COPD患者血清NLR、CRP/ALB水平对频繁急性加重的预测价值及剂量-效应关系分析  

Predictive value and"dose-effect"relationship analysis of serum NLR,CRP/ALB levels in patients with chronic obstructive pulmonary disease for frequent acute exacerbations

作　　者：向海 李辛岚 范小兵 刘翠华 XIANG Hai;LI Xinlan;FAN Xiaobing;LIU Cuihua(Respiratory and Critical Care Department,Mianyang Central Hospital,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology,Mianyang 621000,Sichuan,China;Emergency Department,Mianyang Central Hospital,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology,Mianyang 621000,Sichuan,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院呼吸与危重症科,四川绵阳621000 [2]电子科技大学医学院附属绵阳医院·绵阳市中心医院急诊科,四川绵阳621000

出　　处：《西部医学》2025年第4期558-563,共6页Medical Journal of West China

基　　金：中华国际医学交流基金会呼吸疾病青年实用研究项目(Z-2023-24-2301)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者血清中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白/白蛋白比值(CRP/ALB)水平对频繁急性加重的预测价值及剂量-效应关系。方法选取2021年7月—2022年7月我院COPD患者153例,随访1年根据患者急性加重情况分稳定组(n=55)、急性加重组(n=39)、频繁急性加重组(n=59),同期体检健康者51例作为对照组。比较4组血NLR、CRP/ALB水平。多因素COX回归分析COPD患者频繁急性加重的影响因素,受试者工作特征(ROC)曲线分析血清NLR、CRP/ALB水平评估COPD患者频繁急性加重的价值。限制性立方样条图分析血清NLR、CRP/ALB水平与COPD患者频繁急性加重的剂量-效应关系。结果对照组、稳定组、急性加重组、频繁急性加重组血NLR、CRP/ALB水平依次升高(P<0.05);NLR、CRP/ALB是COPD患者频繁急性加重的独立危险因素,长期家庭氧疗是COPD患者频繁急性加重的独立保护因素(P<0.05);NLR、CRP/ALB联合评估COPD患者频繁急性加重的AUC值为0.849,大于NLR、CRP/ALB单独评估;NLR(χ^(2)=20.730,P<0.001),CRP/ALB(χ^(2)=19.931,P<0.001)与COPD患者频繁急性加重存在非线性剂量-效应关系,两条曲线均大致呈“J”形,当NLR>4.50,CRP/ALB>3.40时,NLR(β=0.893,95%CI=1.389~4.294,P<0.001),CRP/ALB(β=0.973,95%CI=1.451~4.826,P<0.001)与COPD患者频繁急性加重风险呈正相关。结论COPD患者血清NLR、CRP/ALB水平与频繁急性加重关系密切,存在独立的“剂量-效应”关系,可为临床评估频繁急性加重风险提供参考。Objective To Explore the predictive value and"dose-effect"relationship of serum neutrophil-to-lymphocyte ratio(NLR)and C-reactive protein-to-albumin ratio(CRP/ALB)in patients with chronic obstructive pulmonary disease(COPD)for frequent acute exacerbations.Methods A total of 153 patients with COPD in our hospital from July 2021 to July 2022 were selected and followed up for 1 year.According to the acute exacerbation of the patients,they were divided into stable group(n=55),acute plus recombination(n=39),frequent acute plus recombination(n=59),and 51 healthy subjects were selected as control group during the same period.Blood levels of NLR and CRP/ALB were compared among the four groups.Multivariate COX regression analysis was performed to analyze the influencing factors of frequent acute exacerbations in COPD patients,and receiver operating characteristic curve(ROC curve)was used to analyze the value of blood NLR and CRP/ALB levels in evaluating frequent acute exacerbations in COPD patients.The"dose-effect"relationship between blood levels of NLR,CRP/ALB and frequent acute exacerbations in COPD patients was analyzed with restricted cubic spline diagram.Results The levels of NLR and CRP/ALB in the blood increase in turn in the control group,stable group,acute exacerbation group,and frequent acute exacerbation group(P<0.05).NLR,CRP/ALB were independent risk factors for frequent acute exacerbations in COPD patients,and long-term home oxygen therapy was independent protective factor for frequent acute exacerbations in COPD patients(P<0.05).The AUC value of frequent acute exacerbations in COPD patients assessed by NLR and CRP/ALB combined was 0.849,which was higher than that assessed by NLR(Z statistic=2.924,P=0.004)and CRP/ALB(Z statistic=2.736,P=0.006)alone.NLR(χ^(2)=20.730,P<0.001),CRP/ALB(χ^(2)=19.931,P<0.001)had a nonlinear"dose-effect"relationship with frequent acute exacerbations in COPD patients.Both curves were roughly"J"shaped.When NLR>4.50 and CRP/ALB>3.40,NLR(β=0.893,95%CI=1.389-4.294,P<0.001),CRP/ALB(β

关 键 词：慢性阻塞性肺疾病 中性粒细胞 淋巴细胞 C反应蛋白 频繁急性加重 

分 类 号：R563[医药卫生—呼吸系统]