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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 132 -138. doi: 10.3877/cma.j.issn.1674-6902.2026.01.021

论著

平均血小板体积/血小板计数、乳酸/白蛋白比值对119例重症肺炎预后预测的价值研究
杨德建1, 晏东1, 戴忠红1, 黎宏1, 杨鹏2, 钟常文3   
  1. 1611230　成都，崇州市人民医院重症科
    2610000　成都，四川省人民医院重症科
    3611000　成都，成都市金牛区人民医院重症科
  • 收稿日期:2025-08-14 出版日期:2026-02-25

Study on value of mean platelet volume/platelet count ratio and lactate/albumin ratio combined for predicting prognosis of 119 patients with severe pneumonia

Dejian Yang1, Dong Yan1, Zhonghong Dai1, Hong Li1, Peng Yang2, Changwen Zhong3   

  1. 1Intensive Care Department of Chongzhou People′s Hospital, Chengdu 611230, China
    2Intensive Care Department of Sichuan Provincial People′s Hospital, Chengdu 610000, China
    3Intensive Care Department of Jinniu District People′s Hospital, Chengdu 611000, China
  • Received:2025-08-14 Published:2026-02-25
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引用本文：

杨德建, 晏东, 戴忠红, 黎宏, 杨鹏, 钟常文. 平均血小板体积/血小板计数、乳酸/白蛋白比值对119例重症肺炎预后预测的价值研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 132-138.

Dejian Yang, Dong Yan, Zhonghong Dai, Hong Li, Peng Yang, Changwen Zhong. Study on value of mean platelet volume/platelet count ratio and lactate/albumin ratio combined for predicting prognosis of 119 patients with severe pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 132-138.

目的

分析平均血小板体积/血小板计数(mean platelet volume/platelet count ratio, MPR)、乳酸/白蛋白比值(lactate/albumin ratio, LAR)联合预测重症肺炎患者预后的意义。

方法

回顾性选取2020年1月至2024年12月我院收治的119例重症肺炎患者为对象，记录患者生存情况，119例重症肺炎患者生存者88例、死亡者31例，比较两者临床资料及MPR、LAR值。应用Pearson相关分析探讨MPR、LAR与重症肺炎患者急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)评分的相关性；多因素Logistic回归分析明确重症肺炎患者预后不良的影响因素；绘制受试者工作特征(receiver operating characteristic, ROC)曲线、决策曲线分析评价MPR、LAR及联合应用预测重症肺炎患者预后不良的价值及临床净获益。

结果

生存者与死亡者APACHE Ⅱ评分[(19.76±4.01)分比(25.59±3.38)分]、D-二聚体[(3.89±1.06)μg/ml比(4.35±1.19)μg/ml]、C反应蛋白[(102.75±26.15)mg/L比(114.56±30.12)mg/L]、降钙素原[(7.23±1.56)ng/ml比(8.91±2.64)ng/ml]、MPR[(4.58±0.90)比(5.73±1.15)]、LAR[(0.05±0.01)比(0.09±0.03)]水平比较，差异有统计学意义(P<0.05)。Pearson相关分析显示，MPR、LAR与重症肺炎患者APACHE Ⅱ评分均呈正相关关系(P<0.05)。Logistic回归分析显示，校正其他混杂因素后，MPR(OR＝2.962，95%CI：1.674~5.242)、LAR(OR＝13.045，95%CI：3.899~43.649)是重症肺炎患者预后不良的危险因素(P<0.05)。ROC曲线显示，MPR、LAR预测重症肺炎患者预后有临床意义，联合预测的AUC高于单一指标预测(P<0.05)。决策曲线分析结果显示，MPR联合LAR预测在阈值概率为0.30~0.65时可获得最大临床效益。

结论

MPR、LAR与重症肺炎患者病情及预后密切相关，两者联合检测预测患者预后具有临床意义。

关键词: 重症肺炎, 平均血小板体积/血小板计数, 乳酸/白蛋白比值, 预后
Objective

To analyze the value of mean platelet volume/platelet count ratio (MPR) and lactate/albumin ratio (LAR) combined for predicting the prognosis of patients with severe pneumonia.

Methods

A total of 119 patients with severe pneumonia admitted to our hospital from January 2020 to December 2024 were retrospectively selected as study subjects. According to the survival status of patients, they were divided into good prognosis group (survival) and poor prognosis group (death). Clinical data and MPR and LAR values of the two groups were collected and compared. Pearson correlation analysis was used to explore the correlation between MPR, LAR and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores in patients with severe pneumonia. Multivariate logistic regression analysis was used to identify the influencing factors for poor prognosis in patients with severe pneumonia. Receiver operating characteristic (ROC) curves and decision curve analysis were drawn to evaluate the value and clinical net benefit of MPR, LAR, and their combined application for predicting poor prognosis in patients with severe pneumonia.

Results

Among 119 patients with severe pneumonia, 88 cases survived and 31 cases died after treatment. The APACHE Ⅱscore[(19.76±4.01)vs.(25.59±3.38)], D-D[(3.89±1.06)μg/ml vs.(4.35±1.19)μg/ml], CRP[(102.75±26.15)mg/L vs.(114.56±30.12)mg/L], PCT[(7.23±1.56)ng/ml vs.(8.91±2.64)ng/ml], MPR[(4.58±0.90)vs.(5.73±1.15)], LAR[(0.05±0.01)vs.(0.09±0.03)] of survivors and the dead, with statistically significant differences were found in comparison(P<0.05). Pearson correlation analysis showed that MPR and LAR were both positively correlated with APACHE Ⅱ scores in patients with severe pneumonia (P<0.05). Logistic regression analysis showed that after adjusting for other confounding factors, MPR (OR=2.962, 95%CI: 1.674~5.242) and LAR (OR=13.045, 95%CI: 3.899~43.649) were still independent risk factors for poor prognosis in patients with severe pneumonia (P<0.05). ROC curves showed that MPR and LAR had clinical significance in predicting the prognosis of patients with severe pneumonia, and the AUC of combined prediction was higher than that of single indicator prediction (P<0.05). Decision curve analysis results showed that MPR combined with LAR prediction could obtain maximum clinical benefit when the threshold probability was 0.30~0.65.

Conclusion

MPR and LAR are closely related to the condition and prognosis of patients with severe pneumonia, and their combined detection has higher efficacy in predicting poor prognosis of patients.

Key words: Severe pneumonia, Mean platelet volume/platelet count ratio, Lactate/albumin ratio, Prognosis
表1 重症肺炎不同预后患者MPR、LAR水平及临床资料比较[n，(±s)]
临床资料 生存者(n＝88) 死亡者(n＝31) χ2/t值 P值
吸烟史(例) 35 15 0.698 0.403
病原体分布(例)     0.351 0.476
革兰阴性菌 41 13    
革兰阳性菌 15 2    
支原体 8 4    
病毒感染 16 7    
混合感染 8 5    
COPD(例)16   8 0.828 0.363
哮喘(例) 4 3 0.361 0.548
高血压(例) 34 16 1.585 0.208
冠心病(例) 5 3 0.120 0.729
糖尿病(例) 8 4 0.067 0.795
心率(次/min) 98.75±11.38 101.52±10.52 1.188 0.237
呼吸频率(次/min) 24.78±5.38 25.05±6.25 0.230 0.818
平均动脉压(mmHg) 91.64±15.78 88.45±16.38 0.958 0.340
PaO2(mmHg) 89.38±17.64 86.54±18.52 0.761 0.448
PaCO2(mmHg) 45.68±9.87 48.25±11.24 1.202 0.232
pH 7.35±0.09 7.38±0.11 1.504 0.135
SaO2(%) 92.52±7.15 89.58±9.25 1.818 0.072
APACHE Ⅱ评分(分) 19.76±4.01 25.59±3.38 7.235 0.000
白细胞计数(×109/L) 12.84±3.89 14.05±4.05 1.474 0.143
淋巴细胞计数(×109/L) 0.92±0.21 0.86±0.15 1.463 0.146
D-二聚体(μg/ml) 3.89±1.06 4.35±1.19 2.012 0.047
C反应蛋白(mg/L) 102.75±26.15 114.56±30.12 2.077 0.040
降钙素原(ng/ml) 7.23±1.56 8.91±2.64 4.241 0.000
中性粒细胞计数(×109/L) 11.94±3.11 12.78±3.06 1.299 0.197
总胆红素(μmol/L) 13.48±3.89 15.05±4.15 1.899 0.060
总胆固醇(mmol/L) 3.34±0.61 3.12±0.52 1.791 0.076
血肌酐(μmol/L) 97.57±37.58 102.35±36.54 0.613 0.541
血尿素氮(mmol/L) 9.13±1.48 9.52±1.65 1.224 0.223
血糖(mmol/L) 6.59±1.13 6.78±1.56 0.725 0.470
MPR 4.58±0.90 5.73±1.15 5.675 0.000
LAR 0.05±0.01 0.09±0.03 10.964 0.000
表2 重症肺炎患者预后不良的Logistic回归分析
变量 β SE Z值 OR 95%CI P值
模型1            
MPR 1.158 0.199 5.807 3.184 2.154~4.706 0.000
LAR 2.670 0.441 6.058 14.437 6.087~34.246 0.000
模型2            
MPR 1.086 0.291 3.730 2.962 1.674~5.242 0.000
LAR 2.568 0.616 4.168 13.045 3.899~43.649 0.000
图1 ROC曲线
图2 临床决策曲线
表3 MPR、LAR预测重症肺炎ROC曲线分析
指　标 约登指数 cut-off值 AUC 95%CI 敏感度 特异度 P值
MPR 0.483 5.20 0.787 0.714~0.860 71.43% 76.87% <0.001
LAR 0.548 0.06 0.774 0.716~0.832 87.50% 67.35% <0.001
联合检测 0.599 0.28 0.884 0.837~0.930 80.36% 79.59% <0.001
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