中性粒细胞与淋巴细胞比值在慢性阻塞性肺疾病急性加重期中的价值  

The value of neutrophil to lymphocyte ratio in acute exacerbations of chronic obstructive pulmonary disease

作　　者：肖华叶 梁斌苗[1] 欧雪梅[1] XIAO Huaye;LIANG Binmiao;OU Xuemei(Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Respiratory Medicine,Fushun People's Hospital,Zigong,Sichuan 643200,P.R.China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,四川成都610041 [2]自贡市富顺县人民医院呼吸内科,四川自贡643200

出　　处：《中国呼吸与危重监护杂志》2021年第2期85-90,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金(31671189);四川省科技厅重点研发项目(2018SZ0109、2019YFS0033)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)在慢性阻塞性肺疾病(简称慢阻肺)急性加重中的价值。方法按纳入标准共收集了610例慢阻肺急性加重病例,整理患者的基本情况、辅助检查资料、治疗与预后等基本信息,分析患者NLR水平对患者病情、治疗方案的选择及患者预后等方面的影响。结果入院时合并肺炎的患者NLR水平更高(P<0.05),且肺部炎症程度越重,NLR水平越高(P<0.05);入院时合并心力衰竭的患者NLR水平更高(P<0.05);住院期间使用呼吸机通气及静脉糖皮质激素治疗的患者的NLR水平高于未使用组(P<0.05);住院时间≥14 d的患者,其NLR水平较住院时间<14 d的患者高(P<0.05);住院期间死亡患者的NLR水平比存活组高(P<0.05),且随着NLR值的增高,住院病死率呈逐步增加趋势。相较于C反应蛋白及白细胞介素-6,NLR在二元回归分析中具有较高的预测死亡优势比。预测住院死亡的受试者工作特征曲线分析得出NLR曲线下面积为0.727(比值比4.112,95%可信区间0.609-0.849,P=0.002),截点值为5.92,敏感性为88%,特异性为51%。结论 NLR可作为评估慢阻肺急性加重病情严重度及预测预后的炎症标志物。Objective To investigate the value of neutrophil/lymphocyte ratio(NLR) in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers. Methods Retrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed. Results The level of NLR was higher in the group with pneumonia than that in the non-pneumonia group(P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level(P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid(P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days(P<0.05). The NLR value of the death group was higher than that of the survival group(P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727(OR=4.112, 95% confidence interval 0.609-0.849, P=0.02). Conclusions NLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.

关 键 词：中性粒细胞与淋巴细胞比值 慢性阻塞性肺疾病急性加重 炎症指标 病情 结局 

分 类 号：R563.9[医药卫生—呼吸系统]