血小板平均体积与血小板计数比值预测老年人慢性阻塞性肺疾病急性加重期近期预后的临床价值

Clinical value of mean platelet volume/platelet count ratio in predicting short-term prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease

目的:探讨血小板平均体积(MPV)与血小板计数(PLT)比值(MPV/PLT)预测老年慢性阻塞性肺疾病急性加重期(AECOPD)患者近期预后的临床价值。方法:回顾性选取2017年1月至2019年1月郑州大学第一附属医院收治的226例老年AECOPD患者,按照入院后28 d的预后情况分为存活组(175例)和死亡组(51例),比较两组患者临床资料和实验室检查指标,采用Logistic回归分析患者死亡的相关因素,受试者工作特征曲线(ROC)评估MPV/PLT预测预后的价值,按照最佳界值绘制Kaplan-Meier生存曲线。结果:与存活组患者比较,死亡组急性生理学与慢性健康状况(APACHEⅡ)评分、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、血肌酐、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、MPV水平偏高,白蛋白、PLT水平偏低(均P<0.05)。死亡组患者住院时间和费用高于存活组(P<0.05);MPV/PLT水平(0.065±0.016)亦高于存活组(0.054±0.013)患者(t=5.036,P<0.01)。多因素Logistic回归分析,MPV/PLT是老年AECOPD患者近期死亡的独立危险因素(OR=2.331,95%CI:1.772~8.224,P<0.01)。MPV/PLT预测患者近期死亡的曲线下面积(AUC)为0.829,敏感度为83.41%,特异度为82.80%,最佳界值为0.061。按照最佳界值分组分析,MPV/PLT≥0.061组患者APACHEⅡ评分、PCT、hs-CRP水平、死亡率均高于MPV/PLT<0.061组患者(P<0.05)。绘制的Kaplan-Meier生存曲线显示MPV/PLT≥0.061组(60例)患者累及生存率低于MPV/PLT<0.061组(166例)患者(Log-rank=6.323,P<0.05)。结论:MPV/PLT增高可能是老年AECOPD患者近期死亡的独立危险因素,预测患者预后不良具有较好的临床价值。

Objective To explore the clinical value of mean platelet volume/platelet count ratio(MPV/PLT)in predicting short-term prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 226 elderly patients with AECOPD admitted to our hospital from January 2017 to January 2019 were retrospectively enrolled as research subjects.All cases were divided into the survival group(n=175)and the death group(n=51),based on prognosis 28-day after admission.General data and laboratory test results were compared between the two groups.The relevant factors for death were analyzed by the Logistic regression equation.The receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of MPV/PLT,and the Kaplan-Meier survival curve was drawn according to the cut-off.Methods Compared with the survival group,Acute Physiology and Chronic Health Status Evaluation(APACHEⅡ)score,levels of procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),creatinine,neutrophil count(NEU),lymphocyte count(LYM)and MPV were elevated,and levels of albumin and PLT decreased in the death group(P<0.05).Hospital stay lengths and costs were higher in the death group than in the survival group(P<0.05).The level of MPV/PLT was higher in the death group than in the survival group(0.065±0.016 vs.0.054±0.013,t=5.036,P<0.01).Multivariate Logistic regression showed that MPV/PLT was an independent risk factor for recent death(OR=2.331,95%CI:1.772-8.224,P<0.01).ROC curve analysis showed that the area under the curve(AUC)of MPV/PLT was 0.829,the sensitivity was 83.41%,the specificity was 82.80%,and the cut-off was 0.061.Optimal cut-off value analysis showed that APACHEⅡscore,PCT and hs-CRP levels and mortality were higher in patients with MPV/PLT≥0.061 than in patients with MPV/PLT<0.061(P<0.05).The Kaplan Meier survival curve showed that the cumulative survival rate was lower in those with MPV/PLT≥0.061 than in those with MPV/PLT<0.061(Log-rank=6.323,P<0.05).Conclusions The increase of MPV/PLT may be an independent risk factor for recent death in elderly patients with AECOPD and has good clinical value in predicting poor prognosis.