目的:探讨蛇咬伤患者粒细胞联合血小板与蛇咬伤严重程度及发生并发症的相关性,并构建模型预测蛇咬伤患者发生严重并发症的概率.方法:回顾性分析2013年1月1日-2023年10月30日由恩施土家族苗族自治州中心医院西医部急诊中心收治的577例蛇咬伤患者,收集患者的一般资料、白细胞(white blood cell,WBC)、血小板(platelet,PLT)、血小板分布宽度(platelet distribution width,PDW)、平均血小板体积(mean plate-let volume,MPV)、中性粒细胞绝对值(NE#)、淋巴细胞绝对值(LY#)、NLR(NE#/LY#)、PLR(PLT/LY#)、系统免疫炎症指数(systemic immune-inflammation index,SII)、PDWLR(PDW/LY#)、首次就诊时间、住院时间、住院费用、抗蛇毒血清使用时间等资料.根据是否发生严重并发症分成发生并发症组和未发生并发症组,根据蛇咬伤分度分成轻度和中重度蛇咬伤组.比较各组患者的一般资料及实验室数据,然后进行多因素logistic回归分析,构建ROC曲线评价指标的特异度和灵敏度,最后构建多因素的预测模型.结果:不同程度、不同预后的两组患者的年龄及性别等一般资料差异无统计学意义(P＞0.05),轻度蛇咬伤的WBC、NE#、NLR、SII、PDWLR、住院时间、住院费用较中重度蛇咬伤患者更低,发生感染、组织坏死及需要输血和手术的患者更少,肿胀程度轻,PLT、LY#、PLR高,差异有统计学意义(P＜0.05);预后良好组的患者较发生并发症组WBC、NE#、NLR、SII和PDWLR更低,首次就诊时间和住院时间更短,抗蛇毒血清使用时间更早,住院费用更低,而PLT、LY#、PLR则更高,且两组间比较差异有统计学意义(P＜0.05).结论:WBC、PLT、NLR、PLR、SII、PDWLR和抗蛇毒血清使用时间是蛇咬伤患者分度的影响因素.LY#、NLR、PLR、PDWLR及抗蛇毒血清使用时间是蛇咬伤患者预后的影响因素,其中LY#、NLR、PDWLR是预后的危险因素,而PLR和早期使用抗蛇毒血清是预后的保护因素,且综合分析上述因素能辅助蛇伤分度诊断和预测患者预后.
The predictive value of granulocyte combined with platelet detection in the severity and prognosis of snake bites
Objective:To investigate the correlation between granulocyte combined with platelets and the se-verity and complications of snakebite patients,and to build a model to predict the probability of severe complica-tions in snakebite patients.Methods:The snakebite patients admitted to our hospital from January 1,2013 to Oc-tober 30,2023 were retrospectively analyzed,and the general data,white blood cell(WBC),platelet(PLT),plate-let distribution width(PDW),mean platelet volume(MPV),NE#,LY #,NLR(NE#/LY#),PLR(PLT/LY#),systemic immune-inflammation index(SII),PDWLR(PDW/LY#),time of first visit,length of stay,hos-pitalization cost,and duration of antivenom use of patients were collected.According to the occurrence of serious complications,the patients were divided into two groups:the group with complications and the group without complications,and the group with mild and moderate to severe snake bites were divided into two groups according to the snakebite scale.General data and laboratory data of each group of patients were compared,and then multi-variate logistic regression analysis was performed to construct the specificity and sensitivity of ROC curve evalua-tion indicators,and finally a multivariate prediction model was constructed.Results:There was no statistical sig-nificance in age,gender and other general data of the two groups with different degrees and different prognoses(P＞0.05).The WBC,NE #,NLR,SII,PDWLR,length of hospital stay and hospitalization cost of mild snakebite were lower than those of moderate and severe snakebite.Fewer patients suffered from infection,tissue necrosis and needed blood transfusion and surgery,and the degree of swelling was mild.PLT,LY # and PLR were high,and the results were statistically significant(P＜0.05).Compared with the complication group,the patients in the good prognosis group had lower WBC,NE#,NLR,SII and PDWLR,shorter first visit time and hospital stay,earlier use of antivenin and lower hospital cost,while the PLT,LY # and PLR were higher,and there was statistical significance between the two groups(P＜0.05).Conclusion:WBC,PLT,NLR,PLR,SII,PDWLR and duration of antivenom use were the factors influencing the classification of snakebite patients.LY #,NLR,PLR,PDWLR and duration of antivenom use were the influencing factors for prognosis of snakebite pa-tients,among which LY #,NLR and PDWLR were the risk factors of prognosis,while PLR and early use of antivenom were the protective factors of prognosis(P＜0.05).And the comprehensive analysis of the above fac-tors can assist in the classification diagnosis of snakebite and predict the prognosis of patients.
snake bitegranulocyteplateletprognosispredictive value
NETL
NSTL
万方数据
