血常规数值和比值在鉴别消化性溃疡出血与食管胃静脉曲张出血中的诊断价值。

Diagnostic Values of Blood Count Values and Ratios in Distinguishing between Peptic Ulcer Bleeding and Esophagogastric Variceal Bleeding.

出版信息

Clin Lab. 2020 Apr 1;66(4). doi: 10.7754/Clin.Lab.2019.190927.

DOI:10.7754/Clin.Lab.2019.190927

Abstract

BACKGROUND

To investigate the diagnostic values of blood count values and ratios in distinguishing between peptic ulcer bleeding (PUB) and esophagogastric variceal bleeding (EGVB).

METHODS

Due to acute hematemesis and or melaena, 57 patients diagnosed with PUB (PUB group) and 33 cases with EGVB (EGVB group) were enrolled in this retrospective study. The levels of peripheral blood leukocyte counts (leukocyte), neutrophil counts (neutrophil), lymphocyte counts (lymphocyte), platelet counts (platelet), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were recorded and compared between the two groups. Student's t-test of independent samples was adopted for comparing the mean between the two groups. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Comparison of AUC was performed using the Z-test.

RESULTS

The levels of leukocyte, neutrophil, lymphocyte, platelet, and PLR were significantly increased in PUB group compared with EGVB group (all p < 0.05), while there was no significant statistical difference of NLR (p > 0.05); moreover, AUCs in distinguishing PUB from EGVB were 0.859, 0.811, 0.760, 0.952, and 0.687 for leukocyte, neutrophil, lymphocyte, platelet, and PLR, respectively, and significant differences were observed between platelet and any parameter of the rest (all p < 0.05); finally, the cutoff values were 8 x 109/L in distinguishing between PUB and EGVB (specificity 78.95%, sensitivity 87.88%, and Youden index 0.668) for leukocyte, 5.3 x 109/L (specificity 70.18%, sensitivity 81.82%, and Youden index 0.520) for neutrophil, 1.2 x 109/L (specificity 84.21%, sensitivity 60.61%, and Youden index 0.448) for lymphocyte, 131 x 109/L (specificity 92.98%, sensitivity 90.91%, and Youden index 0.839) for platelet, and 88 (specificity 70.18%, sensitivity 63.64%, and Youden index 0.338) for PLR.

CONCLUSIONS

Leukocyte, neutrophil, lymphocyte, platelet and PLR are useful and potential biomarkers in distinguishing between PUB and EGVB; moreover, platelet can demonstrate more accurate and reliable diagnostic value.

摘要

背景

为了探究血细胞计数和比值在鉴别消化性溃疡出血（PUB）和食管胃静脉曲张出血（EGVB）中的诊断价值。

方法

本回顾性研究纳入了 57 例诊断为 PUB（PUB 组）和 33 例 EGVB（EGVB 组）的患者，这些患者均因急性呕血和/或黑便入院。记录并比较两组患者外周血白细胞计数（白细胞）、中性粒细胞计数（中性粒细胞）、淋巴细胞计数（淋巴细胞）、血小板计数（血小板）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。采用两独立样本 t 检验比较两组均值。采用受试者工作特征曲线（ROC）下面积（AUC）评价模型鉴别能力。采用 Z 检验比较 AUC 的差异。

结果

与 EGVB 组相比，PUB 组的白细胞、中性粒细胞、淋巴细胞、血小板和 PLR 水平显著升高（均 P < 0.05），而 NLR 无显著统计学差异（P > 0.05）；此外，白细胞、中性粒细胞、淋巴细胞、血小板和 PLR 鉴别 PUB 和 EGVB 的 AUC 分别为 0.859、0.811、0.760、0.952 和 0.687，血小板与其他参数的 AUC 差异均有统计学意义（均 P < 0.05）；最后，白细胞鉴别 PUB 和 EGVB 的截断值为 8 x 109/L（特异度 78.95%，敏感度 87.88%，约登指数 0.668），中性粒细胞为 5.3 x 109/L（特异度 70.18%，敏感度 81.82%，约登指数 0.520），淋巴细胞为 1.2 x 109/L（特异度 84.21%，敏感度 60.61%，约登指数 0.448），血小板为 131 x 109/L（特异度 92.98%，敏感度 90.91%，约登指数 0.839），PLR 为 88（特异度 70.18%，敏感度 63.64%，约登指数 0.338）。