中性粒细胞计数联合血尿酸对急性一氧化碳中毒患者心肌损伤的预测价值

doi:10.3969/j.issn.1004-583X.2023.03.009

摘要/Abstract

摘要：

目的探究中性粒细胞计数联合血尿酸对急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)患者心肌损伤的预测价值。方法选取2021年1月至2022年6月于锦州医科大学附属第一医院消化内科住院治疗的ACOP患者114例。根据入院24小时内超敏肌钙蛋白I是否增高将患者分为心肌损伤组( $n$ =72)和无心肌损伤组( $n$ =42)。收集并比较两组临床资料,采用二元多因素Logistic回归分析筛选ACOP患者心肌损伤的独立危险因素,采用受试者工作特征曲线分析相关指标对ACOP患者心肌损伤的预测价值。结果两组性别、高血压病史、糖尿病史、吸烟史、入院时体温差异均无统计学意义( $P$ >0.05)。与无心肌损伤组比较,心肌损伤组年龄较大、中性粒细胞计数水平较高、血肌酐水平较高、血尿酸水平较高,差异均有统计学意义( $P$ <0.05)。二元多因素Logistic回归分析显示,年龄、中性粒细胞计数、血尿酸是ACOP患者心肌损伤的独立危险因素。中性粒细胞计数、血尿酸预测ACOP患者心肌损伤的界值分别为9.55×10⁹/L、325 μmol/L。中性粒细胞计数联合血尿酸预测ACOP患者心肌损伤的敏感度为68.1%,特异度73.8%,曲线下面积为0.737,约登指数为0.419。结论年龄、中性粒细胞计数、血尿酸是ACOP患者心肌损伤的独立危险因素。中性粒细胞计数联合血尿酸对预测ACOP患者心肌损伤具有一定的价值。

关键词: 一氧化碳中毒, 心肌损伤, 中性粒细胞计数, 血尿酸

Abstract:

Objective To investigate the predictive value of neutrophil count combined with serum uric acid (SUA) on myocardial injury in patients with acute carbon monoxide poisoning (ACOP). Methods A total of 114 ACOP patients who were hospitalized in the Department of Gastroenterology at the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled. Patients were allocated to a myocardial injury group ( $n$ =72) and a non-myocardial injury group ( $n$ =42) based on whether there was an increase in cardiac troponin I (cTnI) within 24 hours of admission. Clinical data of two sets were compared. Multivariate binary logistic regression analysis was employed to assess independent risk factors for myocardial injury in ACOP patients. Receiver operating characteristic curve analysis was performed to analyze the predictive value of relevant indicators in these patients. Results There was no significant difference in gender, hypertension history, diabetes history, smoking history and body temperature at admission between the two groups ( $P$ >0.05). Compared with the non-myocardial injury group, the myocardial injury group had significantly higher age, neutrophil count levels, blood creatinine levels, and higher SUA levels ( $P$ <0.05). Binary multivariate logistic regression analysis showed that age, neutrophil count, and SUA were independent risk factors for myocardial injury in ACOP patients. The cutoff values of neutrophil count and SUA for predicting myocardial injury in ACOP patients were 9.55×10⁹/L and 325 μmol/L, respectively. The sensitivity and specificity of neutrophil count combined with SUA in predicting myocardial injury in ACOP patients were 68.1%, 73.8%, respectively, and 0.737 for the area under the curve (AUC), 0.419 for Jordan index. Conclusion Age, neutrophil count, and SUA are independent risk factors for myocardial injury in ACOP patients. The combination of neutrophil count and SUA has certain value in predicting myocardial injury in ACOP patients.

Key words: carbon monoxide poisoning, myocardial injury, neutrophil count, serum uric acid

中图分类号:

R595.1

刘彬, 翟桂兰, 孙巨峰. 中性粒细胞计数联合血尿酸对急性一氧化碳中毒患者心肌损伤的预测价值[J]. 临床荟萃, 2023, 38(3): 245-249.

Liu Bin, Zhai Guilan, Sun Jufeng. Forecast value of neutrophil count combined with serum uric acid on myocardial injury after acute carbon monoxide poisoning[J]. Clinical Focus, 2023, 38(3): 245-249.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.009

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/245

图/表 5

表1 两组一般资料比较

Tab.1 Comparison of general information between the two groups

组别	例数	年龄(岁)	男性 [例(%)]	高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	入院时体温 (℃)
心肌损伤组	72	62.00(53.25, 68.75)	33(45.8)	20(27.8)	11(15.3)	19(26.4)	36.50(36.50, 36.60)
无心肌损伤组	42	54.50(44.00, 63.25)	15(35.7)	6(14.3)	2(4.8)	10(23.8)	36.50(36.48, 36.60)
统计值		$Z$ =-2.574	χ²=1.114	χ²=2.743	χ²=1.956	χ²=0.093	$Z$ =-1.142
$P$ 值		0.010	0.291	0.098	0.162	0.760	0.253

表1 两组一般资料比较

Tab.1 Comparison of general information between the two groups

组别	例数	年龄(岁)	男性 [例(%)]	高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	入院时体温 (℃)
心肌损伤组	72	62.00(53.25, 68.75)	33(45.8)	20(27.8)	11(15.3)	19(26.4)	36.50(36.50, 36.60)
无心肌损伤组	42	54.50(44.00, 63.25)	15(35.7)	6(14.3)	2(4.8)	10(23.8)	36.50(36.48, 36.60)
统计值		$Z$ =-2.574	χ²=1.114	χ²=2.743	χ²=1.956	χ²=0.093	$Z$ =-1.142
$P$ 值		0.010	0.291	0.098	0.162	0.760	0.253

表2 两组实验室资料比较

Tab.2 Comparison of laboratory data between the two groups

组别	例数	中性粒细胞计数 (×10⁹/L)	淋巴细胞计数 (×10⁹/L)	血小板计数 (×10⁹/L)	NLR	PLR	血尿酸 (μmol/L)	血肌酐 (μmol/L)	血白蛋白 (g/L)
心肌损伤组	72	10.28±4.20	1.23 (0.88, 1.65)	221.95 (183.23, 274.60)	8.41 (4.94, 14.14)	182.63 (129.85, 247.40)	330.05 (260.72, 415.20)	67.35 (54.25, 80.65)	40.85±3.23
无心肌损伤组	42	7.74±2.63	1.20 (0.84, 1.78)	224.55 (190.03, 263.28)	6.47 (3.42, 10.52)	191.62 (115.40, 266.43)	264.20 (228.21, 310.98)	56.45 (48.53, 67.20)	41.37±3.13
统计值		$t$ =-3.962	$Z$ =-0.141	$Z$ =-0.582	$Z$ =-1.933	$Z$ =-0.288	$Z$ =-3.792	$Z$ =-3.345	$t$ =0.840
$P$ 值		0.000	0.888	0.561	0.053	0.773	0.000	0.001	0.403

表2 两组实验室资料比较

Tab.2 Comparison of laboratory data between the two groups

组别	例数	中性粒细胞计数 (×10⁹/L)	淋巴细胞计数 (×10⁹/L)	血小板计数 (×10⁹/L)	NLR	PLR	血尿酸 (μmol/L)	血肌酐 (μmol/L)	血白蛋白 (g/L)
心肌损伤组	72	10.28±4.20	1.23 (0.88, 1.65)	221.95 (183.23, 274.60)	8.41 (4.94, 14.14)	182.63 (129.85, 247.40)	330.05 (260.72, 415.20)	67.35 (54.25, 80.65)	40.85±3.23
无心肌损伤组	42	7.74±2.63	1.20 (0.84, 1.78)	224.55 (190.03, 263.28)	6.47 (3.42, 10.52)	191.62 (115.40, 266.43)	264.20 (228.21, 310.98)	56.45 (48.53, 67.20)	41.37±3.13
统计值		$t$ =-3.962	$Z$ =-0.141	$Z$ =-0.582	$Z$ =-1.933	$Z$ =-0.288	$Z$ =-3.792	$Z$ =-3.345	$t$ =0.840
$P$ 值		0.000	0.888	0.561	0.053	0.773	0.000	0.001	0.403

表3 ACOP并发心肌损伤独立危险因素的二元Logistic回归分析

Tab.3 Independent risk factors for myocardial injury after ACOP in multivariate binary logistic regression analysis

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.041	0.017	5.782	0.016	1.042	1.008	1.077
中性粒细胞计数	0.159	0.074	4.550	0.033	1.172	1.013	1.356
血尿酸	0.008	0.004	3.982	0.046	1.008	1.000	1.015
血肌酐	0.010	0.019	0.262	0.609	1.010	0.972	1.049

表3 ACOP并发心肌损伤独立危险因素的二元Logistic回归分析

Tab.3 Independent risk factors for myocardial injury after ACOP in multivariate binary logistic regression analysis

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.041	0.017	5.782	0.016	1.042	1.008	1.077
中性粒细胞计数	0.159	0.074	4.550	0.033	1.172	1.013	1.356
血尿酸	0.008	0.004	3.982	0.046	1.008	1.000	1.015
血肌酐	0.010	0.019	0.262	0.609	1.010	0.972	1.049

表4 中性粒细胞计数、血尿酸、中性粒细胞计数联合血尿酸对ACOP并发心肌损伤的预测价值

Tab. 4 Respective predictive value of neutrophil count, SUA, and their combination in predicting myocardial injury after ACOP

指标	AUC	标准误	$P$ 值	95% $C I$		敏感度 (%)	特异度 (%)	约登指数	界值
指标	AUC	标准误	$P$ 值	下限	上限	敏感度 (%)	特异度 (%)	约登指数	界值
中性粒细胞计数	0.686	0.049	0.001	0.590	0.783	55.6	78.6	0.342	9.55×10⁹
血尿酸	0.713	0.048	0.000	0.620	0.807	52.8	88.1	0.409	325
中性粒细胞计数联合血尿酸	0.737	0.046	0.000	0.647	0.827	68.1	73.8	0.419	0.599

表4 中性粒细胞计数、血尿酸、中性粒细胞计数联合血尿酸对ACOP并发心肌损伤的预测价值

Tab. 4 Respective predictive value of neutrophil count, SUA, and their combination in predicting myocardial injury after ACOP

指标	AUC	标准误	$P$ 值	95% $C I$		敏感度 (%)	特异度 (%)	约登指数	界值
指标	AUC	标准误	$P$ 值	下限	上限	敏感度 (%)	特异度 (%)	约登指数	界值
中性粒细胞计数	0.686	0.049	0.001	0.590	0.783	55.6	78.6	0.342	9.55×10⁹
血尿酸	0.713	0.048	0.000	0.620	0.807	52.8	88.1	0.409	325
中性粒细胞计数联合血尿酸	0.737	0.046	0.000	0.647	0.827	68.1	73.8	0.419	0.599

图1 中性粒细胞计数、血尿酸、中性粒细胞计数联合血尿酸预测ACOP患者心肌损伤的ROC曲线

Fig.1 ROC curve of neutrophil count, SUA, and their combination in predicting myocardial injury in ACOP patients

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