慢性阻塞性肺疾病急性加重期机械通气患者中性粒细胞与淋巴细胞比值与预后的相关性

Correlation Between Neutrophil-Lymphocyte Ratio and Prognosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated with Mechanical Ventilation

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者外周血中性粒细胞与淋巴细胞比值(NLR)与预后的相关性。方法回顾性分析2015年1月至2019年1月郑州大学第一附属医院呼吸重症监护室收治的97例AECOPD机械通气患者的临床资料。根据28 d预后将患者分为好转组(66例)和恶化组(31例)。比较两组中性粒细胞计数(NC)、淋巴细胞计数(LC)、NLR、C反应蛋白(CRP)及急性生理与慢性健康评分Ⅱ(APACHEⅡ)。对NLR与CRP、APACHEⅡ评分进行相关性分析。统计基线期NLR四分位区间,并比较各个区间的死亡率。结果恶化组NLR、CRP和APACHEⅡ评分均高于好转组,差异有统计学意义(均P<0.05)。两组NC、LC比较,差异无统计学意义(均P>0.05)。AECOPD机械通气患者NLR与CRP、APACHEⅡ评分呈正相关(r=0.279、0.315,P=0.006、0.002)。不同NLR四分位区间患者的死亡率比较,差异有统计学意义(P<0.05)。结论监测AECOPD机械通气患者的NLR水平,有助于评估病情严重程度及预后。

Objective To explore the correlation between neutrophil-lymphocyte ratio(NLR) in peripheral blood and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) treated with mechanical ventilation.Methods The clinical data of 97 patients with AECOPD treated with mechanical ventilation admitted to the Department of Respiratory Intensive Care Unit in the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2019 were retrospectively analyzed. The patients were divided into improved group(66 cases) and deteriorated group(31 cases) according to the prognosis after 28 days. Neutrophil count(NC), lymphocyte count(LC), NLR, C-reactive protein(CRP) and acute physiology and chronic health score Ⅱ(APACHEⅡ) were compared between the two groups. The correlations between NLR and CRP, APACHEⅡ score were analyzed. The NLR quartile intervals of baseline period were counted and the mortality rates of the four intervals were compared.Results The values of NLR, CRP and APACHEⅡ in deterioration group were higher than those in improved group, and the differences were statistically significant(all P<0.05). There were no significant differences in NC and LC between the two groups(both P>0.05). NLR was positively correlated with CRP and APACHEⅡ in patients with AECOPD undergoing mechanical ventilation(r=0.279, 0.315, P=0.006, 0.002). The mortality rates of the four intervals were significantly different(P<0.05).Conclusion Monitoring the level of NLR of patients with AECOPD treated with mechanical ventilation is helpful to evaluate the severity and prognosis of the disease.