摘要
目的研究PE患者WBC、中性粒细胞计数、淋巴细胞计数、NLR、PLR和血清IL-6水平治疗后14d内的变化规律及其与血栓近期溶解效果的关系。方法前瞻性研究2015-06-2017-02三家医院呼吸内科经肺动脉CT血管造影（CTPA）首次确诊的PE患者，Mastora评分法评估治疗前后肺动脉阻塞指数（PAOI）。于治疗前24h内及治疗后第1、3、7和14天检测WBC计数、中性粒细胞计数、淋巴细胞计数、NLR和PLR，于治疗前24h内和治疗后第14天检测血清IL-6水平，描述上述炎症指标的变化规律及其与PAOI变化率的关系。结果本研究共纳入47例PE患者，WBC计数、中粒细胞计数治疗后持续下降，变化规律均符合二次方曲线模型（F分别为0．089、0．414，P均为0．000），不同时间点比较差异有统计学意义（F分别为22．149、25．118，P均为0．000）；淋巴细胞计数治疗后第1-3天上升，第3-7天平稳，第7-14天上升，变化规律符合二次方曲线模型（F=0．860，P=0．002），不同时间点比较差异有统计学意义（F=4．411，P=0．004）；NLR治疗后持续下降，变化规律符合三次方曲线模型（F=0．000，P=0．000），不同时间点比较差异有统计学意义（F=16．543，P=0．000）；PLR治疗后第1-3天下降，第3-7天上升，第7-14天平稳，变化规律不符合曲线模型，不同时间点比较差异无统计学意义（P〉0．05）。PE患者治疗后IL-6水平较前明显下降[（6．25±7．45）pg/mL vs．（25．14±25．97）pg／mL，P=0．000]。PE患者治疗前后PAOI变化率与治疗前NLR呈负相关（r=-0．352，P=0．015），与淋巴细胞计数呈正相关（r=0．335，P=0．021）。结论PE治疗后NLR持续下降，淋巴细胞计数持续上升，提示PE炎症反应减弱，血栓溶解吸收。治疗前NLR、淋巴细胞计数与PAOI变化率有一定的相关性，可反映PE患者的近期血栓溶解效果。
Objective To investigate the change regularities of white blood cell （WBC）, neutrophils, lymphocytes, NLR, PLR and serum IL- 6 level in pulmonary embolism （PE） patientspost- treatment and its relationships with resent thrombus resolvation. Methods PE patients first - diagnosed by CTPA were studied prospectively in 3 hospitals from June 2015 to February 2017. The pulmonary artery obstruction index （ PAOI ） was assessed according to the Mastora scoring method to estimate the thrombus load. The WBC, nentrophils, lymphocytes, NLR and PLR were examined pre - treatment and on the 1st, 3rd, 7th and 14th day post- treatment. The serum IL-6 level was examined pre - treatment and on the 14th day post - treatment. The change regularities of inflammation biomarkers above were investigated and its relationships with PAOI varies were also analyzed. Results Forty - seven PE patients were enrolled into our study. The WBC and neutrophils were declined post - treatment and their curve changes were in accordance with the quadratic model （ F was 0. 089 and 0. 414 respectively, both P = 0. 000）, different reviews were significantly lower compared with pre - treatment （F was 22. 149 and 25.118 respectively, both P = 0.000）. The lymphocytes were rose from the 1st to 3rd day, kept stable from the 3rd to 7th day and rose from the 7th to 14th day post -treatment, and its curve change was in accordance with the quadratic model （ F = 0. 860, P = 0. 002 ）, different reviews were significantly higher compared with pre - treatment （ F = 4. 411, P = 0. 004）. The NLR were declined post - treatment and its curve change was in accordance with the cubic model （ F = 0. 000, P = 0. 000） , different reviews were significantly higher compared with pre - treatment （ F = 16. 543, P = 0.000）. The PLR was declined from the 1st to 3rd day, rose from the 3rd to 7th day and kept stable from the 7th to 14th day post - treatment and its curve change was not in accordance with any models, different reviews didn＇t have statistical difference compared with pre -treatment （P 〉 0.05 ）. The IL- 6 post - treatment was significantly lower compared with pre - treatment [ （ 25. 14 ± 25.97 ） pg/mL vs. （6.25 ± 7.45 ）pg/mL, P = 0. 000]. The varied rate of PAOI pre- and post- treatment was negatively correlated with NLR （r = -0. 352, P = 0. 015）, but positively correlated with lymphocytes （r = 0.335, P = 0. 021 ）, not correlated with WBC, neutrophils, PLR, IL - 6 pre - treatment. Conclusion The NLR and lymphocytes are kept continuous declining and rising respectively post -treatment, indicating that the inflammation is weakened and the thrombus is dissolving and absorbed. The varied rate of PAOI pre - and post - treatment was correlated with NLR and lymphocytes, which could suggest the thrombus resolvation recently.
作者
周怀海
秦志强
覃少佳
刘学冠
陈桂荣
冯广弘
冯宗莲
梁秋妹
Zhou Huai-hai;Qin Zhi-qiang;Qin Shao-jia;Liu Xue-guan;Chen Gui-rong;Feng Guang-hong;Feng Zong-lian;Liang Qiu-mei(Department of Respiratory Disease,the People＇s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第10期847-853,共7页
Chinese Journal of Critical Care Medicine
基金
广西科技厅重大专项项目（桂科AB16380218）
广西卫计委科研课题（Z2015314）
