中性粒细胞delta指数在化脓性关节炎与痛风性关节炎急性发作期早期诊断中的临床意义
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摘要
目的探讨中性粒细胞delta指数(delta neutrophil index,DNI)在化脓性关节炎与痛风性关节炎急性发作期患者中早期诊断的临床意义。方法回顾分析2015年1月至2017年12月,在我院接受治疗的80例痛风关节炎急性发作期(痛风急性发作组)和60例化脓性关节炎(化脓性关节炎组)患者的临床资料。比较两组患者在临床特征方面的差异。利用受试者工作特征曲线(ROC曲线)分析不同指标在鉴别化脓性关节炎与痛风性关节炎急性发作期发作中的诊断价值。采用单因素、多因素Logistic回归分析评价不同指标在化脓性关节炎与痛风性关节炎急性发作期发作中的预测价值。结果白细胞计数:痛风急性发作组(9.15±2.88)化脓性关节炎组(11.33±3.02)(P<0.01);DNI:痛风急性发作组(0.77±0.25)%,化脓性关节炎组(4.02±1.25)%,(P<0.01);红细胞沉降率:痛风急性发作组(60.25±25.24) mm/h,化脓性关节炎组(75.61±23.44) mm/h,(P<0.01);C-反应蛋白:痛风急性发作组(81.27±24.31) mg/L,化脓性关节炎组(118.64±30.55)(P<0.01);尿素氮:痛风急性发作组(350.26±26.52) mg/L,化脓性关节炎组(200.71±19.47) mg/L,(P<0.01);肌酐:痛风急性发作组(20.02±4.03) mg/L,化脓性关节炎组(10.14±2.12) mg/L,(P<0.01);尿酸:痛风急性发作组(80.22±10.26) mg/L,化脓性关节炎组(30.57±6.33) mg/L,(P<0.01)。鉴别化脓性关节炎与痛风性关节炎急性发作期发作的最佳诊断界值为:白细胞计数11.20×103/mm3、DNI 2.00%、红细胞沉降率68.50 mm/h、C-反应蛋白105.25 mg/L、尿素氮290.15 mg/L、肌酐17.75 mg/L、尿酸60.50 mg/L。多因素Logistic回归分析显示,DNI≥2.00%、红细胞沉降率≥68.50 mm/h、C-反应蛋白≥105.25 mg/L是预测化脓性关节炎的重要参数(P<0.05),尿酸≥60.50 mg/L是预测痛风性关节炎急性发作期的重要参数(P<0.05)。结论 DNI是除红细胞沉降率、C-反应蛋白、尿酸指标外早期鉴别化脓性关节炎与痛风性关节炎急性发作期患者的重要诊断指标。
Objective To investigate the clinical significance of delta neutrophil index( DNI) in the early diagnosis of pyogenic arthritis and acute gout attack. Methods Eighty patients with acute gout attack( acute gout attack group) and 60 patients with pyogenic arthritis( pyogenic arthritis group) in our hospital from Jan 2015 to Dec 2017 were selected as study subjects. Clinical differences between the 2 groups were compared. ROC curve was applied to analyze the different indexes. Single factor and multi-factor Logistic regression analysis was used to evaluate the predictive value of different indexes in pyogenic arthritis and acute gout attack. Results Leukocyte count:( 9.15 ± 2.88) in the acute gout attack group;( 11.33 ± 3.02) in the pyogenic arthritis group;( P < 0.01). DNI:( 0.77 ± 0.25) % in the acute gout attack group;( 4.02 ± 1.25) % in the pyogenic arthritis group;( P < 0.01). Erythrocyte sedimentation rate:( 60.25 ± 25.24) mm/h in the acute gout attack group;( 75.61 ± 23.44) mm/h in the pyogenic arthritis group;( P < 0.01). Creactive protein:( 81.27 ± 24.31) mg/L in the gout acute attack group;( 118.64 ± 30.55) in the pyogenic arthritis group;( P < 0.01). Urea nitrogen:( 350.26 ± 26.52) mg/L in the acute gout attack group;( 200.71 ± 19.47) mg/L in the pyogenic arthritis group;( P < 0.01). Creatinine:( 20.02 ± 4.03) mg/L in the acute gout attack group;( 10.14 ± 2.12) mg/L in the pyogenic arthritis group;( P < 0.01). Uric acid:( 80.22 ± 10.26) mg/L in the acute gout attack group;( 30.57 ± 6.33) mg/L in the pyogenic arthritis group;( P < 0.01). The optimal cutoff value of DNI, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, urea nitrogen, creatinine and uric acid in differentiating pyogenic arthritis and acute gout attack were 11.20 × 103/mm3, 2.00%, 68.50 mm/h, 105.25 mg/L, 290.15 mg/L, 17.75 mg/L, 60.50 mg/L, respectively. Multivariate Logistic regression analysis showed that DNI ≥ 2.00%, erythrocyte sedimentation rate ≥ 68.50 mm/h, C-reaction protein ≥ 105.25 mg/L were important parameters to predict pyogenic arthritis( P < 0.05); uric acid ≥ 60.50 mg/L was an important parameter to predict acute gout attack( P < 0.05). Conclusions DNI is an important diagnostic indicator for the identification of patients with pyogenic arthritis and acute gout attack in addition to erythrocyte sedimentation rate, C-reactive protein, and uric acid.
Objective To investigate the clinical significance of delta neutrophil index( DNI) in the early diagnosis of pyogenic arthritis and acute gout attack. Methods Eighty patients with acute gout attack( acute gout attack group) and 60 patients with pyogenic arthritis( pyogenic arthritis group) in our hospital from Jan 2015 to Dec 2017 were selected as study subjects. Clinical differences between the 2 groups were compared. ROC curve was applied to analyze the different indexes. Single factor and multi-factor Logistic regression analysis was used to evaluate the predictive value of different indexes in pyogenic arthritis and acute gout attack. Results Leukocyte count:( 9.15 ± 2.88) in the acute gout attack group;( 11.33 ± 3.02) in the pyogenic arthritis group;( P < 0.01). DNI:( 0.77 ± 0.25) % in the acute gout attack group;( 4.02 ± 1.25) % in the pyogenic arthritis group;( P < 0.01). Erythrocyte sedimentation rate:( 60.25 ± 25.24) mm/h in the acute gout attack group;( 75.61 ± 23.44) mm/h in the pyogenic arthritis group;( P < 0.01). Creactive protein:( 81.27 ± 24.31) mg/L in the gout acute attack group;( 118.64 ± 30.55) in the pyogenic arthritis group;( P < 0.01). Urea nitrogen:( 350.26 ± 26.52) mg/L in the acute gout attack group;( 200.71 ± 19.47) mg/L in the pyogenic arthritis group;( P < 0.01). Creatinine:( 20.02 ± 4.03) mg/L in the acute gout attack group;( 10.14 ± 2.12) mg/L in the pyogenic arthritis group;( P < 0.01). Uric acid:( 80.22 ± 10.26) mg/L in the acute gout attack group;( 30.57 ± 6.33) mg/L in the pyogenic arthritis group;( P < 0.01). The optimal cutoff value of DNI, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, urea nitrogen, creatinine and uric acid in differentiating pyogenic arthritis and acute gout attack were 11.20 × 103/mm3, 2.00%, 68.50 mm/h, 105.25 mg/L, 290.15 mg/L, 17.75 mg/L, 60.50 mg/L, respectively. Multivariate Logistic regression analysis showed that DNI ≥ 2.00%, erythrocyte sedimentation rate ≥ 68.50 mm/h, C-reaction protein ≥ 105.25 mg/L were important parameters to predict pyogenic arthritis( P < 0.05); uric acid ≥ 60.50 mg/L was an important parameter to predict acute gout attack( P < 0.05). Conclusions DNI is an important diagnostic indicator for the identification of patients with pyogenic arthritis and acute gout attack in addition to erythrocyte sedimentation rate, C-reactive protein, and uric acid.
引文
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[9]王婷,刘振国,柴春燕,等.白细胞计数、中性粒细胞百分比、降钙素原和C反应蛋白在80岁以上老年感染性患者中的应用评价[J].实用老年医学,2016,30(8):654-656.
[10]Lenski M,Scherer MA.Analysis of synovial inflammatory markers to differ infectious from gouty arthritis[J].Clin Biochem,2014,47(1-2):49-55.
[11]Lim TS,Kim BK,Lee JW,et al.Use of the delta neutrophil index as a prognostic factor of mortality in patients with spontaneous bacterial peritonitis:implications of a simple and useful marker[J].Plos One,2015,9(1):e86884.
[12]Lee H,Kim IK,Ju MK.Which patients with intestinal obstruction need surgery?The delta neutrophil index as an early predictive marker[J].Ann Surg Treat Res,2017,93(5):272-276.
[13]Park JH,Byeon HJ,Lee KH,et al.Delta neutrophil index(DNI)as a novel diagnostic and prognostic marker of infection:a systematic review and meta-analysis[J].Inflamm Res,2017,66(10):863-870.
[14]Chen YH,Hsieh SC,Chen WY,et al.Spontaneous resolution of acute gouty arthritis is associated with rapid induction of the anti-inflammatory factors TGFβ1,IL-10 and soluble TNFreceptors and the intracellular cytokine negative regulators CISand SOCS3[J].Ann Rheum Dis,2011,70(9):1655-1663.
[15]黄志饶,江中芳,王友莲.基线超敏C反应蛋白对高尿酸血症患者发生痛风性关节炎急性发作期性关节炎的风险预测价值[J].中国药物与临床,2016,16(10):1475-1477.
[16]陆世凯.不同剂量秋水仙碱治疗痛风性关节炎患者的临床效果比较[J].中华全科医学,2017,15(10):1700-1703.
[2]Cardoso L,Alves P,Santos F,et al.Septic arthritis of the pubic symphysis[J].BMJ Case Rep,2017,1(5):340-345.
[3]Kim JW,Park JH,Kim DJ,et al.The delta neutrophil index is a prognostic factor for postoperative mortality in patients with sepsis caused by peritonitis[J].Plos One,2017,12(8):e0182325.
[4]Pyo JY,Jung SM,Song JJ,et al.THU0436 Clinical significance of delta neutrophil index in the differential diagnosis between septic arthritis and acute gout attack within 24 hours after hospitalisation[J].Medicine,2017,96(30):e7431.
[5]Pyo JY,Ha YJ,Song JJ,et al.Delta neutrophil index contributes to the differential diagnosis between acute gout attack and cellulitis within 24 hours after hospitalization[J].Rheumatology,2017,56(5):795-801.
[6]周立峰,李群伟,王华强,等.缺血性脑卒中早期神经功能恶化CISS分型特点及危险因素分析[J].心脑血管病防治,2015,15(3):207-208.
[7]Cho HY,Jung I,Kwon JY,et al.The Delta Neutrophil Index as a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes:A retrospective study[J].Plos One,2017,12(3):e0173382.
[8]危立军,罗军,易观俊,等.血清降钙素原及血沉与C-反应蛋白联合检测诊断化脓性关节炎临床价值[J].中华医院感染学杂志,2015,25(20):4664-4666.
[9]王婷,刘振国,柴春燕,等.白细胞计数、中性粒细胞百分比、降钙素原和C反应蛋白在80岁以上老年感染性患者中的应用评价[J].实用老年医学,2016,30(8):654-656.
[10]Lenski M,Scherer MA.Analysis of synovial inflammatory markers to differ infectious from gouty arthritis[J].Clin Biochem,2014,47(1-2):49-55.
[11]Lim TS,Kim BK,Lee JW,et al.Use of the delta neutrophil index as a prognostic factor of mortality in patients with spontaneous bacterial peritonitis:implications of a simple and useful marker[J].Plos One,2015,9(1):e86884.
[12]Lee H,Kim IK,Ju MK.Which patients with intestinal obstruction need surgery?The delta neutrophil index as an early predictive marker[J].Ann Surg Treat Res,2017,93(5):272-276.
[13]Park JH,Byeon HJ,Lee KH,et al.Delta neutrophil index(DNI)as a novel diagnostic and prognostic marker of infection:a systematic review and meta-analysis[J].Inflamm Res,2017,66(10):863-870.
[14]Chen YH,Hsieh SC,Chen WY,et al.Spontaneous resolution of acute gouty arthritis is associated with rapid induction of the anti-inflammatory factors TGFβ1,IL-10 and soluble TNFreceptors and the intracellular cytokine negative regulators CISand SOCS3[J].Ann Rheum Dis,2011,70(9):1655-1663.
[15]黄志饶,江中芳,王友莲.基线超敏C反应蛋白对高尿酸血症患者发生痛风性关节炎急性发作期性关节炎的风险预测价值[J].中国药物与临床,2016,16(10):1475-1477.
[16]陆世凯.不同剂量秋水仙碱治疗痛风性关节炎患者的临床效果比较[J].中华全科医学,2017,15(10):1700-1703.