常用血常规指标对慢性阻塞性肺疾病急性加重的诊断价值

Diagnostic Values of Routine Blood Indicators in Patients with AECOPD

背景慢性阻塞性肺疾病急性加重(AECOPD)是慢性阻塞性肺疾病(COPD)患者反复出现的问题,可导致患者死亡率增加。目前,AECOPD的预测和诊断缺少量化指标,因此探讨常用血常规指标对AECOPD的预测和诊断价值具有重要意义。目的探讨淋巴细胞百分数(LY%)、中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞百分数(NE%)及白细胞计数(WBC)在AECOPD诊断中的价值。方法选取2017年11月2018年9月在湛江中心人民医院呼吸内科就诊的AECOPD患者130例为AECOPD组,另选取同期在该院体检的健康体检者122例为健康对照组。所有研究对象均测定血常规。比较两组LY%、NLR、NE%、WBC指标差异,并采用受试者工作特征(ROC)曲线评价LY%、NLR、NE%、WBC对AECOPD的预测和诊断价值。结果AECOPD组患者NLR、NE%、WBC均高于健康对照组,LY%低于健康对照组,差异有统计学意义(P<0.05)。LY%、NLR、NE%及WBC对AECOPD诊断的ROC曲线下面积分别为0.904、0.901、0.892、0.616(P<0.01)。LY%对AECOPD诊断的最佳截断值为24.9%,灵敏度为82.31%,特异度为90.98%;NLR对AECOPD诊断的最佳截断值为2.73,灵敏度为79.23%,特异度为92.62%;NE%对AECOPD诊断的最佳截断值为65.4%,灵敏度为78.46%,特异度为93.44%;WBC对AECOPD诊断的最佳截断值为9×109/L,灵敏度为37.69%,特异度为90.98%。结论LY%<24.9%、NLR>2.73、NE%>65.4%可有效诊断AECOPD的发生,WBC对AECOPD的诊断价值较低。

Background Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is a recurrent problem in patients with chronic obstructive pulmonary disease(COPD),which can lead to increased mortality.Due to lack of quantitative indicators for the prediction and diagnosis of AECOPD,it is important to explore the predictive and diagnostic values of commonly used routine blood indicators for AECOPD.Objective To investigate the value of lymphocyte percentage(LY%),neutrophil/lymphocyte ratio(NLR),neutrophil percentage(NE%)and white blood cell count(WBC)in the diagnosis of AECOPD.Methods Participants were recruited from Central People's Hospital of Zhanjiang from November 2017 to September 2018,including 130 patients with AECOPD(AECOPD group)from Department of Respiratory Medicine,and 122 physical examinees(control group).LY%,NLR,NE%and WBC levels were measured in all cases via a routine blood test,and their predictive and diagnostic values in AECOPD were evaluated by ROC curve analysis.Results Compared with control group,patients in AECOPD group showed higher mean NLR,NE%and WBC,but lower mean LY%(P<0.05).In the diagnosis of AECOPD,the AUC of LY%was 0.904(P<0.01),with a ROC curve-determined optimal cut-off value of 24.9%,with a sensitivity of 82.31%,and a specificity of 90.98%.The AUC of NLR was 0.901(P<0.01),with a ROC curve-determined optimal cut-off value of 2.73,with a sensitivity of 79.23%,and a specificity of 92.62%.The AUC of NE%was 0.892(P<0.01),with a ROC curve-determined optimal cut-off value of 65.4%,with a sensitivity of 78.46%,and a specificity of 93.44%.And the AUC of WBC was 0.616(P<0.01),with a ROC curve-determined optimal cut-off value of 9×109/L,with a sensitivity of 37.69%,and a specificity of 90.98%.Conclusion LY%<24.9%,NLR>2.73 and NE%>65.4%can effectively diagnose the occurrence of AECOPD,but WBC has lower diagnosis value.