内科

目的探讨中性粒细胞与淋巴细胞比值（NLR）对多发伤患者并发急性肾损伤（AKI）的预测价值。方法回顾性分析87例多发伤患者的临床资料，根据住院期间是否并发AKI将患者分为AKI组和非AKI组。比较两组患者的年龄、性别、合并疾病（糖尿病、高血压）、创伤严重度评分（ISS）和入院时平均动脉压、血常规、肾功能等。采用二元logistic回归模型分析多发伤患者并发AKI的影响因素，绘制受试者操作特征（ROC）曲线分析NLR对多发伤患者并发AKI的预测价值。结果 AKI组和非AKI组患者年龄、性别、合并疾病（糖尿病、高血压）、入院白细胞计数、入院血红蛋白水平、入院C反应蛋白水平、入院血清肌酐水平比较，差异均无统计学意义（均P>0.05）；AKI组ISS、入院NLR均高于非AKI组，入院平均动脉压低于非AKI组（均P＜0.05）。二元logistic回归分析结果显示，入院NLR高是多发伤患者并发AKI的独立危险因素（P<0.05）；ROC曲线分析结果显示，NLR预测多发伤患者并发AKI的敏感度为73.3%，特异度为83.3%，ROC曲线下面积为0.781（P<0.05）。结论 NLR升高是多发伤患者并发AKI的独立危险因素，NLR可作为多发伤患者并发AKI的早期预测指标。

Objective To investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for complicated acute kidney injury (AKI) in patients with multiple injuries. Methods The clinical data of 87 patients with multiple injuries were retrospectively analyzed, and the patients were divided into an AKI group or a non-AKI group according to whether they had complicated AKI during hospitalization. The two groups of patients were compared in age, gender, comorbidities (diabetes mellitus, hypertension), and injury severity score (ISS), as well as the mean arterial pressure, blood routine test results, and renal function at admission. The binary logistic regression model was used to analyze influencing factors for AKI in patients with multiple injuries, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of NLR for AKI in patients with multiple injuries. Results There was no statistically significant difference in age, gender, comorbidities (diabetes mellitus, hypertension), white blood cell count at admission, hemoglobin level at admission, C-reactive protein level at admission, or serum creatinine level at admission between the AKI group and the non-AKI group (all P>0.05). The ISS and the NLR at admission of the AKI group were higher than those of the non-AKI group, and the mean arterial pressure at admission of the AKI group was lower than that of the non-AKI group (all P<0.05). The results of the binary logistic regression analysis showed that a high NLR at admission was an independent risk factor for AKI in patients with multiple injuries (P<0.05). The results of the ROC curve analysis showed that the sensitivity and specificity of NLR in predicting AKI in patients with multiple injuries were 73.3% and 83.3%, respectively, while the area under the ROC curve was 0.781 (P<0.05). Conclusion The elevated NLR is an independent risk factor for complicated AKI in patients with multiple injuries, and the NLR can be used as an early predictor of complicated AKI in patients with multiple injuries.