中性粒细胞/淋巴细胞比值对老年AECOPD患者住院期间不良预后的影响

Influence of neutrophile granulocyte/lymphocyte ratio(NLR)on poor prognosis of elderly AECOPD patients during hospital stay

目的：探讨中性粒细胞／淋巴细胞比值（NLR）对老年慢性阻塞性肺疾病急性加重期（AECOPD）患者住院期间不良预后的影响。方法：选取本院收治的133例老年AECOPD患者为研究对象，以住院期间发生死亡将所有患者分为死亡组（n=31例）和存活组（n=102例）；比较两组入院时一般临床资料、治疗方式、肺功能、白细胞计数（WBC）、中性粒细胞计数及淋巴细胞计数并计算两者间此值（NLR）、C反应蛋白（CRP）、血气分析及血生化指标，并应用绘制受试者工作特征曲线（ROC曲线）分析NLR预测患者死亡的临床价值。结果：132例老年AECOPD患者中死亡31例，病死率为23．39／6；与存活组比较，死亡组中合并肺心病及接受机械通气的比例较高，差异具有统计学意义（P〈0．05）；PaCO2、WBC计数、中性粒细胞计数、NLR、CRP水平偏高，差异具有统计学意义（P〈0．05）；而淋巴细胞计数、血清白蛋白（ALB）偏低，差异具有统计学意义（P〈0．05）；多因素Logistic回归分析显示：NLR与老年AE-COPD患者住院死亡呈现独立正相关（P〈0．05）；ROC曲线分析显示：NLR对老年AECOPD患者住院死亡的曲线下面积（ROCAUC）为0．787（95％CI=0．536～0．927，P〈0．05），最佳的诊断截点值为7．3，敏感性和特异性分别为77．4％和74．5％；以NLR的截点值7．3为分界将患者分为两组（即：NLR≥7．3组及NLR〈7．3组），NLR≥7．3组患者住院时间、CRP水平及病死率高于NLR〈7．3组（P〈0．05）。结论：NLR是老年AECOPD患者住院死亡的高危因素，早期检测NLR水平对于评估老年AE-COPD近期预后进而指导治疗具有一定意义。

Objective： To discuss the influence of neutrophile granulocyte/lymphocyte ratio（NLR） on poor prognosis of elderly AECOPD patients during the stay in hospital. Methods： A total of 133 cases elderly patients with AECOPD admitted in our hospital from March 2013 to September 2014 were selected, and divided them into death group （n= 31 cases） and survival group （n=102 cases） according to in-hospital death occurrence. Admission general clinical data, therapy method, lung func- tion, blood routine examination white blood cell count （WBC）, neutrophile granulocyte/lymphocyte ratio （NLR）, C-reactive protein （CRP）, blood gas analysis and blood biochemical indexes were compared, and ROC curve was used for analysis of the clinical value of NLR in the prediction of death. Results： Among 133 cases of elderly AECOPD patients, there were 31 death cases （23.3 % ） ; the proportion of combined pulmonary heart disease and mechanical ventilation in death group was higher than that in survival group （P〈0.05）. PaCO2, WBC count, neutrophil count, NLR, CRP level in death group was higher （P〈 0.05）, but lymphocyte count.serum albumin （ALB） in death group was lower （P〈0.05）. Multiple logistic regression analysis showed that NLR had independent positive correlation with the in-hospital death in elderly AECOPD patients （P〈0.05）, ROC curve analysis showed that the ROCAUC of NLR to the in-hospital death in elderly AECOPD patients was 0. 787 （95%CI=0. 536-0. 927,P〈0.05）, the best diagnostic node value was 7.3, sensitivity and specificity were 77.4% and 74.5%, respective- ly; hounded by NLR（7.3）, divided patients into NLR≥7.3 group and NLR〈7.3 group, hospital stays, CRP level and mor- tality in NLR≥7.3 group were higher than that in NLR〈7.3 group （P〈0.05）. Conclusion： NLR is the high risk factor of the in-hospital death in elderly AECOPD patients, early detection of NLR level has a certain difference to the evaluation for short- term prognosis of elderly AECOPD patients and guide treatment.