外周血RDW、NLR、FAR、SP-A检测对慢性阻塞性肺疾病患者病情及急性加重风险的评估价值  

Values of peripheral blood RDW,NLR,FAR and SP⁃A in evaluating patient condition and risks of acute exacerbation of COPD

作　　者：刘丽君[1] 李翔云 杨娅娟 LIU Lijun;LI Xiangyun;YANG Yajuan(Department of Respiratory and Critical Care Medicine,Hebei University Affiliated Hospital,Baoding 071000,Hebei,China;不详)

机构地区：[1]河北大学附属医院呼吸与危重症医学科,河北保定071000 [2]保定市第二医院感染性疾病科,河北保定071000

出　　处：《实用医学杂志》2024年第22期3244-3250,共7页The Journal of Practical Medicine

基　　金：保定市科技计划项目(编号:2241ZF183)。

摘　　要：目的分析外周血红细胞分布宽度(RDW)、中性粒细胞(NEU)和淋巴细胞(LYM)比值(NLR)、纤维蛋白原(FIB)与白蛋白(ALB)比值(FAR)、肺表面活性蛋白A(SP-A)检测对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者病情及急性加重风险的评估价值。方法选取2021年1月至2023年12月河北大学附属医院收治的200例COPD患者为研究对象,均在近3个月内于该院门诊复诊,依据有无急性加重分为加重组(n=96)、未加重组(n=104),另选择同期体检的健康志愿者50例作为对照组,对比三组外周血RDW、NEU、LY、FIB、ALB、SP-A,并计算NLR、FAR,分析RDW、NLR、FAR、SP-A随AECOPD病情的变化及相关性,绘制ROC曲线分析RDW、NLR、FAR、SP-A评估COPD急性加重风险的价值,多因素logistic回归法分析AECOPD的危险因素,同时比较不同预后者的RDW、NLR、FAR、SP-A差异。结果加重组外周血RDW、NEU、NLR、FIB、FAR、SP-A高于未加重组,而LYM、ALB低于未加重组(P<0.05);AECOPDⅢ级患者RDW、NLR、FAR、SP-A较Ⅱ级、Ⅰ级者更高,Ⅱ级患者RDW、NLR、FAR、SP-A高于Ⅰ级患者(P<0.05);AECOPD患者RDW、NLR、FAR、SP-A、病情分级两两呈正相关(P<0.05);RDW、NLR、FAR、SP-A联合预测AECOPD的敏感度、ROC曲线下面积分别为0.798、0.830(95%CI:0.738~0.922),均优于各指标单独诊断;多因素分析发现,吸烟、RDW>14.33%、NLR>2.80、FAR>0.08、SP-A>2.21 ng/mL为COPD患者病情急性加重的危险因素(P<0.05);出院后30 d内再入院组RDW、NLR、FAR、SP-A高于未再入院组(P<0.05)。结论RDW、NLR、FAR、SP-A与COPD病情有密切关系,可预测患者急性加重风险及预后,临床可加以监测。Objective To analyze the values of peripheral blood red blood cell distribution width(RDW),neutrophil(NEU)to lymphocyte(LYM)ratio(NLR),fibrinogen(FIB)to albumin(ALB)ratio(FAR)and surfactant protein A(SP-A)in evaluating patient condition and risks of acute exacerbation of COPD.Methods A total of 200 patients with COPD admitted to Hebei University Affiliated Hospital from January 2021 to December 2023 were selected as study subjects.All the patients had follow-up visits in the outpatient department within the past three months.According to the presence or absence of acute exacerbation,they were divided into exacerbation group(n=96)and non-exacerbation group(n=104).Meanwhile,50 healthy volunteers were assigned to a control group.Peripheral blood RDW,NEU,LY,FIB,ALB and SP-A in the three groups were compared.NLR and FAR were cal-culated.The correlation of RDW,NLR,FAR,and SP-A with the severity of AECOPD was analyzed.ROC curves were used to analyze the values of RDW,NLR,FAR,and SP-A in evaluating the risks of acute exacerbation of COPD.Multivariate logistic regression analysis was conducted to identify the risk factors for AECOPD.The differences in RDW,NLR,FAR,and SP-A were compared among the patients with different prognoses.Results Peripheral blood RDW,NEU,NLR,FIB,FAR and SP-A were higher in the exacerbation group than in the non-exacerbation group,whereas LYM and ALB were lower(P<0.05).Levels of RDW,NLR,FAR and SP-A were higher in the patients with gradeⅢAECOPD than those with gradeⅡor gradeⅠAECOPD(P<0.05).RDW,NLR,FAR,SP-A,and grade of patient condition in patients with AECOPD were positively correlated in pairs(P<0.05).The sensitivity,specificity and area under the ROC curve of combined prediction of AECOPD using RDW,NLR,FAR and SP-A were 0.798 and 0.830(95%CI:0.738~0.922),all of which were superior to prediction using a single indicator.Multivariate analysis found that smoking,RDW>14.33%,NLR>2.80,FAR>0.08,and SP-A>2.21 ng/mL were risk factors for acute exacerbation of COPD(P<0.05).RDW,NLR,FAR,and SP-A in the

关 键 词：红细胞分布宽度 中性粒细胞/淋巴细胞比值 纤维蛋白原/白蛋白比值 肺表面活性蛋白A 慢性阻塞性肺疾病 病情 急性加重 

分 类 号：R446.112[医药卫生—诊断学]