临床检测指标对慢性阻塞性肺疾病急性加重期预后的判断价值

Value of clinical indicators for predicting the prognosis of acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(慢阻肺)急性加重期(AECOPD)患者出院后1年内预后不良的影响因素。方法本研究为回顾性队列研究,采用目的抽样法选取2021年10月至2022年10月就诊于内蒙古自治区人民医院的AECOPD患者206例为研究对象,根据患者出院后1年内的预后情况,分为预后良好组(155例)和预后不良组(51例)。对比2组性别、年龄、吸烟史、住院时间、ADO评分、慢阻肺肺功能分级、改良英国医学研究委员会呼吸困难量表(mMRC)评分,入院第1天抽血化验白细胞、中性粒细胞、血小板、淋巴细胞、单核细胞计数,计算中性粒细胞和淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、单核细胞淋巴细胞比值(MLR)和第1秒用力呼气容积占预计值百分比(FEV 1%pred)差异,应用受试者操作特性(ROC)曲线评价AECOPD患者预后不良的影响因素。结果预后良好组155例,男106例,女49例,年龄(68.05±7.95)岁;预后不良组51例,男38例,女13例,年龄(71.71±7.85)岁。预后良好组155例,男106例,女49例,年龄(68.05±7.95)岁;预后不良组51例,男38例,女13例,年龄(71.71±7.85)岁。预后不良组比预后良好组年龄较大(t=0.68;P=0.005)、有吸烟史者较多(Z=6.84,P=0.033)、ADO指数[5.00(5.00,7.00)比4.00(4.00,5.00),Z=4.22,P<0.001]和GOLD分级的级别较高(Z=11.070,P=0.011);NLR[3.70(2.27,4.48)比2.67(1.89,3.93)]、PLR[1012.93(699.07,1409.33)比702.44(557.80,1010.10)]、MLR[0.36(0.24,0.49)比0.30(0.22,0.40)]均较高,FEV 1%pred,[39.70(25.00,54.20)%比47.47(32.71,61.30)%]较低;差异均有统计学意义(Z值分别为2.54、3.28、2.36、2.79,均P<0.05)。2组间性别、mMRC及住院天数差异性无统计学意义(均P>0.05)。多因素logistic逐步回归分析显示年龄(OR:2.86,95%CI:1.37~5.96)、PLR(OR:2.71,95%CI:1.32~5.58)、FEV 1%pred(OR:0.39,95%CI:0.18~0.84)、ADO指数(OR:2.61,95%CI:1.26~5.40)为AECOPD预后不良的影响因素。应用ROC曲线预测PLR、NLR、MLR、ADO指数对慢阻肺患者的影响,ADO指数ROC曲线下面积最大为0.69,敏感度为76.47%。结论年龄、PLR、FEV 1%pred和ADO指数可能是AECOPD患者预后不良的影响因素。

ObjectiveTo explore the influencing factors of poor prognosis within one year after discharge in patients with acute exacerbation of COPD(AECOPD).MethodsThis is a retrospective cohort study,using purposive sampling method to select 206 AECOPD patients who visited Inner Mongolia Autonomous Region People′s Hospital from October 2021 to October 2022 as the study subjects.Based on the prognosis of the patients within one year after discharge,they were divided into good prognosis group(155 cases)and poor prognosis group(51 cases).The following items were compared:gender,age,smoking history,length of hospital stay,ADO score,COPD lung function grade,and dyspnea scale(mMRC score)between two groups.On the first day of admission,blood analysis was done to ascertain the counts of white blood cells,neutrophils,platelets,lymphocytes,and monocytes.The neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR),and the percentage of forced expiratory volume at 1 second(FEV 1%predicted value)were calculated.Receiver operating characteristic(ROC)curve was used to evaluate the influencing factor of poor prognosis in AECOPD patients.ResultsThere were 155 cases in the group with good prognosis,including 106 males and 49 females,aged(68.05±7.95)years old;there were 51 cases in the poor prognosis group,including 38 males and 13 females,aged(71.71±7.85)years old.The patients in the poor prognosis group are older(t=0.68;P=0.005),have a higher history of smoking(Z=6.84,P=0.033),higher level of ADO index(5.00[5.00,7.00]vs 4.00[4.00,5.00],Z=4.22,P<0.001),higher GOLD grading(Z=11.070,P=0.011),higher NLR,PLR,MLR(3.70[2.27,4.48]vs 2.67[1.89,3.93];1012.93[699.07,1409.33]vs 702.44[557.80,1010.10];0.36[0.24,0.49]vs 0.30[0.22,0.40],respectively),and lower FEV 1%predicted values(39.70[25.00,54.20]vs 47.47[32.71,61.30]).All the differences were statistically significant(Z=2.54,3.28,2.36,2.79 respectively;all P<0.05),but there was no statistical significance in gender,mMRC,and length of hospital stay between the two groups(all P>0.05).Multivariate logistic stepwise regression analysis showed that age(OR:2.86,95%CI:1.37~5.96),PLR(OR:2.71,95%CI:1.32~5.58),FEV 1%predicted value(OR:0.39,95%CI:0.18~0.84),and ADO index(OR:2.61,95%CI:1.26~5.40)were the influencing factors for poor prognosis of AECOPD.ROC curves were applied to predict the impact of PLR,NLR,MLR,and ADO index on patients with COPD.The maximum area of ADO index under the ROC curve is 0.69,with a sensitivity of 76.47%.ConclusionsAge,PLR,FEV 1%predicted value,and ADO index may be influencing factors for poor prognosis in AECOPD patients.