外周血PLR、Fib水平对老年COPD患者急性加重及病情程度的评估价值

The Value of Peripheral Blood PLR and Fib Levels in Evaluating Acute Exacerbation and Severity of COPD in Elderly Patients

目的:探讨外周血血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、纤维蛋白原(fibrinogen,Fib)水平对老年慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)及病情程度的评估价值。方法:选取2020年1月至2022年12月期间我院呼吸与危重症医学科收治的老年AECOPD患者40例作为AECOPD组,根据病情程度将其分为Ⅰ级(n=9)、Ⅱ级(n=17)、Ⅲ级(n=14)。选取同期在我院门诊复诊的老年慢性阻塞性肺疾病稳定期(stable chronic obstructive pulmonary disease, SCOPD)患者40例作为SCOPD组。比较各组一般资料及PLR、Fib水平。采用logistic回归模型分析老年AECOPD的独立危险因素,通过受试者工作特征曲线(receiver operating characteristic curve, ROC)评估PLR、Fib对老年AECOPD的预测价值。结果:AECOPD组外周血PLR、Fib水平均高于SCOPD组(P<0.05);老年AECOPD不同临床分级患者PLR、Fib水平比较,差异有统计学意义(P<0.05),Ⅲ级最高,其次是Ⅱ级,Ⅰ级最低;Logistic回归分析显示,PLR、Fib的比值比分别为1.857、2.094,是老年AECOPD的独立危险因素(P<0.05);ROC曲线分析显示,PLR、Fib及二者联合预测老年AECOPD的曲线下面积分别为0.862、0.853、0.948,以二者联合预测价值最高(敏感度为87.50%,特异度为95.00%)。结论:外周血PLR、Fib水平与老年AECOPD患者病情程度相关,二者联合对老年AECOPD的诊断价值最高。

Objective:To investigate the value of platelet-to-lymphocyte ratio(PLR)and fibrinogen(Fib)in evaluating the severity of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the elderly.Methods:Forty elderly patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of our hospital from January 2020 to December 2022 were selected as AECOPD group.According to the severity of the disease,they were divided into grade I(n=9),grade II(n=17)and grade III(n=14).Forty elderly patients with stable chronic obstructive pulmonary disease(SCOPD)were selected as SCOPD group.The general data,PLR and Fib levels of each group were compared.Logistic regression model was used to analyze the independent risk factors of elderly AECOPD.The predictive value of PLR and Fib for elderly AECOPD was evaluated by receiver operating characteristic curve(ROC).Results:The levels of PLR and Fib in peripheral blood of AECOPD group were higher than those of SCOPD group(P<0.05).The levels of PLR and Fib in elderly patients with AECOPD of different clinical grades were compared,and the differences were statistically significant(P<0.05).Grade III was the highest,followed by grade II,and grade I was the lowest.Logistic regression analysis showed that the odds ratios of PLR and Fib were 1.857 and 2.094,respectively,which were independent risk factors for AECOPD in the elderly(P<0.05).ROC curve analysis showed that the area under the curve of PLR,Fib and their combination in predicting AECOPD in the elderly was 0.862,0.853 and 0.948,respectively,and the combination of the two had the highest predictive value(sensitivity 87.50%,specificity 95.00%).Conclusion:The levels of PLR and Fib in peripheral blood are related to the severity of AECOPD in elderly patients,and the combination of the two has the highest diagnostic value for AECOPD in elderly patients.