N/LPR对AECOPD患者28天死亡预测价值研究

Study on the predictive value of N/LPR in 28-day death of AECOPD patients

目的探讨中性粒细胞计数与淋巴细胞和血小板计数比值(N/LPR)对慢性阻塞性肺疾病急性加重期(AECOPD)患者28天死亡预测价值。方法选择2018年2月~2020年10月在我院就诊的169例AECOPD患者病例资料进行研究。收集患者性别、年龄等一般资料及入组时中性粒细胞计数、淋巴细胞计数、血小板计数,并分别计算中性粒细胞计数与淋巴细胞计数比值(NLR)及N/LPR。根据28天生存情况将患者分为生存组与死亡组,比较两组患者一般资料及实验室检查指标。并以ROC分析法评估NLR及N/LPR对AECOPD患者28天生存情况的预测价值。结果纳入的169例AECOPD患者中28天内死亡35例。两组患者性别、年龄、慢阻肺病程、吸烟史、饮酒史及并发脓毒症例数比较差异均无统计学意义(P>0.05)。死亡组中性粒细胞计数、NLR、N/LPR及APACHEⅡ评分、PaCO_(2)均高于生存组,淋巴细胞计数、血小板计数、PaO_(2)均低于生存组,差异有统计学意义(P<0.05)。相关性分析结果显示,中性粒细胞计数、NLR、N/LPR、PaCO_(2)与APACHEⅡ评分均呈正相关(均P<0.05),淋巴细胞计数、血小板计数、PaO_(2)与APACHEⅡ评分均呈负相关(均P<0.05)。NLR对AECOPD患者28天死亡最佳预测截断值为14.28,敏感度为71.42%,特异度为78.36%,曲线下面积(AUC)低于N/LPR(0.766,95%CI:0.691~0.842 vs 0.916,95%CI:0.869~0.963);当最佳预测截断值为17.13时,敏感度为85.71%,特异度为86.57%。结论N/LPR可用于AECOPD患者的28天死亡预测,且其预测价值较NLR更高。

Objective To explore the predictive value of N/LPR for 28-day death of AECOPD patients.Methods The case data of 169 AECOPD patients who visited our hospital from February 2018 to October 2020 were selected for research.Collect general data such as gender and age of the patients and the neutrophil count,lymphocyte count and platelet count at the time of enrollment,and calculate the NLR and N/LPR respectively.The patients were divided into survival group and death group according to the 28-day survival status,and the general information and laboratory examination indexes of the two groups were compared.The ROC analysis method was used to evaluate the predictive value of NLR and N/LPR on 28d survival of AECOPD patients.Results Among the 169 patients included,35 died within 28 days,and the 28-day mortality rate was 20.71%.There was no significant difference in gender,age,chronic obstructive pulmonary disease course,smoking history,drinking history,and the number of patients with sepsis between the two groups(P>0.05).The neutrophil count,NLR,N/LPR,APACHEⅡscore,and PaCO_(2) in the death group were higher than those in the survival group,while the lymphocyte count,platelet count and PaO_(2) were lower than those in the survival group,and the difference was statistically significant(P<0.05).Correlation analysis results showed that neutrophil count,NLR,N/LPR,PaCO_(2) were positively correlated with APACHEⅡscore(r>0,P<0.05),lymphocyte count,platelet count,PaO_(2) and APACHEⅡscore were negatively correlated(r<0,P<0.05).The cutoff value of NLR was 14.28,sensitivity was 71.42%,specificity was 78.36%,area under curve(AUC)was 0.766,95%CI:0.691~0.842,AUC lower than N/LPR was 0.916,95%CI:0.869~0.963.When the cutoff value of NLR was 17.13,sensitivity was 85.71%,specificity was 86.57%.Conclusion N/LPR can be used to predict the 28-day death of AECOPD patients and its predictive value is higher than NLR.