中性粒细胞/淋巴细胞比值对AECOPD发展为肺性脑病风险的预测价值

Predictive value of neutrophil/lymphocyte ratio for the risk of AECOPD developing into pulmonary encephalopathy

目的 评估中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)发展为肺性脑病风险的预测价值。方法 收集2016年1月至2022年6月辽宁健康产业集团本钢总医院急诊及呼吸科收治的AECOPD患者83例,根据患者治疗中的格拉斯哥昏迷评分(GCS),将其分为意识障碍组35例及非意识障碍组48例。回顾性分析AECOPD患者入院时的临床资料,采用单因素分析比较两组入院时实验室指标差异;采用二元多因素logistic回归分析筛选AECOPD发展为肺性脑病的高危因素;绘制受试者工作特征曲线(ROC),评估NLR对AECOPD发展为肺性脑病风险的预测价值。结果 意识障碍组与非意识障碍组比较,患者的白细胞计数(WBC)、中性粒细胞计数(NEU)、血小板计数(PLT)、碳酸氢根(HCO3-)、血乳酸(Lac)、动脉血p H值、二氧化碳分压(PaCO_(2))、氧分压(PaO2)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血肌酐(SCr)比较差异均无统计学意义(P> 0.05)。但意识障碍组淋巴细胞(LYM)、 NLR与非意识障碍组比较,差异均有统计学意义[LYM:1.66(1.17, 2.03)vs 2.31(1.82, 2.89), NLR:7.16±1.49 vs 4.48±1.29,均P<0.001]。多因素logistic回归分析显示,NLR(OR=2.822,95%CI=1.734~4.594,P<0.001)为AECOPD发展为肺性脑病的独立危险因素。ROC曲线分析显示,NLR对AECOPD发展为肺性脑病风险具有很好的预测价值,AUC为0.876;当最佳截断值为6.04时,敏感度为82.9%,特异度为85.4%,阳性似然比为5.678,阴性似然比为0.200。结论 入院时NLR升高是AECOPD患者发展为肺性脑病的高危因素,并且升高的NLR对AECOPD患者发展为肺性脑病风险具有良好的预测价值。

Objective To evaluate the predictive value of neutrophil/lymphocyte ratio(NLR) on the risk of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) developing into pulmonary encephalopathy. Methods From January 2016to June 2022, the clinical data of 83 patients with AECOPD were collected from the Emergency Department and Respiratory Department of Liaoning Health Industry Group Benxi Steel General Hospital. According to the Glasgow Coma Scale(GCS)score during the treatment, they were divided into conscious disorder group(35 patients) and with non-conscious disorder group(48 patients). The first clinical data of AECOPD patients at admission were analyzed retrospectively, and the differences of laboratory indexes between the two groups at admission were compared by single factor analysis. The risk factors for AECOPD to develop into pulmonary encephalopathy were screened by binary multivariate logistic regression analysis. An receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of NLR on the risk of AECOPD developing into pulmonary encephalopathy. Results There were no significant differences in the white blood cell count(WBC),neutrophil count(NEU), platelet count(PLT), bicarbonate(HCO3-), blood lactic acid(Lac), arterial blood pH, partial pressure of carbon dioxide(PaCO2), partial pressure of oxygen(PaO2), alanine aminotransferase(ALT), aspartate aminotransferase(AST), and serum creatinine(SCR) between the conscious disorder group and the non-conscious disorder group(P>0.05).However, lymphocytes(LYM) and neutrophils/lymphocytes(NLR) in the conscious disorder group were significantly different from those in the non-conscious disorder group [LYM: 1.66(1.17, 2.03) vs 2.31(1.82, 2.89), NLR: 7.16 ± 1.49 vs 4.48 ± 1.29, both P< 0.001]. Multivariate logistic regression analysis revealed that NLR(OR=2.822, 95%CI=1.734-4.594, P< 0.001) was an independent risk factor for AECOPD to develop into pulmonary encephalopathy. ROC curve analysis showed that NLR had a good predictive value for the risk of AECOPD developing into pulmonary encephalopathy with an AUC of 0.876. When the optimal cut-off value was 6.04, the sensitivity was 82.9%, the specificity was 85.4%, the positive likelihood ratio was 5.678, and the negative likelihood ratio was 0.200. Conclusion The increase of NLR at admission is a high risk factor for AECOPD patients to develop pulmonary encephalopathy and has a good predictive value for the risk of AECOPD patients to develop pulmonary encephalopathy.