多项血液指标对慢性阻塞性肺疾病长期死亡率的预测价值

Predictive value of blood indicators for the long-term mortality of chronic obstructive pulmonary disease

目的探讨C反应蛋白(CRP)、中性粒细胞、嗜酸性粒细胞、中性粒细胞/淋巴细胞比值(NRL)、胆碱脂酶、白蛋白(Alb)和维生素D与慢性阻塞性肺疾病(COPD)患者长期死亡率的相关性。方法选取2015年1月-2017年1月广东省罗定市人民医院COPD患者120例,并对其开展为期24个月的随访,统计患者长期死亡率。根据结果将研究对象分为长期死亡组(17例)和存活组(89例)。比较2个组CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、Alb和25-羟基维生素D[25(OH)D](维生素D)水平。采用Logistic分析评价COPD患者各血液指标与长期死亡率的相关性。采用受试者工作特征(ROC)曲线分析各血液指标对COPD患者长期死亡率的预测价值。结果长期死亡组CRP、中性粒细胞、嗜酸性粒细胞水平及NRL均显著高于存活组(P<0.05),胆碱酯酶、25(OH)D、Alb水平显著低于存活组(P<0.05)。CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、25(OH)D和Alb均可作为预测COPD患者长期死亡率的独立危险因素,比值比分别为1.23、0.99、1.45、2.75、1.30、1.08、0.59(P<0.05)。CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、25(OH)D和Alb的敏感性与特异性比较差异均无统计学意义(P>0.05),NRL的曲线下面积(AUC)显著大于其他血液指标(P<0.05)。结论 CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、Alb和25(OH)D对COPD患者长期死亡率预测均有积极意义,其中NRL的预测价值较为显著。

Objective To investigate the relations of C-reactive protein(CRP),neutrophil,eosinophil,neutrophil-to-lymphocyte ratio(NRL),cholinesterase,albumin(Alb) and vitamin D with the long-term mortality in patients with chronic obstructive pulmonary disease(COPD). Methods A total of 120 COPD patients in Luoding People’s Hospital from January 2015 to January 2017 were enrolled and followed up for 24 months. The subjects were classified into long-term death group(17 cases) and survival group(89 cases). The levels of CRP,neutrophil,eosinophil,NRL,cholinesterase,Alb and 25-hydroxyvitamin D [25(OH)D](vitamin D) between the 2 groups were compared. Logistic analysis was used to evaluate the relations between the blood indicators and long-term mortality,and the predictive value of the blood indicators was analyzed by receiver operating characteristic(ROC) curve analysis. Results The levels of CRP,neutrophil,eosinophil and NRL in long-term death group were higher than those in survival group(P<0.05),and the cholinesterase,Alb and 25(OH)D levels were lower than those in survival group(P<0.05). CRP,neutrophil,eosinophil,NRL,cholinesterase,25(OH)D and Alb were independent risk factors for predicting long-term mortality in COPD patients(odds ratios were 1.23,0.99,1.45,2.75,1.30,1.08 and 0.59,respectively)(P<0.05). The sensitivities and specificities of the 7 indicators had no statistical significance(P>0.05),and the area under curve(AUC) of NRL was bigger than those of the other 6 indicators(P<0.05). Conclusions CRP,neutrophil,eosinophil,NRL,cholinesterase,Alb and 25(OH)D have positive significance in predicting the long-term mortality of COPD,and NRL is a significant predictive indicator.