红细胞分布宽度联合中性粒细胞/淋巴细胞比值对慢性阻塞性肺疾病急性加重期患者预后的评估价值

Evaluation value of red blood cell distribution width combined with neutrophil/lymphocyte ratio in prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨红细胞分布宽度(RDW)联合中性粒细胞/淋巴细胞比值(NLR)对慢性阻塞性肺疾病急性加重期(AECOPD)患者预后的评估价值。方法选取2017年1月—2019年12月徐州医科大学附属宿迁医院收治的160例AECOPD患者,根据其住院期间预后生存情况分为存活组(120例)与死亡组(40例)。比较两组治疗方式、并发症发生情况及RDW和NLR水平。采取多因素logistic回归分析RDW、NLR对AECOPD预后的影响。采用ROC曲线下面积评估血清RDW和NLR对AECOPD预后的诊断价值。结果存活组机械通气治疗比例显著低于死亡组(P<0.05);两组β2受体激动剂及吸入激素治疗比例比较,差异无统计学意义(P>0.05)。存活组肺心病发生率显著低于死亡组(P<0.05);两组高血压、高血脂、糖尿病、心房颤动等发生率比较,差异无统计学意义(P>0.05)。存活组RDW和NLR水平均显著低于死亡组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,机械通气(OR=23.050,95%CI:1.688~314.701,P<0.05)、肺心病(OR=15.223,95%CI:1.248~185.706,P<0.05)、RDW(OR=171.288,95%CI:6.075~4829.307,P<0.05)和NLR(OR=8.410,95%CI:1.414~50.022,P<0.05)是影响AECOPD预后的独立危险因素(P<0.05)。联合检测曲线下面积明显高于RDW与NLR,差异有统计学意义(P<0.05)。结论RDW和NLR水平升高是AECOPD患者预后的危险因素,早期联合检测可作为诊断患者预后的重要生化标志物。

Objective To investigate the evaluation value of red blood cell distribution width(RDW)combined with neutrophil/lymphocyte ratio(NLR)in prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred and sixty patients with AECOPD admitted to Suqian Hospital Affiliated to Xuzhou Medical University from January 2017 to December 2019 were selected and divided into survival group(120 cases)and death group(40 cases)according to their prognosis and survival.The treatment methods,complications,RDW and NLR levels of two groups were compared.The effects of RDW and NLR on the prognosis of AECOPD were analyzed by multivariate logistic regression.The diagnostic value of serum RDW and NLR in the prognosis of AECOPD were evaluated by the area under ROC curve.Results The proportion of mechanical ventilation in survival group was significantly lower than that in death group(P<0.05).There were no significant differences in the proportion ofβ2 receptor agonist and inhaled hormone between two groups(P>0.05).The incidence rate of pulmonary heart disease in survival group was significantly lower than that in death group(P<0.05).There were no significant differences in the incidence of hypertension,hyperlipidemia,diabetes and atrial fibrillation between two groups(P>0.05).The levels of RDW and NLR in survival group were significantly lower than those in death group(P<0.05).Multivariate logistic regression analysis showed that mechanical ventilation(OR=23.050,95%CI:1.688-314.701,P<0.05),pulmonary heart disease(OR=15.223,95%CI:1.248-185.706,P<0.05),RDW(OR=171.288,95%CI:6.075-4829.307,P<0.05)and NLR(OR=8.410,95%CI:1.414-50.022,P<0.05)were independent risk factors for the prognosis of AECOPD(P<0.05).The area under the curve of combined detection was significantly higher than that of RDW and NLR(P<0.05).Conclusion The elevated levels of RDW and NLR are risk factors for the prognosis of AECOPD patients,early combined detection can be used as an important biochemical marker to diagnose the prognosis of patients.