重症监护的AECOPD患者嗜酸性粒细胞⁃中性粒细胞比值的临床意义  

Clinical value of eosinophilic to neutrophilic ratio in patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care

作　　者：陈莹玉 刘学妮 吴梅 赵婷婷 刘永飞 Chen Yingyu;Liu Xueni;Wu Mei;Zhao Tingting;Liu Yongfei(Department of Critical Care Medicine,PLA Rocket Army Characteristic Medical Center,Beijing 100088)

机构地区：[1]中国人民解放军火箭军特色医学中心重症医学科,北京100088

出　　处：《中华肺部疾病杂志(电子版)》2025年第1期48-54,共7页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：北京市自然科学基金项目(7182122)。

摘　　要：目的分析慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者嗜酸性粒细胞(eosinophile,EOS)与中性粒细胞(neutrophile,NEU)比值(ENR)与细菌感染及预后的关系。方法选择2020年1月至2024年1月期间入住我院重症监护室(intensive care unit,ICU)的115例AECOPD患者为对象。检测患者入院时的EOS和NEU百分比,计算ENR。入院后24 h内行实验室检测、培养检测和PCR检测病原体感染状况。主要结局是患者住院期间预后,根据住院期间预后分为生存者94例为对照组,死亡者21例为观察组。结果入院时细菌或病毒鉴定结果:细菌感染者30例,病毒感染者36例,细菌⁃病毒混合感染者21例,无感染者28例。仅细菌感染或者细菌⁃病毒混合感染的患者ENR(H=56.407,P<0.001)和EOS计数(H=42.010,P<0.001)低。经ROC曲线分析,ENR对于仅细菌感染/细菌⁃病毒混合感染有鉴定意义,AUC值为0.821(95%CI:0.754~0.888),高于EOS的鉴定意义(AUC=0.779)。ICU患者住院期间死亡21例(18.26%)。观察组入院ENR值0.21%低于对照组1.69%(Z=-5.365,P<0.001)。多变量COX回归分析揭示入院ENR与病死率相关的危险因素之一(HR=0.179,P=0.003)。低ENR患者生存38例(65.52%)低于高ENR患者56例(98.25%);低ENR患者中位生存时间20 d短于高ENR患者22 d(log rankχ^(2)=17.376,P<0.001)。结论低ENR与入住ICU的AECOPD患者细菌感染和住院死亡风险增加有关。ENR可能成为判断AECOPD患者细菌感染状况及住院预后的临床指标。Objective To investigate the relationship between eosinophil(EOS)to neutrophil(NEU)ratio(ENR)and bacterial infection and in⁃hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in intensive care.Methods A total of 115 cases AECOPD patients admitted to the intensive care unit(ICU)between January 2020 and January 2024 were selected as study subjects.The percentage of EOS and NEU at admission was measured by blood cell analyzer,and the ratio ENR was calculated.Within 24 hours after admission,all patients underwent laboratory tests,culture tests and PCR to detect pathogen infection status.The primary outcome was survival during hospitalization,and patients were divided into death and survival according to the prognosis.Results According to the results of bacterial or viral identification at admission,all the patients were divided into four groups:30 cases of bacterial infection only,36 cases of viral infection only,21 cases of mixed bacteria⁃virus infection,and 28 cases of no infection.The ENR(H=56.407,P<0.001)and EOS counts(H=42.010,P<0.001)were significantly lower in patients with bacterial infection alone or with a combination of bacterial and viral infections.According to ROC curve analysis,ENR had higher identification value for bacterial infection only/bacteria⁃virus mixed infection,with an AUC value of 0.821(95%CI:0.754~0.888),which was higher than that of EOS(AUC=0.779).The in⁃hospital mortality rate of ICU patients was 18.26%.Admission ENR was significantly lower in deceased patients compared with survivors[1.69(0.45,2.94)vs.0.21(0.11,0.33),Z=-5.365,P<0.001].Multivariate COX regression analysis revealed that admission ENR was one of the independent risk factors associated with in⁃hospital mortality(HR=0.179,P=0.003).During the 28⁃day follow⁃up period,patients with low ENR had lower survival rates compared with patients with high ENR[98.25%(56/57)vs.65.52%(38/58)]and a shorter median survival time(log rankχ^(2)=17.376,P<0.001).Conclusion Low ENR on

关 键 词：急性加重期 肺疾病 慢性阻塞性 嗜酸性粒细胞与中性粒细胞比值 细菌感染 预后 

分 类 号：R563[医药卫生—呼吸系统]