RDW、PCT、CRP、MPV/PLT对AECOPD患者预后的预测价值

The value of red cell distribution width,procalcitonin,C-reactive protein,and mean platelet volume/platelet count in predicting the prognosis of patients with acute exacerbations of chronic obstructive pulmonary disease

目的:探讨红细胞分布宽度(RDW)、降钙素原(PCT)、C反应蛋白(CRP)、血小板平均体积(MPV)/血小板计数(PLT)对慢性阻塞性肺疾病急性加重期(AECOPD)患者预后的预测价值。方法:回顾性分析海阳市人民医院2020年3月至2021年3月收治的AECOPD患者137例的临床资料,依据其预后情况分为生存组(99例)与死亡组(38例)。采用血细胞分析仪(mindray ABC5390)检测患者RDW、MPV、PLT水平;采用ETHealthcare仪检测患者PCT、CRP水平;对比两组患者RDW、PCT、CRP、MPV/PLT水平差异,通过受试者工作特征曲线(ROC曲线)分析RDW、PCT、CRP、MPV/PLT对AECOPD患者预后的预测价值。结果:生存组住院时间[(10.75±2.51)d]、住院费用[(1.49±0.46)万元]明显短于、低于死亡组[(12.81±3.36)d、(2.18±0.57)万元]( t=6.11、14.45,均 P < 0.05);生存组PLT[(214.01±63.97)×10^(9)/L]明显高于死亡组[(189.04±61.75)×10^(9)/L],生存组RDW[(13.18±2.30)%]、PCT[(4.30±1.82)ng/L]、CRP[(31.06±10.38)mg/L]、MPV[(11.39±2.16)fL]、MPV/PLT[(0.05±0.01)]明显低于死亡组[(16.65±1.78)%、(9.55±2.11)ng/L、(68.21±20.94)mg/L、(12.28±2.09)fL、(0.06±0.02)]( t=2.07、8.38、14.45、13.82、2.18、3.88,均 P < 0.05);ROC曲线分析结果显示,RDW、PCT、CRP、MPV/PLT及联合预测AECOPD预后的曲线下面积分别为0.831、0.978、0.966、0.713、0.988,敏感性分别为62.6%、89.9%、91.9%、59.6%、98.0%,特异性分别为97.4%、97.4%、100.0%、65.8%、92.1%。 结论:联合检测RDW、PCT、CRP、MPV/PLT对AECOPD患者预后具有较高的预测价值,临床需根据患者实际情况选取相应指标指导临床诊治。

Objective:To investigate the value of red cell distribution width(RDW),procalcitonin(PCT),C-reactive protein(CRP),mean platelet volume(MPV)/platelet count(PLT)in predicting the prognosis of patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods:The clinical data of 137 patients with AECOPD admitted to the Department of Laboratory Medicine of Haiyang People's Hospital from March 2020 to March 2021 were retrospectively analyzed.According to their prognosis,these patients were divided into the survival group(n=99)and the death group(n=38).RDW,MPV,and PLT were measured using a blood cell analyzer(mindray ABC5390)in all patients.PCT and CRP levels were measured using the ETHealthcare instrument in all patients.RDW,PCT,CRP,and MPV/PLT were compared between the two groups.The value of RDW,PCT,CRP and MPV/PLT in predicting the prognosis of patients with AECOPD was analyzed using receiver operating characteristic curves.Results:The length of hospital stay and hospitalization expenses in the survival group were(10.75±2.51)days and(1.49±0.46)ten thousand yuan,respectively,which were significantly shorter and lower than(12.81±3.36)days and(2.18±0.57)ten thousand yuan in the death group(t=6.11,14.45,both P<0.05).The level of PLT in the survival group was significantly higher than that in the death group[(214.01±63.97)×10^(9)/L vs.(189.04±61.75)×10^(9)/L,t=2.07,P<0.05].RDW,PCT,CRP,MPV,and MPV/PLT in the survival group were(13.18±2.30)%,(4.30±1.82)ng/L,(31.06±10.38)mg/L,(11.39±2.16)fL,and(0.05±0.01),respectively,which were significantly lower than(16.65±1.78)%,(9.55±2.11)ng/L,(68.21±20.94)mg/L,(12.28±2.09)fL,(0.06±0.02)in the death group(t=8.38,14.45,13.82,2.18,3.88,all P<0.05).The receiver operating characteristic curve analysis results showed that the area under the curves depicting the value of RDW,PCT,CRP,MPV/PLT and their combination in predicting AECOPD was 0.831,0.978,0.966,0.713,0.988,with the predictive sensitivity of 62.6%,89.9%,91.9%,59.6%,98.0%,respectively,and the predictive specificity of 97.4%,97.4%,100.0%,65.8%,92.1%,respectively.Conclusion:Combined detection of RDW,PCT,CRP and MPV/PLT has a high value for the prediction of AECOPD.Corresponding indicators should be selected according to the actual situation of patients to guide clinical diagnosis and treatment.