慢性阻塞性肺疾病炎症和过敏性指标的分析和应用

Analysis and application of inflammation and allergic indicators in chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病(COPD)炎症和过敏性相关指标及其临床应用。方法选取2016年12月至2019年2月入院的COPD患者100例,根据入院时病情分为稳定组和急性加重组,各50例,所有患者均进行血常规、超敏C反应蛋白(hs-CRP)、血小板压积(PCT)及血清总免疫球蛋白(Ig)E检查,并计算中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR),使用肺功能仪对患者的静态肺通气功能进行测定,检测第一秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC。结果急性加重组气喘和呼吸困难发生率高于稳定组(44.00%vs 72.00%,42.00%vs 84.00%,P<0.01)。急性加重组NLR和PLR高于稳定组[(5.60±2.81)vs(4.62±1.48),(85.60±34.57)vs(70.84±31.41),P<0.05]。稳定组患者嗜酸性粒细胞(EOS)计数及血清总IgE均低于急性加重组(P<0.01)。稳定组患者FEV1及FEV1/FVC高于急性加重组(P<0.05)。急性加重期患者经相应的治疗后EOS、NLR、PLR均不同程度的下降(P<0.05,P<0.01),但总IgE下降并不明显,治疗前后对比差异无统计学意义(P>0.05)。血清总IgE的ROC曲线图显示,曲线下面积为0.712,P值为0.000,最佳截断值为255 U/L。结论 NLR和PLR作为系统炎性指标,在描述COPD患者机体炎症变化的状态具有简便、高效的作用,与过敏性指标外周血EOS和血清总IgE联合,能够准确的反应COPD患者病情的严重程度,并对治疗效果和预后的判断有重要的作用。

Objective To analyze allergy-and inflammation and allergic indicators of chronic obstructive pulmonary disease(COPD) and their clinical application.Methods A total of 100 patients with COPD admitted to hospital from December 2016 to February 2019 were enrolled and divided into stable group and acute exacerbation of COPD(AECOPD) group according to the condition of admission(n=50,each).All patients underwent laboratory examinations,including routine blood tests,high sensitivity C-reactive protein(hs-CRP),platelet hematocrit(PCT) and serum total immunoglobulin(Ig) E,and neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte(PLR) were calculated.The pulmonary function meter was used to measure one second forced expiratory volume(FEV1),forced vital capacity(FVC) and FEV1/FVC ratio.Results The incidences of asthma(72.00% vs 44.00%) and dyspnea(84.00% vs 42.00%) in AECOPD group were statistically higher than those in stable group(P<0.01).NLR[(5.60 ± 2.81) vs(4.62 ± 1.48)] and PLR [(85.60 ±34.57) vs(70.84± 31.41)] in AECOPD group were significantly higher than those in stable group(P<0.05).Compared with AECOPD group,eosinophils(EOS) count and serum total IgE decreased,and FEV1 and FEV1/FVC increased statistically in stable group(P<0.05,P<0.01).After corresponding treatment,EOS,NLR and PLR decreased statistically compared with before treatment in AECOPD group(P<0.05,P<0.01),but there was no significant difference in total IgE level before and after treatment(P>0.05).ROC curve of serum total IgE showed that AUC was 0.712(P=0.000),and the best cut off value was 255 U/L.Conclusions NLR and PLR,as systemic inflammatory indicators,were the simple and efficient means in describing the state of inflammatory changes in patients with COPD.Combined with allergic indicators of peripheral blood EOS and serum total IgE,NLR and PLR can accurately reflect the severity of COPD and play an important role in juding the therapeutic effect an prognosis.