中性粒细胞淋巴细胞比值与IL-10联合检测对COPD患者预后的预测价值

Predictive value of neutrophil-to-lymphocyte ratio and IL-10 combined detection for the prognosis in patients with chronic obstructive pulmonary disease

目的探讨中性粒细胞淋巴细胞比值(NLR)与白细胞介素-10(IL-10)联合检测对慢性阻塞性肺疾病(COPD)患者预后的预测价值。方法回顾性收集2017年1月至2019年7月期间在青岛大学附属威海市中心医院住院治疗的COPD患者216例为研究对象,根据患者病情分为稳定COPD组122例[男76例、女46例,年龄(68.7±7.1)岁]和慢性阻塞性肺疾病急性加重期(AECOPD)组94例[男58例、女36例,年龄(69.7±7.6)岁]。比较两组NLR、IL-10水平及肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC]的差异及其相关性;用受试者工作特征曲线(ROC)预测COPD病情,评估NLR、IL-10联合检测对AECOPD的诊断价值;根据NLR、IL-10水平截断值分层分析不同NLR、IL-10水平对COPD患者预后的预测价值。采用t检验、χ^(2)检验、Pearson相关性分析、Kaplan-Meier曲线、Log-rank检验。结果AECOPD组NLR水平[(9.96±2.87)]高于稳定COPD组[(4.15±2.84)],IL-10[(46.06±8.42)ng/L]、FEV1[(1.58±0.31)L]、FVC[(2.06±0.34)L]、FEV1/FVC水平[(65.02±9.27)%]均低于稳定COPD组[(68.53±7.49)ng/L、(2.14±0.45)L、(3.56±0.38)L、(72.37±5.08)%],差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,患者NLR水平与肺功能指标FEV1、FVC、FEV1/FVC水平均呈负相关(均P<0.05),IL-10与FEV1、FVC、FEV1/FVC水平均呈正相关(均P<0.05)。ROC分析发现,NLR、IL-10均对AECOPD有较好诊断价值[曲线下面积(AUC)为0.803、0.826],而两者联合检测的诊断效能优于单独检测(AUC为0.875)。根据NLR、IL-10的截断值将216例COPD患者分为A组(NLR>9.15,IL-10≤45.72 ng/L)64例、B组(NLR>9.15,IL-10>45.72 ng/L)72例、C组(NLR≤9.15,IL-10≤45.72 ng/L)49例、D组(NLR≤9.15,IL-10>45.72 ng/L)31例。用ROC对各组进行生存分析发现,随访期间,A组、B组、C组、D组患者病死率分别为35.9%(23/64)、29.2%(21/72)、12.2%(6/49)、9.7%(3/31),中位生存期分别为(9.22±0.48)个月、(10.04±0.51)个月、(13.54±0.60)个月、(16.02±0.76)个月,4组比较差异均有统计学意义(均P<0.05)。结论NLR、IL-10水平与COPD患者肺功能密切相关,两者联合检测对AECOPD具有较好的诊断价值,且对患者预后有一定的预测价值。

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)and interleukin-10(IL-10)combined detection for the prognosis in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 216 COPD patients were collected from Weihai Central Hospital Affiliated to Qingdao University from January 2017 to July 2019,and they were divided into a stable COPD group[122 cases,including 76 males and 46 females,aged(68.7±7.1)years]and an acute exacerbation of COPD(AECOPD)group[94 cases,including 58 males and 36 females,aged(69.7±7.6)years]based on their clinical conditions.The levels and correlations of NLR,IL-10,and pulmonary function parameters[forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and FEV1/FVC]were compared between the two groups.The receiver operating characteristic curve(ROC)was used to predict the severity of COPD,and the diagnostic value of combined detection of NLR and IL-10 in AECOPD was evaluated.Stratified analysis based on the cutoff values of NLR and IL-10 levels was performed to assess their predictive values for the prognosis in COPD patients.t test,χ^(2) test,Pearson correlation analysis,Kaplan-Meier curve analysis,and Log-rank test were used.Results The level of NLR in the AECOPD group[(9.96±2.87)]was higher than that in the stable COPD group[(4.15±2.84)],and the levels of IL-10[(46.06±8.42)ng/L],FEV1[(1.58±0.31)L],FVC[(2.06±0.34)L],and FEV1/FVC[(65.02±9.27)%]were lower than those in the stable COPD group[(68.53±7.49)ng/L,(2.14±0.45)L,(3.56±0.38)L,and(72.37±5.08)%],with statistically significant differences(all P<0.05).Pearson correlation analysis showed that FEV1,FVC,and FEV1/FVC had a negative correlation with NLR and a positive correlation with IL-10(all P<0.05).ROC analysis showed that both NLR and IL-10 had good diagnostic values for AECOPD[area under the curve(AUC)of 0.803 and 0.826],and the diagnostic efficiency of combined detection was superior to that of single detection(AUC of 0.875).According to the cut-off values of NLR and IL-10,the 216 COPD patients were divided into group A(NLR>9.15,IL-10≤45.72 ng/L)with 64 cases,group B(NLR>9.15,IL-10>45.72 ng/L)with 72 cases,group C(NLR≤9.15,IL-10≤45.72 ng/L)with 49 cases,and group D(NLR≤9.15,IL-10>45.72 ng/L)with 31 cases.Survival analysis using the ROC during the follow-up period showed that the mortality rates of group A,group B,group C,and group D were 35.9%(23/64),29.2%(21/72),12.2%(6/49),and 9.7%(3/31),respectively,and the median survival periods were(9.22±0.48)months,(10.04±0.51)months,(13.54±0.60)months,and(16.02±0.76)months,respectively,with statistically significant differences among the four groups(both P<0.05).Conclusions NLR and IL-10 levels are closely associated with the pulmonary function in COPD patients.The combined detection of NLR and IL-10 has good diagnostic value for AECOPD and can predict the prognosis to a certain extent.