中性粒细胞/淋巴细胞比率和凝血功能异常对慢性阻塞性肺疾病严重程度的判断价值

The value of neutrophil to lymphocyte ratio and coagulation abnormality in judging the severity of chronic obstructive pulmonary disease

目的:探讨中性粒细胞/淋巴细胞比率(NLR)和凝血功能(PT、APTT、TT、Fib、D-二聚体)在判断慢性阻塞性肺疾病(COPD)病情严重程度中的价值。方法:选取2015-01—2018-10期间就诊于南京医科大学第一附属医院的405例COPD患者为研究对象,根据病程划分为急性加重期COPD(AECOPD)组(A组,274例)和稳定期COPD组(B组,131例),再另取同期204例健康对象作为对照组(C组)。比较3组患者的血常规、凝血功能指标及炎症水平,并采用Pearson相关分析法分析AECOPD患者NLR与WBC、Fib和D-二聚体的相关性。结果:①A、B组WBC和NLR明显高于C组(P<0.05),而A组变化更显著,尤以NLR为甚;②A组的PCT水平明显高于C组(P<0.05),但A、B两组间PCT的差异无统计学意义;③A组和B组的APTT、Fib、D-二聚体均高于C组(P<0.05),且A组变化更明显(P<0.05);④AECOPD患者的NLR与WBC、Fib、D-二聚体均呈显著正相关(r=0.523、0.221、0.123)(均P<0.05)。结论:NLR可作为潜在炎症指标,凝血功能异常反映血栓前状态,二者联合对于COPD患者的诊疗评估具有重要的指导意义。

Objective:To explore the value of neutrophil to lymphocyte ratio(NLR)and coagulation abnormality(PT,APTT,TT,Fib,D-D)in judging the severity of chronic obstructive pulmonary disease(COPD).Method:Four hundred and five COPD patients from January 2015 to October 2018 were selected as subjects.According to the course of disease,they were divided into Group A(274 patients with acute exacerbation of COPD)and Group B(131 patients with stable COPD).Another 204 healthy subjects in the same period were selected as control group(Group C).In this study,we compared the blood routine,coagulation function and inflammation levels among the three groups,and analyzed the correlation between NLR and WBC,Fib,D-D in AECOPD patients by Pearson correlation analysis.Result:①WBC and NLR in group A and B were significantly higher than those in group C(P<0.05),but the changes in group A were more significant,especially the NLR.②The level of PCT in group A was significantly higher than that in group C(P<0.05),but there was no significant difference between group A and group B.③APTT,Fib and D-D in group A and group B were higher than those in group C(P<0.05),and the change was more obvious in group A(P<0.05).④The NLR of AECOPD was positively correlated with WBC,Fib and D-D(r value was 0.523,0.221,0.123 respectively and all P<0.05).Conclusion:NLR can be used as a potential indicator of inflammation.Coagulation dysfunction reflects pre-thrombotic state.The combination of the NLR and the coagulation function has important guiding significance for the diagnosis and treatment evaluation of COPD patients.