中性粒细胞/淋巴细胞比值对老年慢性阻塞性肺疾病急性加重期患者并发心力衰竭的预测价值

Predictive Value of Neutrophil/Lymphocyte Ratio in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with Heart Failure

目的探讨中性粒细胞/淋巴细胞比值(NLR)对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者并发心力衰竭的预测价值。方法选取通州湾三余人民医院在2018年1月至2020年2月诊治的老年AECOPD患者138例为研究对象,根据是否合并心衰分为合并心衰组与单纯AECOPD组,每组69例。对两组空腹静脉血进行抽取,检测氨基末端脑钠肽前体(NT-proBNP)与血常规,计算NLR;另抽取动脉血,对动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)进行检测。回归分析老年AECOPD患者合并心力衰竭的主要危险因素;用受试者工作特征(ROC)区间,就NLR对老年AECOPD患者并发心衰的预测价值进行评价。结果合并心衰组的NLR、收缩压、NTproBNP、PaCO2、中性粒细胞计数及合并冠心病、高血压患者比例较单纯AECOPD组,均显著偏高(P<0.05),而PaO2、淋巴细胞计数相对单纯AECOPD组比较,均显著偏低(P<0.05)。经Logistic回归分析得知,NLR是老年AECOPD合并心衰的独立危险因素(P<0.05),经ROC曲线分析可知,采用NLR对老年AECOPD患者合并心衰进行预测的ROC曲线下面积是0.828,如果将6.78作为最佳诊断截点,那么其特异度、敏感度分别为72.80%、78.50%。结论针对老年AECOPD合并心衰患者,其NLR有明显升高,且是此病的独立危险因素。

Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with heart failure.Methods Totally 138 elderly patients with AECOPD who were treated in Sanyu People's Hospital of Tongzhou Bay from January 2018 to February 2020 were selected as the study subjects,and divided into combined heart failure group and simple AECOPD group according to whether they had combined heart failure or not,with 69 cases in each group.Fasting venous blood was drawn from both groups to detect NT-proBNP and blood routine,and NLR was calculated.In addition,arterial blood was drawn to detect partial pressure of oxygen(PaO2)and carbon dioxide(PaCO2)in arterial blood.Regression analysis was used to analyze the main risk factors of heart failure in elderly AECOPD patients.The predictive value of NLR in elderly AECOPD patients with heart failure was evaluated using receiver operating characteristic(ROC)interval.Results NLR,systolic blood pressure,NT-proBNP,PaCO2,neutrophil count and the proportion of patients with coronary heart disease and hypertension in the heart failure group were significantly higher than those in the simple AECOPD group(P<0.05),while PaO2 and lymphocyte count were significantly lower than those in the simple AECOPD group(P<0.05).Logistic regression analysis showed that NLR was an independent risk factor for elderly AECOPD complicated with heart failure(P<0.05).ROC curve analysis showed that the area under ROC curve for predicting elderly AECOPD patients with heart failure using NLR was 0.828.If 6.78 was taken as the best diagnostic cut-off point,the specificity and sensitivity were 72.8%and 78.5%respectively.Conclusion NLR is significantly increased in elderly patients with AECOPD complicated with heart failure,and it is an independent risk factor for this disease.