单核细胞计数与高密度脂蛋白比值联合单核细胞/大血小板比率检测对老年慢性阻塞性肺疾病急性加重期肺栓塞危险分层诊断效能  

Diagnostic efficacy of monocyte count to high-density lipoprotein ratio combined with monocyte/large platelet ratio test for risk stratification of pulmonary embolism during acute exacerbation of chronic obstructive pulmonary disease in elderly

作　　者：高栋材 杨慧俐 郎伟宇 刘亮 GAO Dongcai;YANG Huili;LANG Weiyu;LIU Liang(Department of Respiratory and Critical Care Medicine,Changzhi People's Hospital,Changzhi,Shanxi 046000,China)

机构地区：[1]长治市人民医院呼吸与危重症医学科,山西长治046000

出　　处：《安徽医药》2024年第3期608-613,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨单核细胞计数与高密度脂蛋白比值(MHR)联合单核细胞/大血小板比率(MLPR)检测对老年慢性阻塞性肺疾病急性加重期(AECOPD)肺栓塞危险分层诊断效能。方法 回顾2018年5月至2022年5月长治市人民医院收治的233例老年AECOPD并发肺栓塞病人的临床资料,比较不同危险分层病人MHR、MLPR水平,并分析MHR、MLPR与危险分层的相关性。采用多元有序logistic回归分析明确MHR、MLPR与AECOPD肺栓塞危险分层的关系,并评估其对危险分层的预测价值。结果高危组病人MHR、MLPR分别为0.74(0.70,0.86)、1.83(1.52,2.10),高于非高危组的0.55(0.39,0.62)、0.80(0.59,1.27)(P<0.05);中高危组和中低危组的MHR分别为0.62(0.57,0.71)、0.39(0.31,0.56),MLPR分别为1.32(0.75,1.61)、0.64(0.55,0.90),高危组MHR、MLPR高于中高危组,中高危组高于中低危组(P<0.05)。Spearman分析显示,MHR、MLPR水平与危险分层均呈正相关(P<0.001)。多元有序logistic结果显示年龄>80岁、白蛋白降低、血肌酐升高、MHR升高、MLPR升高均是老年AECOPD伴肺栓塞中高危和高危分层的独立危险因素(P<0.05)。ROC分析显示,MHR、MLPR对肺栓塞高危与非高危分层诊断AUC及其95%CI为0.92(0.88,0.95)、0.93(0.89,0.96),低于二者联合诊断效能0.97(0.94,0.99)(P<0.05);MHR、MLPR单独对肺栓塞中危病人分层诊断AUC及其95%CI为0.89(0.83,0.93)、0.84(0.78,0.89),低于二者联合诊断效能0.95(0.91,0.98)(P<0.05)。结论MHR、MLPR可作为老年AECOPD肺栓塞病人早期危险分层的可靠参考指标。Objective To investigate the diagnostic efficacy of the monocyte count to high-density lipoprotein ratio(MHR) combined with the monocyte/large platelet ratio(MLPR) assay for the risk stratification of pulmonary embolism in elderly people with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinical data of 233 elderly patients with AECOPD complicated by pulmonary embolism admitted to Changzhi People's Hospital from May 2018 to May 2022 were reviewed.The MHR and MLPR levels of patients in different risk strata were analyzed,and the correlation between MHR and MLPR and risk stratification was analyzed.Multiple ordered logistic regression analysis was used to clarify the relationship between MHR,MLPR and risk stratification of AECOPD pulmonary embolism,and to assess their predictive value for risk stratification.Results MHR and MLPR in high-risk group were 0.74(0.70,0.86) and 1.83(1.52,2.10),respectively,which were higher than those in non-high-risk group [0.55(0.39,0.62)and 0.80(0.59,1.27)](P<0.05).The MHR of the medium-high risk and low-risk groups were 0.62(0.57,0.71) and 0.39(0.31,0.56),respectively,and the MLPR were 1.32(0.75,1.61) and 0.64(0.55,0.90),MHR and MLPR were higher in the high-risk group than in the medium-high-risk group,and in the medium-high risk group than in the medium-low risk group(P<0.05).Spearman analysis showed that MHR and MLPR levels were all positively correlated with risk stratification(P<0.001).Multivariate ordered logistic results showed that age >80 years,decreased albumin,elevated blood creatinine,elevated MHR,and elevated MLPR were all independent risk factors for high risk and high risk stratification in elderly AECOPD with pulmonary embolism(P<0.05).ROC analysis showed that the diagnostic AUC 95%CI of MHR and MLPR for high-risk and non-high-risk stratification of pulmonary embolism was 0.92(0.88,0.95) and 0.93(0.89,0.96),which was lower than the diagnostic efficacy of 0.97(0.94,0.99) for the combination of the two(P<0.05).The stratified diagnostic

关 键 词：肺疾病 慢性阻塞性 肺栓塞 危险分层 单核细胞计数与高密度脂蛋白比值 单核细胞/大血小板比率 

分 类 号：R563.9[医药卫生—呼吸系统] R563.5[医药卫生—内科学]