mMRC评分联合血清炎性因子水平对慢性阻塞性肺疾病患者急性加重风险的评估价值  

Value of mMRC score combined with serum inflammatory factor level in evaluating the risk of acute exacerbation in patients with COPD

作　　者：李颖[1] 顾国忠[1] 侯衍修[1] 朱英娟 王培培 LI Ying;GU Guozhong;HOU Yanxiu;ZHU Yingjuan;WANG Peipei(Ward of Department of Respiratory and Critical Care Medicine,Daqing Oil Field General Hospital,Daqing,Heilongjiang 163000,China)

机构地区：[1]大庆油田总医院呼吸与危重症医学科45病区,黑龙江大庆163000

出　　处：《临床肺科杂志》2024年第9期1360-1367,共8页Journal of Clinical Pulmonary Medicine

摘　　要：目的 探讨mMRC评分结合炎性因子对于慢阻肺急性加重风险的诊断效能。方法 选取我院2022年7月至2023年5月收治的慢阻肺患者112例,其中急性加重期60例,稳定期52例,并选择我院同期参加体检志愿者60例为对照组,采用单因素及多因素Logistic回归分析影响因素,并分析mMRC评分联合炎性因子对慢阻肺急性加重期的评估价值,并构建预测模型及进行模型效能评价。结果 三组患者在吸烟史、白细胞计数、中性粒细胞/淋巴细胞比值、降钙素原、纤维蛋白原方面差异显著(P<0.05)。急性加重期、稳定期IL-2、IL-6、TNF-α、mMRC评分较对照组显著增加,IL-10显著降低;急性加重期IL-2、IL-6、TNF-α、mMRC评分较稳定期升高更加显著,IL-10降低更加显著(P<0.05)。急性加重期、稳定期FEV_(1)、FEV_(1)/FVC及FEV_(1)%pred较对照组明显降低,且急性加重期较稳定期明显降低(P<0.05)。相关性显示IL-2、IL-6、TNF-α与急性加重呈明显正相关,与IL-10呈明显负相关;多因素Logistic回归分析显示纤维蛋白原、降钙素原、NLR、mMRC评分、IL-2、IL-6及TNF-α是急性加重的独立危险因素,IL-10是保护因素(P<0.05);基于此构建了列线图预测模型,且该模型预测效能较好。结论 mMRC评分联合血清炎性因子能提高慢阻肺急性加重的诊断价值。Objective To explore the diagnostic efficacy of mMRC score combined with inflammatory factors in the diagnosis of acute exacerbation risk in patients with chronic obstructive pulmonary disease(COPD).Methods 112 COPD patients admitted to our hospital from July 2022 to May 2023 were selected,including 60 at acute exacerbation phase and 52 at stable phase.Additionally,60 volunteers who participated in physical examinations at our hospital during the same period were selected as the control group.It used univariate and multivariate logistic regression to analyze the influencing factors,and the evaluation value of mMRC score combined with inflammatory factors in the acute exacerbation of COPD,and then it constructed a predictive model and conducting model efficacy evaluation.Results There were significant differences in smoking history,white blood cell count,neutrophil/lymphocyte ratio,procalcitonin,and fibrinogen among the three groups(P<0.05).IL-2,IL-6,TNF-αand mMRC score increased,and IL-10 decreased more pronounced in the acute exacerbation group and the stable group than in the control group,and they were more obvious in the acute exacerbation group than in the stable group(P<0.05).The value of FEV_(1),FEV_(1)/FVC,and FEV_(1)%pred decreased more obviously in the acute exacerbation and stable group than in the control group,and it was more pronounced in the acute exacerbation group(P<0.05).Correlation analysis showed that IL-2,IL-6,TNF-αwere positively correlated with acute exacerbation and negatively correlated with IL-10.Multivariate logistic regression analysis showed that fibrinogen,procalcitonin,NLR,mMRC score,IL-2,IL-6,and TNF-αIL-10 were independent risk factors for acute exacerbation,while IL-10 was a protective factor(P<0.05).A column chart prediction model was constructed based on this,and the model had good predictive performance.Conclusion The combination of mMRC score and serum inflammatory factors can improve the diagnostic value of acute exacerbation of COPD.

关 键 词：mMRC评分 炎性因子 慢性阻塞性肺疾病 评价 

分 类 号：R563.9[医药卫生—呼吸系统]