血液中PLR、NLR及D-二聚体水平对AECOPD患者的预后价值评估

Prognostic value of PLR,NLR and d-dimer levels in blood for patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性疾病急性加重期(AECOPD)患者血小板/淋巴细胞比率(PLR)、中性粒细胞/淋巴细胞比率(NLR)及D-二聚体水平在预测其短期生存状况中的作用。方法选择该院2014年1月至2015年8月收治的151例AECOPD患者为研究对象,根据其出院后120d内的生存状态将其分为观察组(13例)和对照组(138例),调查两组患者的住院基本信息及生存时间,并对两组患者血液中血红蛋白、中性粒细胞计数、PLR、NLR及D-二聚体水平等指标进行比较,并使用多变量Logistic回归分析和受试者工作曲线(ROC曲线)评价这些指标对AECOPD患者短期预后的诊断价值。结果单因素分析两组患者性别差异无统计学意义(P>0.05),而年龄、中性粒细胞计数、血红蛋白、NLR、PLR及D-二聚体差异均有统计学意义(P<0.05),而多变量Logistic回归分析表明,仅PLR和年龄与患者出院后120d内死亡显著相关(P<0.05);通过ROC曲线对PLR的预后价值进一步分析,PLR最佳截断值为232.5,其敏感度和特异度分别为69.2%、70.3%,表明PLR≥232.5的患者预后更差。结论 PLR可作为独立预测AECOPD患者预后的生物学指标之一,当PLR≥232.5与AECOPD患者120d内病死率紧密相关。

Objective To investigate the role of platelet to lymphocyte ratio (PLR),neutrophil to lymphocyte ratio (NLR) and d-dimer levels in predicting short-term survival in patients with acute exacerbation of chronic obstructive disease (AECOPD).Methods We conducted a retrospective cohort study of patients admitted to our hospital with a primary diagnosis of AECOPD between Jan 2014 and Aug 2015.One hundred and fifty-one AECOPD patients were considered for the study.According to their survival status within 120 d after discharge,they were divided into observation group ( n =13) and control group ( n =138).Basic information and survival time of the two groups of patients were investigated,also hemoglobin (Hb),neutrophil count,PLR,NLR and d-dimer levels were compared.Multivariate logistic regression analysis and receiver operating characteristics curves (ROC) were used to evaluate the diagnostic value of these indicators for the short-term prognosis of AECOPD patients.Results Univariable analysis identified:there was no significant difference in gender between the two groups ( P >0.05),but age,haemoglobin,neutrophil count,and D-dimer level,NLR and PLR as being associated with increased 120 d mortality ( P <0.05).Multivariable logistic regression analysis variables demonstrated that only PLR and age were significantly associated with death at 120 d ( P < 0.05 ).ROC identified that the PLR≥232.5 had a sensitivity of 69.2% and specificity of 70.3% in predicting 120 d mortality.indicating that patients with PLR ≥232.5 have worse prognosis.Conclusion May be PLR can be used as one of the biological indicators to independently predict AECOPD.A PLR ≥232.5 was significantly associated with 120 d mortality.