中性粒细胞-淋巴细胞比值与哮喘患者肺功能、急性发作关系研究

Association of neutrophil-to-lymphocyte ratio with lung function and exacerbation in patients with asthma

目的探讨外周血中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)与哮喘患者肺功能及未来急性发作之间的关系。方法收集2016年9月-2017年5月在徐州医科大学附属医院确诊的成人支气管哮喘急性发作期患者204例。分别记录ACT评分,测定1秒钟用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、用力肺活量(FVC)及FEV1/FVC,检测血常规,记录未来一年中患者是否出现哮喘急性发作。根据NLR(NLR=中性粒细胞数绝对值/淋巴细胞数绝对值)四分位点将患者分为4组(Q1≤1.76,1.77<Q2≤2.80,2.80<Q3≤5.43,Q4>5.43),分别比较四组患者ACT评分、肺功能、未来一年出现哮喘急性发作的百分比。结果Q1、Q2、Q3组患者FEV1%和FEV1/FVC差异无统计学意义(均P>0.05)。Q4组的FEV1%和FEV1/FVC明显高于其余3组,且存在统计学意义(P<0.05),FEV1%、FEV1/FVC与NLR均呈负性相关P<0.01(r=-0.478、r=-0.4)。Logistics回归分析显示NLR、FEV1%、过敏、使用ICS对哮喘未来急性发作有统计学意义,FEV1%>60%、使用ICS是哮喘未来急性发作的保护性因素,而NLR与过敏因素是则是哮喘未来急性发作的危险因素,ACT评分、吸烟与哮喘未来急性发作无统计学意义(P<0.05)。结论哮喘患者NLR水平与气流受限呈负性相关,NLR是哮喘急性发作的独立危险因素。

Objective To explore the association of neutrophil-to-lymphocyte ratio with lung function and exacerbation in patients with asthma.Methods It recruited 204 patients with asthma exacerbation from the Affiliated Hospital of Xuzhou Medical University.The levels of FEV 1%,FVC,FEV 1/FVC ratio and blood routine were determined.Asthma control test(ACT)scores were calculated,and the ratio of exacerbation during preceding year was recorded.All patients were categorized into the NLR quartiles(Q1≤1.76,1.77<Q2≤2.80,2.80<Q3≤5.43,Q4>5.43)to compare the ACT scores,lung function,ratio of exacerbation during preceding year in each group.Results There was no significant difference in FEV 1%and FEV 1/FVC among the Q1,Q2 and Q3 groups(P>0.05).The levels of FEV 1%and FEV 1/FVC in the group Q4 were significantly higher than those in the other 3 groups and were negatively associated with NLR level(P<0.01).FEV 1%>60%and ICS use regularly were protective factors for asthma severe exacerbation in last 12 months,while NLR and allergen exposure were risk factors for acute attack of asthma.The ACT scores and smoking had no association with asthma severe exacerbation in last 12 months.Conclusion NLR shows a significantly negative relationship with airflow limitation and is a prognostic marker for future exacerbation in patients with asthma.