NLR、PLR在慢性阻塞性肺疾病合并肺间质纤维化中的临床应用价值

Clinical value of NLR and PLR in COPD with pulmonary interstitial fibrosis

目的本研究旨在探讨中性粒细胞、淋巴细胞比值(neutrophil-to-lymphocyteratio,NLR)、血小板淋巴细胞比值(platelet-to-lymphocyteratio,PLR)与慢性阻塞性肺疾病(简称慢阻肺)合并肺间质纤维化(COPD‐PIF)及其肺功能的相关性。方法选择我院呼吸科2015年12月至2018年6月收治的58例慢性阻塞性肺疾病合并肺间质纤维化患者为COPD‐PIF组,80例慢阻肺患者为COPD组,收集同一时间段在本院接受健康体检的35例体检健康人群作为对照组。采集所有研究对象血常规,记录中性粒细胞、血小板及淋巴细胞计数并计算获得NLR、PLR。记录3组患者第1秒用力呼气容积占预计值的百分比(FEV1/FEV1pred)、用力肺活量(FVC)与血清NLR、PLR的进行相关性分析,根据COPD‐PIF患者NLR、PLR的中位数,分为NLR≤2.07组、NLR>2.07组;PLR≤143.09组、>143.09组,比较NLR、PLR两分组间的BODE指数及指数各指标;根据GOLD指南对COPD‐PIF患者进行肺功能分级,分析各肺功能分级NLR>2.07及PLR>143.09比例。结果3组FVC、FEV1/FEV1pred、NLR、PLR及BODE指数组内皆存在统计学差异,P<0.05;NLR>2.07组FEV1/FEV1pred、BMI、6MWT分别为50.78±6.90%、18.89±2.42、244.46±25.76m均明显高于NLR≤2.07组的62.44±7.31%、22.15±2.56及287.08±29.20m,P<0.01;MMRC(分)、BODE指数分别为2.03±0.45分和4.22±1.06,明显低于NLR≤2.07组的2.31±0.56分和3.67±0.85,P<0.05。两PLR分组间FEV 1/FEV 1pred和6MWT组间存在差异,P<0.01,其他指标未见差异,P>0.05。趋势检验结果显示,随着肺功能分级的提升,NLR>2.07比例、PLR>143.09比例呈递增趋势,均Ptrend<0.01。结论NLR、PLR与慢阻肺合并肺间质纤维化的发生及病情密切相关,其具高性价比,可考虑作为常规评估指标。

Objective To investigate the correlation of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)with COPD complicated with pulmonary interstitial fibrosis(COPD-PIF)and pulmonary function.Methods 58 patients with COPD-PIF and 80 patients with chronic obstructive pulmonary disease(COPD)from December 2015 to June 2018 in respiratory department of our hospital were selected as the COPD-PIF group and the COPD group.35 healthy people who underwent physical examination in our hospital at the same time were collected as the control group.The blood routine of all subjects was collected and the counts of neutrophils,platelets and lymphocytes were recorded,NLR and PLR were calculated at the same time.Percentage of forced expiratory volume in first second to predicted value(FEV1/FEV1pred),forced vital capacity(FVC)and serum NLR and PLR were recorded in the three groups.According to the median of NLR and PLR in COPD-PIF patients,they were divided into the NLR≤2.07 group and the NLR>2.07 group,the PLR≤143.09 group and the PLR>143.09 group.According to GOLD guidelines,the lung function of COPD-PIF patients was graded,and the ratio of NLR>2.07 and PLR>143.09 was analyzed.Results There were significant differences in FVC,FEV1/FEV1pred,NLR,PLR and BODE index among the three groups(P<0.05).FEV 1/FEV 1pred,BMI and 6MWT in the NLR>2.07 group were 50.78±6.90%,18.89±2.42,244.46±25.76m,respectively,which were significantly higher than those in the NLR≤2.07 group(62.44±7.31%,22.15±2.56 and 287.08±29.20m respectively,P<0.01).MMRC score and BODE index were 2.03±0.45 and 4.22±1.06,respectively,significantly lower than those of the NLR≤2.07 group(2.31±0.56 and 3.67±0.85,P<0.05).There were significant differences between the two PLR groups in FEV 1/FEV 1pred and 6MWT(P<0.01),and no difference in other indicators(P>0.05).Trend test results showed that the proportion of NLR>2.07 and PLR>143.09 showed an increasing trend with the improvement of pulmonary function grading(P<0.01).Conclusion NLR and PLR are closely related to the occurrence and condition of COPD complicated with pulmonary interstitial fibrosis.They have high cost performance ratio and can be considered as routine evaluation indicators.