FAR、NLR、PLR及其联合应用对慢性阻塞性肺疾病急性加重的预测价值  

Relationship between FAR,NLR,PLR and acute exacerbation of chronic obstructive pulmonary disease and their predictive value

作　　者：马晶晶 孙波 郭翔 王欣宇 张庆[1] 庞桂芬[1] 杨林瀛[1] Ma Jing-Jing;Sun Bo;Guo Xiang;Wang Xin-Yu;Zhang Qing;Pang Gui-Fen;Yang Lin-Ying(Department of Respiratory and Critical Care Medicine,Chengde Medical College Affiliated Hospital,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院呼吸与危重症医学科,河北承德067000

出　　处：《解放军医学杂志》2022年第6期599-606,共8页Medical Journal of Chinese People's Liberation Army

基　　金：中华医学会临床医学慢性呼吸道疾病科研专项基金(01070260034)。

摘　　要：目的探讨纤维蛋白原(FIB)/白蛋白(ALB)比值(FAR)、中性粒细胞(NEU)/淋巴细胞(LYM)比值(NLR)、血小板(PLT)/淋巴细胞(LYM)比值(PLR)对慢性阻塞性肺疾病(COPD)急性加重的预测价值。方法选择2019年9月-2021年7月在承德医学院附属医院呼吸与危重症医学科住院的COPD急性加重期(AECOPD)患者作为AECOPD组(n=96),在门诊复诊近3个月来无急性加重的稳定期COPD(SCOPD)患者作为SCOPD组(n=103),随机选择同期在该院体检的健康人员作为对照组(n=80)。依据病情严重程度将AECOPD患者分为Ⅰ级(n=20)、Ⅱ级(n=33)与Ⅲ级(n=43)。记录各组一般资料、临床资料,检测各组血清C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、NEU、LYM、PLT、FIB、ALB水平,AECOPD患者检测动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2)),计算FAR、NLR、PLR、氧合指数(PaO_(2)/FiO_(2))。比较各组上述指标的差异,并进行相关性分析。采用多因素logistic回归分析COPD急性加重的影响因素,应用受试者工作特征(ROC)曲线分析各指标预测COPD急性加重的效能。结果对照组、SCOPD组、AECOPD组CRP、PCT、WBC、NEU水平及NLR、PLR、FAR逐渐升高(P<0.05);随着AECOPD严重程度的增加,患者好转时间延长,CRP、PCT、WBC、NEU水平以及NLR、PLR、FAR、PaCO_(2)逐渐升高,PaO_(2)/FiO_(2)逐渐降低(P<0.05)。Pearson或Spearman相关分析显示,FAR、NLR、PLR与AECOPD严重程度、好转时间、CRP、PCT、WBC及PaCO_(2)均呈正相关,与PaO_(2)/FiO_(2)呈负相关(P<0.01)。多因素logistic回归分析显示,FAR、NLR、PLR是COPD急性加重的独立危险因素(P<0.05)。ROC曲线分析显示,FAR、NLR、PLR单项及联合应用预测COPD急性加重的ROC曲线下面积(AUC)均大于0.7,敏感度分别为0.990、0.698、0.563、0.958,特异度分别为0.641、0.883、0.932、0.961。结论FAR、NLR、PLR与AECOPD炎症水平、严重程度和呼吸功能具有一定的相关性,三者联合应用对COPD急性加重有�Objective To explore the predictive value of fibrinogen(FIB)/albumin(ALB)ratio(FAR),neutrophil(NEU)/lymphocyte(LYM)ratio(NLR)and platelet(PLT)/lymphocyte(LYM)ratio(PLR)to acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods Acute exacerbation COPD(AECOPD)patients hospitalized in the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Chengde Medical College from September 2019 to July 2021 were selected as AECOPD group(n=96),and patients with stable chronic obstructive pulmonary disease(SCOPD)and without acute exacerbation in the outpatient clinic for nearly three months in the same period were selected as SCOPD group(n=103),and healthy people who had physical examination in the same period were randomly selected as control group(n=80).According to the severity classification,AECOPD patients were divided into gradeⅠ(n=20),gradeⅡ(n=33)and gradeⅢ(n=43).The general data and clinical data of each group were recorded,and the serum C-reactive protein(CRP),procalcitonin(PCT),white blood cells(WBC),NEU,LYM,PLT,FIB,ALB were detected.In AECOPD patients,carbon dioxide partial pressure(PaCO_(2))and arterial oxygen partial pressure(PaO_(2))were also detected,the FAR,NLR,PLR and oxygenation index(PaO_(2)/FiO_(2))were calculated.The differences of the above indicators in each group were compared,and their correlation was analyzed.The risk factors of AECOPD were analyzed by multivariate logistic regression,and the receiver operating characteristics(ROC)curves were developed to analyze the significance of each indicator in the prediction of AECOPD.Results The levels of CRP,PCT,WBC,NEU,NLR,PLR and FAR decreased gradually(P<0.05)in control group,SCOPD group and AECOPD group;with the increase of AECOPD severity,the improvement time of patients,the levels of CRP,PCT,WBC,NEU as ell as NLR,PLR,FAR and PaCO_(2)increased gradually,and PaO_(2)/FiO_(2)decreased gradually(P<0.05).Pearson or Spearman correlation analysis showed that FAR,NLR and PLR were positively correlated with the severit

关 键 词：慢性阻塞性肺疾病 急性加重 纤维蛋白原/白蛋白比值 中性粒细胞/淋巴细胞比值 血小板/淋巴细胞比值 

分 类 号：R563.9[医药卫生—呼吸系统]