老年慢性阻塞性肺部疾病急性加重期患者住院死亡的危险因素及预后  

Risk factors and prognosis of the in-hospital death of aged patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：孙爱华 赵艳秋 王继灵[2] SUN Ai-hua;ZHAO Yan-qiu;WANG Ji-ling(Department of Geriatrics,the Second People’s Hospital of Hefei/Hefei Hospital Affiliated to Anhui Medical University,Hefei 230011,China;Department of Respiratory Medicine,the Second People’s Hospital of Hefei/Hefei Hospital Affiliated to Anhui Medical University,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院/安徽医科大学附属合肥医院老年医学科,安徽合肥230011 [2]合肥市第二人民医院/安徽医科大学附属合肥医院呼吸内科,安徽合肥230011

出　　处：《基础医学与临床》2022年第9期1414-1418,共5页Basic and Clinical Medicine

基　　金：2018年合肥市卫生计生应用医学研究项目(hwk2018yb005)。

摘　　要：目的评估住院的慢性阻塞性肺疾病急性加重期(AECOPD)老年患者中外周血中性粒细胞计数和淋巴细胞计数比值(NLR)、C反应蛋白和血清白蛋白比值(CRP/ALB)的临床意义和应用价值。方法收集2016年1月至2020年1月在合肥市第二人民医院老年医学科和呼吸内科住院的172例老年AECOPD患者。根据临床转归分为存活组(n=155)和死亡组(n=17),存活组按住院日分为≥10 d和<10 d分组。比较各组患者的临床和实验室检查指标的差异性,采用Logistic回归和受试者工作特征曲线(ROC)分析危险因素及其与住院死亡率的关系。结果172例老年AECOPD住院患者中17例患者住院期间死亡,死亡率9.88%。死亡组和存活组在NLR、CRP、CRP/ALB、红细胞分布宽度(RDW)、吸烟、社区获得性肺炎(CAP)和多种合并症均存在差异,死亡组高于存活组(P<0.01)。同时存活出院的155例老年AECOPD按照住院日≥10 d和<10 d分成两组,发现NLR、CRP、CRP/ALB、RDW、吸烟和CAP也在两组间也存在差异,住院日≥10 d组高于住院日<10 d组(P<0.01)。将NLR、CRP、CRP/ALB、RDW等进行二元和多元Logistic回归分析发现NLR和CRP/ALB可能是住院死亡的独立危险因素。使用ROC曲线进行分析,NLR的截断值为11.04,曲线下面积为77%,CRP/ALB的截断值为1.12,曲线下面积为65%。结论NLR、CRP/ALB可能是老年AECOPD患者住院死亡的危险因素,并与不良预后相关。Objective To evaluate clinical significance and application outcomes of using the neutrophil-to-lymphocyte count ratio(NLR)and C-reactive protein to albumin ratio(CRP/ALB)in the aged patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 172 aged patients with AECOPD who were hospitalized in the Department of Geriatrics and Department of Respiratory Medicine of the Second People s Hospital of Hefei from January 2016 to January 2020 were recruited.According to clinical outcomes,they were divided into survival group(n=155)and death group(n=17).Survival group was divided into groups according to hospitalization days of more or less than ten days.Parameters were got through contrast of clinical and laboratory test indexes of patients in each group.Logistic regression and receiver operating characteristic curve(ROC)were used to analyze the risk factors and their correlation with in-hospital mortality.Results Among 172 aged AECOPD in-patients,17 patients died during hospitalization with mortality as 9.88%.There were differences between the death group and the survival group in NLR,CRP,CRP/ALB,red blood cell distribution width(RDW),cigarette consumption,community acquired pneumonia(CAP)and various comorbidities.Parameters above mentioned in the death group was higher than the survival group(P<0.01).At the same time,155 aged patients with AECOPD who survived and discharged were divided into two subgroups according to the hospitalization≥10 days and<10 days.It was found that NLR,CRP,CRP/ALB,RDW,smoking and CAP in group with hospitalization longer than ten days were significantly more common than those in group of less than ten days hospitalization(P<0.01).The Logistic regression analysis of NLR,CRP,CRP/ALB and RDW showed that NLR and CRP/ALB might be independent risk factors for in-hospital death.From the analysis of the ROC,the cut-off value of NLR was 11.04,the area under the curve was 77%,and the cut-off value of CRP/ALB was 1.12,and the area under the curve was 65%.Con

关 键 词：慢性阻塞性肺部疾病急性加重期(AECOPD) 中性粒细胞计数和淋巴细胞计数比值 C反应蛋白 死亡率 预后 

分 类 号：R563.3[医药卫生—呼吸系统]