基于倾向性评分法的活动性肺结核患者中性粒细胞计数、中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值与营养风险的相关性研究

doi:10.19982/j.issn.1000-6621.20230056

中国防痨杂志 ›› 2023, Vol. 45 ›› Issue (9): 833-838.doi: 10.19982/j.issn.1000-6621.20230056

基于倾向性评分法的活动性肺结核患者中性粒细胞计数、中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值与营养风险的相关性研究

陈宇¹, 刘莹², 方刚², 胡春梅²(), 殷国平¹^,³()

¹南京医科大学公共卫生学院,南京 211166
²南京市第二医院结核一科,南京 210003
³南京市第二医院院长办公室,南京 210003

收稿日期:2023-03-01 出版日期:2023-09-10 发布日期:2023-09-01
通信作者: 胡春梅,Email:hcm200702@163.com;殷国平,Email:yinguoping0304@163.com
作者简介:刘莹与陈宇对本文具有同等贡献,为并列第一作者
基金资助:
江苏省第六期“333人才”培养支持资助项目;江苏省自然科学基金面上项目(BK20221172)

Correlation between neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and nutritional risk in active pulmonary tuberculosis patients based on propensity score method

Chen Yu¹, Liu Ying², Fang Gang², Hu Chunmei²(), Yin Guoping¹^,³()

¹School of Public Health, Nanjing Medical University, Nanjing 211166, China
²The First Department of Tuberculosis, the Second Hospital of Nanjing, Nanjing 210003, China
³The Office of President, the Second Hospital of Nanjing, Nanjing 210003, China

Received:2023-03-01 Online:2023-09-10 Published:2023-09-01
Contact: Hu Chunmei, Email: hcm200702@163.com; Yin Guoping, Email: yinguoping0304@163.com
Supported by:
Sixth Phase of ‘333 Talents’ Training Support Project in Jiangsu Province;Jiangsu Province Natural Science Foundation Project(BK20221172)

摘要/Abstract

摘要：

目的: 探讨外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)及中性粒细胞计数(neutrophil count,NEUT)与活动性肺结核患者营养风险的相关性,为营养风险临床评估和营养干预提供依据。方法: 采用回顾性研究方法,收集2020年7月至2021年3月南京市第二医院结核科收治的786例新诊断为活动性肺结核患者的临床基线资料。根据患者入院后24~48h内的营养风险筛查-2002评分将其分为无营养风险组(评分<3分)和有营养风险组(评分≥3分),采用倾向性评分匹配法对两组患者基线资料进行匹配。通过单因素和二元多因素logistic回归模型评价匹配后患者的NLR、PLR和NEUT水平与营养风险的相关性。结果: 786例患者中,无营养风险组430例(54.71%)、有营养风险组356例(45.29%),经倾向性评分匹配法,共计335对患者匹配成功。单因素分析结果显示,有营养风险组的NLR、PLR和NEUT水平分别为2.86(1.90,5.06)、169.09(124.05,275.53)和3600.00(2690.00,4920.00)个/mm³,分别高于无营养风险组的2.32(1.64,3.65)、146.49(104.21,220.19)和3390.00(2450.00,4520.00)个/mm³,差异均有统计学意义(U=-4.021,P<0.001;U=-4.021,P<0.001;U=-2.719,P=0.029)。多因素logistic回归分析显示,NLR≥5的患者发生营养风险的可能性高于NLR<5的患者[OR(95%CI)=3.061(1.768~5.300),Wald χ²=17.143,P<0.001]。结论: 外周血免疫细胞NLR、PLR和NEUT与活动性肺结核患者营养风险均有一定相关性,其中NLR≥5是活动性肺结核患者发生营养风险的独立危险因素,需要临床进行干预。

关键词: 结核,肺, 营养调查, 疾病影响状态调查, 因素分析, 统计学, 粒细胞

Abstract:

Objective: To investigate the correlation between peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and neutrophil count (NEUT) and the nutritional risk of patients with active pulmonary tuberculosis and to provide basis for clinical assessment of nutritional risk and nutritional intervention. Methods: A retrospective study was conducted to collect clinical baseline data of 786 patients newly diagnosed with active pulmonary tuberculosis who were admitted to the Department of Tuberculosis of the Second Hospital of Nanjing from July 2020 to March 2021. A non-nutritional risk group (score<3) and a nutritional risk group (score≥3) were defined based on the NRS-2002 scores within 24-48 h after admission. The propensity score matching method was used to match the baseline data of the two groups of patients. The correlation between NLR, PLR, and NEUT levels and nutritional risk of the matched patients was evaluated using univariate and binary multivariate logistic regression models. Results: Among the 786 patients, 430 (54.71%) were in the non-nutritional risk group and 356 (45.29%) were in the nutritional risk group. A total of 335 pairs of patients were successfully matched through propensity score matching method. The results of univariate analysis showed that the levels of NLR, PLR and NEUT in the nutritional risk group were 2.86 (1.90, 5.06), 169.09 (124.05, 275.53) and 3600.00 (2690.00, 4920.00) cells/mm³, respectively, which were significantly higher than those in the non-nutritional risk group (2.32 (1.64, 3.65), 146.49 (104.21, 220.19) and 3390.00 (2450.00, 4520.00) cells/mm³, respectively), all the differences were statistically significant (U=-4.021, P<0.001; U=-4.021, P<0.001; U=-2.719, P=0.029). Multivariate logistic regression analysis showed the patients with NLR ≥5 was more likely to develop nutritional risk than patients with NLR<5 (OR (95%CI)=3.061 (1.768-5.300), Wald χ²=17.143, P<0.001). Conclusion: NLR, PLR, and NEUT of peripheral blood immune cells are associated with nutritional risk of pulmonary tuberculosis patients. NLR≥5 is an independent risk factor for nutritional risk of active pulmonary tuberculosis patients, and clinical intervention is needed.

Key words: Tuberculosis, pulmonary, Nutrition surveys, Sickness impact profile, Factor analysis, statistics, Granulocytes

中图分类号:

R521
R151

陈宇, 刘莹, 方刚, 胡春梅, 殷国平. 基于倾向性评分法的活动性肺结核患者中性粒细胞计数、中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值与营养风险的相关性研究[J]. 中国防痨杂志, 2023, 45(9): 833-838. doi: 10.19982/j.issn.1000-6621.20230056

Chen Yu, Liu Ying, Fang Gang, Hu Chunmei, Yin Guoping. Correlation between neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and nutritional risk in active pulmonary tuberculosis patients based on propensity score method[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 833-838. doi: 10.19982/j.issn.1000-6621.20230056

图/表 5

表1

表2

表3

表4

表5

免疫细胞对活动性肺结核患者营养风险影响因素的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
NEUT≥6000个/mm³	0.339	0.287	1.391	0.708	0.897(0.508~1.585)
NLR≥5	-1.160	0.280	17.143	<0.001	3.061(1.768~5.300)
PLR≥200	-0.115	0.189	0.369	0.145	1.326(0.907~1.938)

表5

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特征	无营养风险组(430例)	有营养风险组(356例)	统计检验值	P值
年龄(岁)	52.00(33.75,64.00)	53.00(30.00,68.00)	U=-0.194	0.846
性别			χ²=4.958	0.026
男性	248(57.7)	233(65.4)
女性	182(42.3)	123(34.6)
饮酒			χ²=0.728	0.393
否	416(96.7)	348(97.8)
是	14(3.3)	8(2.2)
吸烟			χ²=2.029	0.154
否	410(95.3)	331(93.0)
是	20(4.7)	25(7.0)
其他部位结核病			χ²=1.216	0.270
无	315(73.3)	273(76.7)
有	115(26.7)	83(23.3)
诊断类型			χ²=7.118	0.008
初治	395(91.9)	305(85.7)
复治	35(8.1)	51(14.3)
耐药			χ²=0.101	0.750
否	386(89.8)	322(90.4)
是	44(10.2)	34(9.6)
HIV感染			χ²=0.165	0.685
否	421(97.9)	347(97.5)
是	9(2.1)	9(2.5)
合并糖尿病			χ²=5.180	0.023
否	350(81.4)	311(87.4)
是	80(18.6)	45(12.6)
体质量指数	22.81(21.47,24.27)	19.03(17.93,20.05)	U=-20.225	<0.001

特征	无营养风险组(335例)	有营养风险组(335例)	统计检验值	P值
年龄(岁)	54.00(33.00,66.00)	54.00(30.00,68.00)	U=-0.252	0.801
性别			χ²=0.058	0.809
男性	216(64.5)	213(63.6)
女性	119(35.5)	122(36.4)
饮酒			χ²=0.228	0.633
否	325(97.0)	327(97.6)
是	10(3.0)	8(2.4)
吸烟			χ²=0.001	1.000
否	317(94.6)	317(94.6)
是	18(5.4)	18(5.4)
其他部位结核病			χ²=0.072	0.789
无	250(74.6)	253(75.5)
有	85(25.4)	82(24.5)
诊断类型			χ²=0.064	0.801
初治	301(89.9)	299(89.3)
复治	34(10.1)	36(10.7)
耐药			χ²=0.017	0.896
否	303(90.4)	302(90.1)
是	32(9.6)	33(9.9)
HIV感染			χ²=0.060	0.806
否	327(97.6)	326(97.3)
是	8(2.4)	9(2.7)
合并糖尿病			χ²=0.674	0.412
否	297(88.7)	290(86.6)
是	38(11.3)	45(13.4)

编码	因素	赋值	编码	因素	赋值
Y	NRS-2002评分	<3分=0,≥3分=1	X₂	NLR	<5=0,≥5=1
X₁	NEUT(个/mm³)	<6000=0,≥6000=1	X₃	PLR	<200=0,≥200=1

基于倾向性评分法的活动性肺结核患者中性粒细胞计数、中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值与营养风险的相关性研究

Correlation between neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and nutritional risk in active pulmonary tuberculosis patients based on propensity score method

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指标	无营养风险组(335例)	有营养风险组(335例)	U值	P值
NEUT(个/mm³)	3390.00(2450.00,4520.00)	3600.00(2690.00,4920.00)	-2.179	0.029
NLR	2.32(1.64,3.65)	2.86(1.90,5.06)	-4.021	<0.001
PLR	146.49(104.21,220.19)	169.09(124.05,275.53)	-4.021	<0.001

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