中性粒细胞/淋巴细胞比率及血小板平均体积对慢阻肺发作风险和严重程度预测价值

Predictive value of neutrophil/lymphocyte ratio and mean platelet volume in COPD exacerbation risk and severity

目的探讨中性粒细胞/淋巴细胞比率(NLR)及血小板平均体积(MPV)对慢性阻塞性肺疾病患者发作风险及严重程度的预测价值。方法选择2014年6月至2015年5月收入我院呼吸内科,明确诊断为慢性阻塞性肺疾病急性加重期患者96例,年龄40-70岁,性别不限,按照两种方法分组:(1)根据发作频率分为频繁发作组67例,非频繁发作组29例;(2)按肺功能气流受限的程度分为3组,其中中度组(50%≤FEV1占预计值%<79%)42例,重度组(30%≤FEV1占预计值<49%)39例,极重度组(FEV1占预计值%<30%)15例。诊断及严重度分组依据2013年修订版《慢性阻塞性肺疾病诊治指南》,同时均排除30天内全身使用糖皮质激素、合并其它器官炎性疾病、自身免疫系统疾病、血液病的患者。收集所有患者治疗前及治疗后外周血常规、CRP、动脉血气、肺功能检查结果,并对所有患者完成CAT评分,按照上述分组方法比较各组患者治疗前、治疗后中性粒细胞/淋巴细胞比率(NLR)、血小板平均体积(MPV)的变化,及其治疗前NLR、MPV与动脉血气、CRP、肺功能、CAT评分之间的相关性。结果 (1)频繁发作组患者NLR明显高于非频繁发作组(t=3.442,P=0.031<0.05);而两组患者MPV比较差异无显著意义(t=1.264,P=0.209>0.05)。(2)在不同严重程度的慢阻肺分组中对患者NLR、MPV进行比较,NLR在不同的严重程度中存在显著的差异(F=5.592,P=0.017<0.05);MPV在严重程度方面无差异(F=0.179,P=0.910>0.05)。(3)NLR与CRP正相关(r=0.26,P<0.05),与FEV1负相关(r=-0.39,P<0.05),与发作频率正相关;MPV与CRP、FEV1、发作频率无明显相关性。(4)NLR、MPV治疗后跟治疗前相比,均下降,说明通过治疗,慢阻肺患者全身性炎症反应减轻。结论 (1)中性粒细胞/淋巴细胞比率(NLR)对慢阻肺发作风险有正向预测价值,即中性粒细胞/淋巴细胞比率高,慢阻肺发作风险越大,中性粒细胞/淋巴细胞比率低,慢阻肺发作风险越小;中性粒细胞/淋巴细胞比率(NLR)对慢阻肺严重程度也有正向预测价值,即比率高,慢阻肺严重程度越严重,比率低时,慢阻肺严重程度越低。(2)血小板平均体积(MPV)对慢阻肺发作风险和严重程度没有预测价值。

Objective To explore the predictive value of NLR（ neutrophil/ lymphocyte ratio） and MPV （mean platelet volume） in exacerbation risk and disease severity in chronic obstructive pulmonary disease （ COPD） patients. Methods 96 COPD patients with acute exacerbation were selected, aging from 40 to 70. They were divid-ed into two groups according to exacerbation frequency （67 cases in the frequent group, and 29 cases in the non-fre-quent group） or into three groups according to the degree of lung function （42 cases in the moderate group, 39 cases in the severe group, and 15 cases in the very severe group）. Patients were excluded if they used systemic corticoste-roids within 30 days or had underlying other organ inflammatory diseases, autoimmune disease, blood disease. Blood routine, C-reactive protein, arterial blood gas, pulmonary function testing and CAT scores were performed and evalu-ated before and after treatment. Changes of NLR and MPV in each group were examined and compared. The relation-ship between retreatment NLR, MPV and arterial blood gas, CRP,pulmonary function and CAT scores was evalua-ted. Results 1. NLR was significantly higher in the frequent group than in the non-frequent group （ x2 = 3. 442, P = 0. 031 〈 0. 05 ） , and there was no significant difference in MPV between the two groups （x2 = 1. 264, P = 0. 209 〉 0. 05）. 2. There was significant difference in NLR between the moderate group and the very severe group （ F = 5. 592, P = 0. 017 〈 0. 05 ） , while MPV did not show any significant difference among the three groups （F = 0. 179,P =0. 910 〉0. 05） . 3. NLR was positively correlated with CRP （r = 0. 26, P 〈0. 05） and exacerbation frequency, while negatively correlated with FEV! （ r = - 0. 39,P 〈 0. 05 ）. There was no significant correlation of MPV with CRP, FEV!,and exacerbation frequency. 4. NLR and MPV were declined after the end of treatment, which indica-ted that systemic inflammatory response mitigated in COPD patients. Conclusion 1. NLR has a positive predictive value for the onset of COPD exacerbation risk and severity. 2. There is no predictive value for MPV in the onset of COPD and disease？ severity.