NLR、IL-17、SAA与AECOPD患者序贯机械通气治疗结局的关系及预测价值  

The relationship and predictive value of NLR,IL-17,SAA and the outcome of sequential mechanical ventilation treatment in patients with acute exacerbation of COPD

作　　者：付轩 包金英 宋鹏飞 赵新成 FU Xuan;BAO Jinying;SONG Pengfei;ZHAO Xincheng(Department of Respiratory and Critical Care Medicine,Lianyungang Municipal Oriental Hospital,Lianyungang Jiangsu 222042,China)

机构地区：[1]连云港市立东方医院呼吸与危重症医学科,江苏连云港222042 [2]连云港市第一人民医院呼吸与危重症医学科,江苏连云港222042

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期229-233,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省优势学科建设工程项目(编号:TRMK1815-087)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)、白细胞介素-17(IL-17)、淀粉样蛋白A(SAA)与慢性阻塞性肺疾病急性加重期(AECOPD)患者序贯机械通气治疗结局的关系及预测价值。方法选取2019年3月—2023年4月连云港市东方医院及连云港市第一人民医院收治的AECOPD患者137例为研究对象,均行序贯机械通气治疗,根据治疗结局分为治疗成功组(n=102)、治疗失败组(n=35)。比较两组临床资料及治疗前、撤机时NLR、IL-17、SAA水平,分析NLR、IL-17、SAA与急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、COPD生活质量评估测试(CAT)及治疗结局的关系,并分析其预测价值。结果治疗失败组年龄、吸烟史比例高于治疗成功组,病程长于治疗成功组[(68.34±3.39)岁vs.(62.15±3.08)岁,68.57%vs.31.37%,(5.17±1.23)年vs.(3.43±1.10)年],差异有统计学意义(P<0.05);两组撤机时APACHEⅡ、CAT评分及NLR、IL-17、SAA水平较治疗前下降,且治疗失败组高于治疗成功组[(16.44±2.59)分vs.(13.52±2.16)分,(18.95±3.14)分vs.(16.43±2.37)分,(3.28±0.83)vs.(2.64±0.57),(38.10±8.11)ng/L vs.(32.47±6.23)ng/L,(85.37±25.19)mg/L vs.(62.55±18.75)mg/L],差异有统计学意义(P<0.05);撤机时NLR、IL-17、SAA水平与APACHEⅡ、CAT评分均呈正相关,差异有统计学意义(P<0.05);撤机时NLR、IL-17、SAA均与AECOPD患者序贯机械通气治疗结局独立相关,且联合预测AECOPD治疗结局的曲线下面积(AUC)为0.927(95%CI:0.870~0.965),敏感度为88.57%,特异度为83.33%,优于三者单独预测。结论NLR、IL-17、SAA水平与AECOPD患者病情均呈正相关,各指标均与序贯机械通气治疗结局独立相关,联合检测对治疗结局具有一定预测价值,可作为临床评估病情、预测序贯通气治疗结局的辅助指标。Objective To study the relationship and predictive value ofneutrophiltolymphocyte ratio(NLR),interleukin 17(IL-17),serum amyloid A(SAA)and the outcome of sequential mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 137 cases of AECOPD patients admitted to Lianyungang Dongfang Hospital and the First People's Hospital of Lianyungang from March 2019 to April 2023 were selected as study subjects,all of which were treated with sequential mechanical ventilation and divided into treatment success group(n=102)and treatment failure group(n=35)according to the treatment outcome.The clinical data and the levels of NLR,IL-17,and SAA before treatment and at at weaning were compared between the two groups,and NLR,IL-17,and SAA were analyzed in relation to the aute physiology and chronic health evaluationⅡ(APACHE II),the COPDassessment test(CAT)scores and treatment outcomes,and analyze their predictive value.Results The age and smoking rate of the treatment failure group were higher than those of the treatment success group,and the duration of disease was longer than that of the treatment success group[(68.34±3.39)years vs.(62.15±3.08)years,68.57%vs.31.37%,(5.17±1.23)years vs.(3.43±1.10)years],with statistically significant differences(P<0.05).The APACHE II,CAT scores,NLR,IL-17,and SAA levels at weaning were all lower than those before treatment in both groups,and the treatment failure group was higher than the treatment success group[(16.44±2.59)scores vs.(13.52±2.16)scores,(18.95±3.14)scores vs.(16.43±2.37)scores,(3.28±0.83)vs.(2.64±0.57),(38.10±8.11)ng/L vs.(32.47±6.23)ng/L,(85.37±25.19)mg/L vs.(62.55±18.75)mg/L],with statistically significant differences(P<0.05).NLR,IL-17,and SAA levels at weaning were positively correlated with APACHE II and CAT scores,with statistically significant differences(P<0.05).NLR,IL-17,and SAA were all independently associated with the outcome of sequential mechanical ventilation therapy in patients with

关 键 词：中性粒细胞/淋巴细胞比值 白细胞介素-17 淀粉样蛋白A COPD急性加重期 序贯机械通气治疗 预测 

分 类 号：R563[医药卫生—呼吸系统]