly patients with community-acquired urinary tract infection

1.
Department of General Practice, Aerospace Center Hospital, Beijing 100049, China

摘要

摘要: 目的探究中性粒细胞计数与淋巴细胞计数比值(NLR)在早期辅助诊断老年社区获得性尿路感染中的价值，为基层临床医生诊治尿路感染提供依据。方法选取2012年1月—2022年12月首都医科大学宣武医院老年社区获得性尿路感染患者159例(感染组)，根据是否进展为血流感染分为尿源性血流感染组(28例)和尿路感染非血流感染组(131例)，同时选取同时间段，年龄≥60岁，因非感染疾病入院的患者172例(非感染组)。采用ROC曲线分析NLR对社区获得性尿路感染的临床诊断价值。结果 NLR辅助诊断老年社区获得性尿路感染的AUC为0.729，最佳阈值、灵敏度、特异度分别为3.5、60%、84%。NLR辅助诊断老年社区获得性尿路感染非血流感染的AUC为0.684，最佳阈值、灵敏度、特异度分别为3.7、47%、90%。NLR辅助诊断老年社区获得性尿路感染血流感染的AUC为0.935，最佳阈值、灵敏度、特异度分别为6.0、86%、99%。结论 (1) NLR对老年社区获得性尿路感染有诊断价值，当NLR≥6.0时，应结合临床表现，警惕进展为血流感染，及时转诊上级医院。(2)尿路感染病原菌以革兰阴性菌为主，最常见的为大肠埃希菌，因此，可根据病原菌分布特点及早干预。
- 中性粒细胞与淋巴细胞比值 /
- 诊断 /
- 尿路感染 /
- 社区获得性 /
- 老年
Abstract: Objective To investigate the value of the neutrophil to lymphocyte ratio (NLR) in the diagnosis of community-acquired urinary tract infection in the elderly. Methods A total of 159 elderly patients with community-acquired urinary tract infection (infection group) were selected from Xuanwu Hospital of Capital Medical University from January 2012 to December 2022. According to whether they progressed to bloodstream infection, they were divided into uro-derived bloodstream infection group (28 cases) and non-bloodstream infection group (131 cases). A total of 172 inpatients were matched for non-infectious diseases during the same period (non-infected group). ROC curve was used to analyze the clinical diagnostic value of NLR in community acquired urinary tract infection. Results The AUC of NLR was 0.729, and the optimal threshold, sensitivity and specificity were 3.5, 60% and 84%, respectively. The AUC of the non-bloodstream infection group was 0.684, and the optimal threshold, sensitivity and specificity were 3.7, 47% and 90%, respectively. The AUC of NLR in the diagnosis of community-acquired urinary tract infection in the elderly was 0.935, and the optimal threshold, sensitivity and specificity were 6.0, 86% and 99%, respectively. Conclusion (1) NLR has diagnostic value for community-acquired urinary tract infection in elderly people. When NLR≥6.0, the patient should be vigilant of progressing to bloodstream infection according to clinical manifestations and be referred to superior hospital in time. (2) The main pathogens of urinary tract infection are gram-negative bacteria, the most common of which is Escherichia coli. Therefore, early intervention can be performed according to the distribution characteristics of the pathogens.
- Neutrophil to lymphocyte ratio /
- Diagnosis /
- Urinary tract infection /
- Community-acquired /
- The elderly

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图 1 NLR辅助诊断老年社区获得性尿路感染的ROC曲线

Figure 1. ROC curve of NLR for diagnosing community-acquired urinary tract infection in elderly patients

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图 2 白细胞计数、中性粒细胞百分比联合NLR辅助诊断老年社区获得性尿路感染的ROC曲线

Figure 2. ROC curve combining white blood cell count, neutrophil percentage, and NLR for diagnosing community-acquired urinary tract infection in the elderly

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图 3 NLR辅助诊断老年社区获得性尿路感染非血流感染的ROC曲线

Figure 3. ROC curve of NLR for diagnosing community-acquired urinary tract infections in elderly patients without bloodstream infections

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图 4 白细胞计数、中性粒细胞百分比联合NLR辅助诊断老年社区获得性尿路感染非血流感染的ROC曲线

Figure 4. ROC curve of NLR for diagnosing community-acquired urinary tract infections in elderly patients without bloodstream infections

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图 5 NLR辅助诊断老年社区获得性尿源性血流感染的ROC曲线

Figure 5. ROC curve of NLR-assisted diagnosis for community-acquired urinary bloodstream infection in elderly patients

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图 6 白细胞计数、中性粒细胞百分比联合NLR联合辅助诊断老年社区获得性尿源性血流感染的ROC曲线

Figure 6. ROC curve combining white blood cell count, neutrophil percentage, and NLR for diagnosing community-acquired urinary tract infection in elderly patients with non-bloodstream infections

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表 1 感染组和非感染组患者基本情况比较

Table 1. Comparison of basic information between the infected and non-infected groups

组别	例数	年龄(x ±s, 岁)	性别(男/女, 例)	合并症[例(%)]
组别	例数	年龄(x ±s, 岁)	性别(男/女, 例)	高血压	2型糖尿病	冠心病
感染组	159	73.0±9.7	80/79	98(61.6)	90(56.6)	30(18.9)
非感染组	172	74.6±8.2	94/78	107(62.2)	75(43.6)	42(24.4)
统计量		1.655^a	0.623^b	0.210^b	5.585^b	1.496^b
P值		0.099	0.430	0.646	0.018	0.221
注：^a为t值，^b为χ²值。

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表 2 老年社区获得性尿路感染病原菌分布(例)

Table 2. Distribution of pathogenic bacteria ommunity-acquired urinary tract infections in the elderly(case)

病原菌	尿路感染非血流感染(n=71)	尿源性血流感染(n=20)
革兰阳性菌	16	4
人葡萄球菌	1	1
屎肠球菌	4	0
溶血葡萄球菌	1	0
表皮葡萄球菌	1	3
粪肠球菌	3	0
肠球菌	2	0
凝固酶阴性葡萄球菌	3	0
无乳链球菌	1	0
革兰阴性菌	50	15
大肠埃希菌	25	9
肺炎克雷伯菌	4	6
解葡萄糖苷棒杆菌	1	0
铜绿假单胞菌	7	0
阴沟/阿氏肠杆菌	1	0
摩氏摩根菌	1	0
弗劳地柠檬酸杆菌	1	0
奇异变形杆菌	6	0
产气肠杆菌	1	0
鲍曼不动杆菌	1	0
纹带棒杆菌	1	0
肠杆菌属	1	0
真菌	5	1
光滑念珠菌	1	0
中间念珠菌	1	0
克柔念珠菌	1	0
白色念珠菌	2	1

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表 3 老年社区获得性尿路感染的单因素分析

Table 3. Univariate analysis of community-acquired urinary tract infection in elderly patients

组别	例数	白细胞计数(x ±s, ×10⁹/L)	中性粒细胞计数(x ±s, ×10⁹/L)	淋巴细胞计数(x ±s, ×10⁹/L)	NLR[M(P₂₅, P₇₅)]
感染组	159	8.4±3.6	6.4±3.6	1.3±0.6	3.9(2.4, 8.9)
非感染组	172	6.4±1.4	4.1±1.1	1.6±0.5	2.6(2.1, 3.2)
统计量		6.511^a	7.456^a	4.939^a	-7.175^b
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 4 老年社区获得性尿路感染的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of community-acquired urinary tract infections in elderly patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
白细胞计数	1.262	0.540	5.463	0.019	3.533	1.226~10.182
中性粒细胞计数	-1.265	0.624	4.112	0.043	0.282	0.083~0.959
NLR	0.708	0.262	7.303	0.007	2.030	1.215~3.392
2型糖尿病	0.988	0.277	12.728	＜0.001	2.686	1.561~4.622
注：高血压、2型糖尿病、冠心病赋值均为无=0，有=1；白细胞计数、中性粒细胞计数、淋巴细胞计数、NLR均为连续变量，以实际值赋值。

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