检测血清PCT、CRP、IL-6联合NLR、PLR对AECOPD患者病情严重程度评估及预后转归的临床价值  

Clinical value of serum PCT,CRP,IL-6 combined with NLR and PLR in the assessment of disease severity and prognosis in patients with AECOPD

作　　者：赖育庭 申严[1] 叶春幸[1] 刘小灵 陈思达[1] LAI Yuting;SHEN Yan;YE Chunxing;LIU Xiaoling;CHEN Sida(Respiratory and Critical Care Medicine of Shenzhen Longgang Central Hospital,Shenzhen,Guangdong 518100,China)

机构地区：[1]深圳市龙岗中心医院呼吸与危重症医学科,广东深圳518100

出　　处：《热带医学杂志》2023年第4期558-562,共5页Journal of Tropical Medicine

基　　金：深圳市龙岗区医疗卫生科技计划项目[LGWJ2021-(13)]。

摘　　要：目的探讨检测降钙素原(PCT)、C反应蛋白(CRP)、白介素-6(IL-6)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)在慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者的临床意义。方法选择2021年5月-2022年5月于深圳市龙岗中心医院就诊的80例AECOPD患者为AECOPD组,根据肺功能分级标准分为A组24例(GOLDⅠ级)、B组19例(GOLDⅡ级)、C组20例(GOLDⅢ级)、D组17例(GOLDⅣ级),根据随访6个月内患者预后情况分为预后良好组(n=58)和预后不良组(n=22);同期纳入80例COPD稳定期(SCOPD)患者作为SCOPD组及80名健康体检者作为对照组。检测及计算NLR、PLR、PCT、CRP、IL-6水平、一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)。结果对照组、SCOPD组、AECOPD组FEV1、FEV1/FVC依次降低,PCT、CRP、IL-6、NLR、PLR依次升高(F=415.603、344.576、700.091、1478.186、561.854、332.932、125.060,P均<0.05)。A组、B组、C组、D组FEV1、FEV1/FVC依次降低,PCT、CRP、IL-6、NLR、PLR依次升高,差异均有统计学意义(F=507.337、173.601、77.258、107.825、101.222、68.812、22.540,P均<0.05)。预后不良组FEV1、FEV1/FVC明显低于预后良好组,PCT、CRP、IL-6、NLR、PLR明显高于预后良好组,差异均有统计学意义(t=24.140、25.708、3.565、5.787、8.385、6.262、5.763,P均<0.05)。预后不良组AECOPD患者PCT、CRP、IL-6、NLR、PLR与FEV1、FEV1/FVC均成负相关(P均<0.05)。PCT、CRP、IL-6、NLR、PLR水平及联合预测AECOPD患者预后不良的曲线下面积(AUC)分别为0.737、0.781、0.752、0.825、0.771、0.966。结论血清PCT、CRP、IL-6联合NLR、PLR可作为AECOPD患者疾病严重程度及预后的评估指标。Objective To investigate the levels of procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),neutrophil to lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)(AECOPD)and their clinical significance.Methods A total of 80AECOPD patients from the Shenzhen Longgang Central Hospital were selected as the AECOPD group.According to the lung function grading criteria,they were grouped into group A(GOLD grade I,n=24),group B(GOLD gradeⅡ,n=19),group C(GOLD gradeⅢ,n=20),and group D(GOLD gradeⅣ,n=17).According to the prognosis of the patients within6 months of follow-up,they were divided into a good prognosis group of 58 cases and a poor prognosis group of 22 cases;during the same period,80 SCOPD patients were included as the SCOPD group and 80 healthy subjects were included as the control group.The NLR,PLR,levels of PCT,CRP and IL-6,forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FVC)were detected or calculated.Results Levels of FEV1 and FEV1/FVC in the control group,SCOPD group,and AECOPD group decreased sequentially,while PCT,CRP,IL-6,NLR,and PLR levels increased sequentially(F=415.603,344.576,700.091,1478.186,561.854,332.932,125.060,all P<0.05).FEV1,FEV1/FVC levels in groups A,B,C,and D decreased sequentially,while PCT,CRP,IL-6,NLR,and PLR levels increased sequentially(F=507.337,173.601,77.258,107.825,101.222,68.812,22.540,all P<0.05).FEV1 and FEV1/FVC levels in the poor prognosis group were significantly lower than those in the good prognosis group,and PCT,CRP,IL-6,NLR,and PLR levels were significantly higher than those in the good prognosis group(t=24.140,25.708,3.565,5.787,8.385,6.262,5.763,all P<0.05).PCT,CRP,IL-6,NLR and PLR levels were all negatively correlated with FEV1,FEV1/FVC levels in AECOPD patients with poor prognosis group(all P<0.05).The areas under the curve(AUC)of PCT,CRP,IL-6,NLR,PLR levels and their joint prediction of poor prognosis in AECOPD patients were 0.737,0.781,0.752,0

关 键 词：慢性阻塞性肺疾病急性加重期 降钙素原 C反应蛋白 白介素-6 中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 

分 类 号：R563.1[医药卫生—呼吸系统]