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血常规及肝肾功能检查在新型冠状病毒肺炎病情预测中的临床应用

[The clinical application of blood routine and liver and kidney function test in COVID-19 disease prediction].

作者信息

Liang Y L, Ma Y T, Huang K K, Luo H D, Wang A M, Xiong Z, Luo Y, Yi B

机构信息

Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, China.

Department of Emergency Department, Xiangya Hospital, Central South University,Changsha 410008, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Jan 6;55(1):89-95. doi: 10.3760/cma.j.cn112150-20200629-00947.

Abstract

To explore the clinical application value of routine indicators such as blood routine and liver and kidney function in auxiliary diagnosis and prognosis of COVID-19 patients. SNK-q and other methods were used to retrospectively analyzed the differences of blood routine test, liver and kidney function and other inflammatory indexes of 30 patients with covid-19, 29 patients with other viral pneumonia, 35 patients with influenza A/B and 25 healthy persons from January 28 to February 14, 2020 in Xiangya Hospital of Central South University. The neutrophils count increased gradually in COVID-19 group, influenza A/B group and other types of viral pneumonia group, and the difference between COVID-19 group and other viral pneumonia groups was statistically significant(=-19.064,0.05); The lymphocyte count decreased gradually in the control group, influenza A/B group, other viral pneumonia group and COVID-19 group. In addition, DB, UA and GLU were also different among groups. Subgroup analysis showed that there were statistically significant differences in N(9.581,-0.152,0.05), N%(5.723,-0.600, 0.05), NLR(4.773, -1.161, 0.05), PCT(17.464, -1.477, 0.05)and CRP(7.656, -1.973, 0.05) between patients with lung involvement +-++ and patients with lung involvement +++-++++. There were statistically significant differences in NLR(63.931, -2.815, 0.01), AST(15.704, -1.930, 0.01), ALT(35.551, -2.199, 0.01), LDH(7.715, -2.703, 0.05) and GLU(6.306, -5.116, 0.05) between the light+common subgroup and the heavy+critical subgroup of COVID-19 clinical classification. Correlation analysis showed that clinical stage and imaging credit period were significantly correlated with NLR (=0.406=0.026; =0.397=0.030), ALT (=0.403=0.049; =0.418=0.047), LDH (=0.543<0.01; =0.643<0.01) and GLU(0.750<0.01; =0.471=0.042). A total of 5 principal components were extracted from all the included indicators, and the comprehensive information extraction rate was 82.86%. Indicators of a large load included Ur, PCT and CRP in PC1; ALT, AST and GLU in PC2; N%, L%, L and NLR in PC3. It indicated that the indicators of acute infection, liver function and blood routine had certein warning effect on disease surveillance. The results of ROC curve analysis showed that the combined detection of N+TB+Urea was the best practice to distinguish COVID-19 and other viral pneumonia, while the combined detection of N+L+UA was the most effective solution to make a distinction between COVID-19 and influenza A/B patients. In the aspect of disease evaluation, NL+LDH+GLU+ALT combined detection represent the best diagnostic performance to distinguish the clinical stage of light+common type and heavy+critical type, achieving the AUC (ROC) to 0.904, with the sensitivity 75% and the specificity 100% at the cut-off value of 0.477. In addition to etiology and imaging examination, doctors can also improve the routine laboratory tests such as blood routine test, liver and kidney function to assist diagnosis and disease prediction of patients with respiratory tract infection.

摘要

探讨血常规、肝肾功能等常规指标在新型冠状病毒肺炎(COVID-19)患者辅助诊断及预后评估中的临床应用价值。采用SNK-q等方法,回顾性分析2020年1月28日至2月14日在中南大学湘雅医院就诊的30例COVID-19患者、29例其他病毒性肺炎患者、35例甲型/乙型流感患者及25例健康人的血常规、肝肾功能等炎症指标差异。COVID-19组、甲型/乙型流感组及其他类型病毒性肺炎组中性粒细胞计数逐渐升高,COVID-19组与其他病毒性肺炎组差异有统计学意义(=-19.064,0.05);对照组、甲型/乙型流感组、其他病毒性肺炎组及COVID-19组淋巴细胞计数逐渐降低。此外,各组间直接胆红素(DB)、尿酸(UA)及葡萄糖(GLU)也存在差异。亚组分析显示,肺部受累+-++患者与肺部受累+++-++++患者在中性粒细胞计数(N)(9.581,-0.152,0.05)、中性粒细胞百分比(N%)(5.723,-0.600,0.05)、中性粒细胞与淋巴细胞比值(NLR)(4.773,-1.161,0.05)、降钙素原(PCT)(17.464,-1.477,0.05)及C反应蛋白(CRP)(7.656,-1.973,0.05)方面差异有统计学意义。COVID-19临床分型中轻型+普通型亚组与重型+危重型亚组在NLR(63.931,-2.815,0.01)、天门冬氨酸氨基转移酶(AST)(15.704,-1.930,0.01)、丙氨酸氨基转移酶(ALT)(35.551,-2.199,0.01)、乳酸脱氢酶(LDH)(7.715,-2.703,0.05)及GLU(6.306,-5.116,0.05)方面差异有统计学意义。相关性分析显示,临床分期及影像学分期与NLR(=0.406=0.026;=0.397=0.030)、ALT(=0.403=0.049;=0.418=0.047)、LDH(=0.543<0.01;=0.643<0.01)及GLU(0.750<0.01;=0.471=0.042)显著相关。从所有纳入指标中共提取5个主成分,综合信息提取率为82.86%。主成分1中载荷较大的指标有尿素(Ur)、PCT及CRP;主成分2中有ALT、AST及GLU;主成分3中有N%、淋巴细胞百分比(L%)、淋巴细胞计数(L)及NLR。提示急性感染指标、肝功能指标及血常规指标对病情监测有一定预警作用。ROC曲线分析结果显示,N+总胆红素(TB)+尿素联合检测是区分COVID-19与其他病毒性肺炎的最佳方案,而N+L+UA联合检测是区分COVID-19与甲型/乙型流感患者的最有效方案。在病情评估方面,NLR+LDH+GLU+ALT联合检测区分轻型+普通型与重型+危重型临床分期的诊断效能最佳,曲线下面积(AUC)(ROC)为0.904,在截断值为0.477时,敏感度为75%,特异度为100%。除病因及影像学检查外,医生还可完善血常规、肝肾功能等常规实验室检查以辅助呼吸道感染患者的诊断及病情预测。

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