NLR和PLR在慢性阻塞性肺疾病急性加重治疗中的临床价值探讨

Clinical values of NLR and PLR in the treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)在慢性阻塞性肺疾病急性加重(AECOPD)治疗中的指导价值。方法选取101例AECOPD患者、48例慢性阻塞性肺疾病(COPD)患者、46例健康体检者分别纳入AECOPD组、COPD稳定期组和对照组。AECOPD组患者于入院后第2天和经临床治疗病情稳定达到出院标准后分别进行采血检查,COPD稳定期组和对照组患者于就诊当日空腹进行采血检查。比较三组白细胞计数(WBC)、中性粒细胞百分率(NEU%)、NLR、PLR、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和降钙素原(PCT)等水平,并采用受试者工作特征曲线分析NLR和PLR在AECOPD中的诊断价值。结果AECOPD组患者治疗后NLR、CRP、SAA、PCT、WBC、NEU%、PLR均明显低于治疗前(t分别=3.40、5.22、3.29、2.67、2.01、3.07,Z=-2.27,P均<0.05)。AECOPD组患者治疗前NLR、CRP、SAA、PCT、NEU%水平均明显高于COPD稳定期组和对照组,PLR水平亦明显高于COPD稳定期组和对照组(t分别=6.40、4.29、2.56、3.23、5.28;7.67、8.91、8.03、4.36、12.09,Z分别=-4.44、-6.47,P均<0.05)。NLR与CRP、SAA、WBC和NEU%呈正相关(r分别=0.34、0.41、0.65、0.94,P均<0.05),PLR与CRP、PCT、SAA和WBC没有明显相关性(r分别=0.23、0.10、0.12、0.16,P均>0.05)。NLR和PLR指数对AECOPD的诊断价值曲线下面积分别为0.90和0.82。结论NLR和PLR可作为临床诊治AECOPD的预测指标。

Objective To explore the clinical values of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Meth⁃ods Totally 101 patients with AECOPD,48 cases with chronic obstructive pulmonary disease(COPD),and 46 healthy subjects from the physical examination center were chosen as AECOPD group,stable COPD group,and control group,respectively.Blood samples were taken from the patients with AECOPD at the second day of hospitalization and before discharge.On the other hand,fasting blood collection were applied on the patients in the stable COPD group and control group.The levels of WBC,NEU%,NLR,PLR,C reactive protein(CRP),serum amyloid protein A(SAA),and procalcitonin(PCT)among three groups were compared,and the diagnostic values of NLR and PLR in AECOPD were analyzed by receiver operating characteristic curve.Results There were significant differences in NLR,CRP,SAA,PCT,WBC,NEU%,PLR before and after treatment in the AECOPD group(t=3.40,5.22,3.29,2.67,2.01,3.07,Z=-2.27,P<0.05).Compared with the stable COPD group and the control group,the NLR,CRP,SAA,PCT,NEU%,and PLR of the AECOPD group before treatment were significantly higher(t=6.40,4.29,2.56,3.23,5.28,7.67,8.91,8.03,4.36,12.09,Z=-4.44,-6.47,P<0.05).In the patients with AECOPD,NLR was positively related with CRP,SAA,WBC,and NEU%(r=0.34,0.41,0.65,0.94,P<0.05).But the PLR was related with CRP,PCT,SAA,and WBC with no significance(r=0.23,0.10,0.12,0.16,P>0.05).Areas under ROC curve of NLR and PLR for diagnosing AECOPD were 0.90 and 0.82.Conclusion NLR and PLR can be as the predictor for diagnosis and treatment of AECOPD.