NLR、IL-6及FeNO对阿奇霉素治疗慢性阻塞性肺疾病合并哮喘稳定期效果的预测价值

Predictive value of NLR,IL-6 and Fe NO on the efficacy of azithromycin in the treatment of chronic obstructive pulmonary disease complicated with asthma in stable stage

目的分析中性粒细胞/淋巴细胞比值(NLR)、白介素-6(IL-6)及呼出气一氧化氮(FeNO)对阿奇霉素治疗慢性阻塞性肺疾病合并哮喘稳定期效果的预测价值。方法选择2019年8月—2020年12月在广东同江医院就诊的慢性阻塞性肺疾病合并哮喘稳定期患者66例作为研究对象,按照FeNO水平分为低FeNO组(FeNO≤32 ppb)28例和高FeNO组(FeNO>32 ppb)38例。2组患者均严格按照《慢性阻塞性肺疾病全球倡议(GOLD)》2020版及《全球哮喘防治倡议(GINA)》2020版稳定期治疗建议行常规治疗,在此基础上给予阿奇霉素0.25 g/d口服,服用16周。比较2组患者治疗前后中性粒细胞/淋巴细胞比值(NLR)、白介素-6(IL-6)、6 min步行试验(6MWT),分析治疗前NLR、IL-6、FeNO水平与治疗前后6MWT差值的关联程度。结果治疗前低FeNO组NLR高于高FeNO组(P<0.05);低FeNO组治疗前IL-6、6MWT与高FeNO组比较差异无统计学意义(P>0.05);低FeNO组患者NLR、IL-6、6MWT治疗前后比较差异均有统计学意义(P<0.01);高FeNO组患者NLR、IL-6、6MWT治疗前后比较差异均有统计学意义(P<0.05);但对低FeNO组和高FeNO组在治疗后6MWT指标进行对比,低FeNO组治疗后6MWT明显高于高FeNO组,结果存在明显差异(P<0.01)。6MWT差值为因变量,治疗前NLR、IL-6、FeNO为自变量,构建的多重逐步线性回归模型具有统计学意义(F=51.281,P<0.001),其中自变量治疗前IL-6为排除变量(t=1.531,P=0.131),而自变量治疗前NLR(β=0.260,P=0.003)、FeNO(β=-0.648,P<0.001)对6MWT差值有预测价值。结论治疗前FeNO及NLR对阿奇霉素治疗慢性阻塞性肺疾病合并哮喘稳定期患者效果有明显预测价值,FeNO水平越低,NLR越高,6MWD改善越明显。

Objective To analyze the predictive value of neutrophil/lymphocyte ratio(NLR),interleukin-6(IL-6)and exhaled nitric oxide(FeNO)on the therapeutic effect of azithromycin in chronic obstructive pulmonary disease with asthma in stable stage.Methods 66 patients with chronic obstructive pulmonary disease and stable asthma who were treated in Guangdong Tongjiang Hospital from August 2019 to December 2020 were selected as the research subjects,and they were divided into low FeNO group(FeNO≤32 ppb)28 cases and high FeNO group(FeNO>32 ppb)38 cases according to FeNO level.Both groups of patients were given routine treatment in strict accordance with the“Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD)”2020 edition and“Global Asthma Prevention and Control Initiative(GINA)”2020 edition stable treatment recommendations,and on this basis,both groups were given azithromycin 0.25 g/d orally for16 weeks.The NLR,IL-6 and 6MWT were compared between the two groups before and after treatment,and the correlation between the levels of NLR,IL-6 and FeNO before treatment and the difference of 6MWT before and after treatment was analyzed.Results Before treatment,the NLR in the low FeNO group was higher than that in the high FeNO group(P<0.05);There were no significant difference in IL-6,6MWT between the low FeNO group and the high FeNO group before treatment(P>0.05);There were significant differences in NLR,IL-6 and 6MWT before and after treatment in the low FeNO group(P<0.01);And also there were significant differences in NLR,IL-6 and 6MWT before and after treatment in the high FeNO group(P<0.05);However,the 6MWT indexes of low FeNO group and high FeNO group were compared after treatment,6MWT in low FeNO group was significantly higher than that in high FeNO group(P<0.01).The 6MWT difference was the dependent variable,and NLR,IL-6 and FeNO were the independent variables before treatment,the multiple stepwise linear regression model constructed was statistically significant(F=51.281,P<0.001),the independent variable IL-6before treatment was an excluded variable(t=1.531,P=0.131),while the independent variable NLR before treatment(β=0.260,P=0.003),FeNO(β=-0.648,P<0.001)has predictive significance for the 6MWT difference.Conclusion FeNO and NLR of all patients before treatment has significant predictive value on the therapeutic effect of azithromycin in chronic obstructive pulmonary disease with asthma in stable stage,the lower the FeNO level,the higher the NLR,and the more pronounced the improvement in 6MWD.