新型炎性指标对老年重度慢性阻塞性肺疾病并发心房颤动的预测价值

Values of new inflammatory indicators in predicting atrial fibrillation in elderly patients with severe chronic obstructive pulmonary disease

目的探讨单核细胞与高密度脂蛋白胆固醇比值(MHR)、中性粒细胞与淋巴细胞比值(NLR)及红细胞分布宽度(RDW)与老年重度慢性阻塞性肺疾病(COPD)并发心房颤动(AF)的相关性。方法选取143例稳定期重度COPD患者,根据非瓣膜性AF发作情况及AF分型[阵发性AF(PAF),持续性、长程持续性以及永久性AF(SAF)]分为3组,即COPD组(n=50)、COPD合并PAF组(n=45)、COPD合并SAF组(n=48)。检测3组外周血MHR、NLR、RDW水平。采用二元Logistic回归模型分析MHR、NLR、RDW是否为PAF和SAF的独立预测因子。采用受试者工作特征(ROC)曲线分析独立预测因子的诊断效能。结果MHR(OR=1.438,95%CI:1.107~2.962,P=0.029)、NLR(OR=2.715,95%CI:1.066~8.537,P=0.042)是老年重度CODP患者发生PAF的独立预测因子。MHR(OR=1.477,95%CI:1.091~2.951,P=0.031)、NLR(OR=2.628,95%CI:1.017~7.063,P=0.036)和RDW(OR=1.149,95%CI:1.003~4.655,P=0.047)均是老年重度CODP患者发生SAF的独立预测因子。ROC曲线分析显示,MHR[曲线下面积(AUC)=0.644,95%CI:0.556~0.831,约登指数为0.653,敏感度为73%,特异度为80%]和NLR(AUC=0.732,95%CI:0.575~0.829,约登指数为0.791,敏感度为78%,特异度为88%)预测老年重度COPD患者发生PAF具有较高的诊断效能,NLR与MHR联合预测时诊断效能最佳(AUC=0.803,95%CI:0.619~0.897)。ROC曲线分析显示,MHR(AUC=0.693,95%CI:0.519~0.766,约登指数为0.753,敏感度为83%,特异度为92%)、NLR(AUC=0.736,95%CI:0.549~0.822,约登指数为0.651,敏感度为91%,特异度为87%)和RDW(AUC=0.708,95%CI:0.642~0.873,约登指数为0.738,敏感度为94%,特异度为80%)预测老年重度COPD患者发生SAF时具有较高的诊断效能,NLR、MHR和RDW联合预测时诊断效能最佳(AUC=0.824,95%CI:0.738~0.916)。结论外周血MHR、NLR和RDW联合检测在预测老年重度COPD患者AF发生和AF严重程度方面具有重要的临床价值。

Objective To investigate the relationships of the monocyte to high-density lipoprotein cholesterol ratio(MHR),the neutrophils to lymphocytes ratio(NLR)and the red blood cell distribution width(RDW)with atrial fibrillation(AF)in elderly patients with severe chronic obstructive pulmonary disease(COPD).Methods A total of 143 patients with severe COPD in stable phase were selected,and according to incidence and classification of non-valvular AF[paroxysmal AF(PAF),persistent and long-standing persistent and sustained AF(SAF)],they were divided into COPD group(n=50),COPD combined with PAF group(n=45),and COPD combined with SAF group(n=48).Levels of MHR,NLR and RDW in peripheral blood were detected in the three groups.A binary Logistic regression model was used to analyze whether MHR,NLR and RDW were independent predictors of PAF and SAF.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of independent predictors.Results MHR(OR=1.438;95%CI,1.107 to 2.962,P=0.029)and NLR(OR=2.715;95%CI,1.066 to 8.537,P=0.042)were the independent predictors of PAF in elderly patients with severe COPD.MHR(OR=1.477;95%CI,1.091 to 2.951,P=0.031),NLR(OR=2.628;95%CI,1.017 to 7.063,P=0.036)and RDW(OR=1.149;95%CI,1.003 to 4.655,P=0.047)were the independent predictors of SAF in elderly patients with severe COPD.ROC curve analysis showed that MHR[area under the curve(AUC)was 0.644,95%CI,0.556 to 0.831,Youden index was 0.653,sensitivity was 73%,and specificity was 80%]and NLR(AUC was 0.732,95%CI,0.575 to 0.829,Youden index was 0.791,sensitivity was 78%,and specificity was 88%)had high diagnostic efficacies in predicting PAF in elderly patients with severe COPD,and the diagnostic efficiency reached the best value when NLR was combined with MHR for prediction(AUC was 0.803,95%CI,0.619 to 0.897).ROC curve analysis showed that MHR(AUC was 0.693,95%CI,0.519 to 0.766,Youden index was 0.753,sensitivity was 83%,and specificity was 92%),NLR(AUC was 0.736,95%CI,0.549 to 0.822,Youden index was 0.651,sensitivity was 91%,and specificity was 87%)and RDW(AUC was 0.708,95%CI,0.642 to 0.873,Youden index was 0.738,sensitivity was 94%,and specificity was 80%)had high diagnostic efficacies in predicting SAF in elderly patients with severe COPD,and the diagnostic efficiency reached the best value when NLR was combined with MHR and RDW for prediction(AUC was 0.824,95%CI,0.738 to 0.916).Conclusion The combined detection of MHR,NLR and RDW in peripheral blood has important clinical value in predicting the occurrence and severity of AF in elderly patients with severe COPD.