HALP指数对慢性阻塞性肺疾病急性加重合并肺性脑病患者接受机械通气治疗的临床结局预测价值  

Predictive value of HALP index for clinical outcomes of mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary encephalopathy

作　　者：安巧和 郝昱芳 丁帅 常静 An Qiaohe;Hao Yufang;Ding Shuai;Chang Jing(Department of Critical Care Medicine,Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi,Yulin 719000,China;不详)

机构地区：[1]西安交通大学第一附属医院榆林医院重症医学科,719000 [2]西安交通大学第一附属医院榆林医院呼吸与危重症医学科,719000

出　　处：《疑难病杂志》2025年第1期41-45,51,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省卫生健康科研项目(2020D0022)。

摘　　要：目的探讨血红蛋白、白蛋白、淋巴细胞和血小板指数(HALP)预测慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者机械通气治疗临床结局的价值。方法回顾性选取2020年1月—2022年12月西安交通大学第一附属医院榆林医院重症医学科收治AECOPD合并肺性脑病患者102例为观察组,未合并肺性脑病的AECOPD患者69例为对照组。观察组患者均接受机械通气治疗,治疗前检测血红蛋白、白蛋白、淋巴细胞计数和血小板计数,计算HALP指数,根据治疗结果分为成功亚组(30例)和失败亚组(72例);多因素Logistic回归分析AECOPD合并肺性脑病患者无创正压通气(NPPV)治疗失败的因素;受试者工作特征(ROC)曲线分析HALP指数预测AECOPD合并肺性脑病患者NPPV治疗失败的价值。结果观察组HALP指数低于对照组(t/P=6.286/<0.001)。失败亚组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分高于成功亚组(t/P=3.834/<0.001),基线格拉斯哥昏迷量表(GCS)评分、HALP指数低于成功亚组(t/P=10.765/<0.001、11.152/<0.001);HALP指数与APACHEⅡ评分呈负相关(r=-0.415,P<0.001),与GCS评分呈正相关(r=0.368,P=0.009)。基线GCS评分偏低、HALP指数偏低是AECOPD合并肺性脑病患者NPPV治疗失败的危险因素[OR(95%CI)=2.782(1.138~6.799)、2.130(1.126~4.027)]。HALP指数预测AECOPD合并肺性脑病患者NPPV治疗失败的曲线下面积为0.811(95%CI 0.722~0.882),临界值为32.19,敏感度为0.867,特异度为0.792,约登指数为0.658。结论AECOPD合并肺性脑病患者NPPV治疗失败与HALP指数降低有关,HALP指数可预测NPPV治疗失败的风险。Objective To investigate the value of hemoglobin,albumin,lymphocyte and platelet(HALP)index in predicting the clinical outcome of mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary encephalopathy.Methods A total of 102 patients with AECOPD combined with pulmonary encephalopathy were selected as the observation group and 69 patients with AECOPD without pulmonary encephalopathy were selected as the control group from January 2020 to December 2022 in the Department of Serious Medicine,Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University.All patients in the observation group received mechanical ventilation.Hemoglobin,albumin,lymphocyte count and platelet count were measured before treatment,and HALP index was calculated.According to the treatment results,patients were divided into successful subgroup(30 cases)and failed subgroup(72 cases).Multivariate Logistic regression analysis of NPPV treatment failure in patients with AECOPD and pulmonary encephalopathy.The value of receiver operating characteristic(ROC)curve analysis of HALP index in predicting NPPV treatment failure in patients with AECOPD and pulmonary encephalopathy.Results HALP index of observation group was lower than that of control group(t/P=6.286/<0.001).The scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)in failure subgroup were higher than those in success subgroup(t/P=3.834/<0.001).Baseline Glasgow Coma Scale(GCS)scores and HALP index were lower than those of successful subgroups(t/P=10.765/<0.001,11.152/<0.001).HALP index was negatively correlated with APACHEⅡscore(r=-0.415,P<0.001),and positively correlated with GCS score(r=0.368,P=0.009).Low baseline GCS score and HALP index were risk factors for NPPV treatment failure in patients with AECOPD and pulmonary encephalopathy[OR(95%CI)=2.782(1.138-6.799),2.130(1.126-4.027)].HALP index predicted NPPV failure in AECOPD patients with pulmonary encephalopathy with an area under the

关 键 词：慢性阻塞性肺疾病急性加重 肺性脑病 血红蛋白、白蛋白、淋巴细胞和血小板指数 机械通气 临床结局 

分 类 号：R563.3[医药卫生—呼吸系统] R747.9[医药卫生—内科学]