NLR在COPD合并CAP与AECOPD患者中诊断与预后的意义

doi:10.3877/cma.j.issn.1674-6902.2022.01.005

目的

对比分析中性粒细胞与淋巴细胞比值(NLR)在慢性阻塞性肺疾病(COPD)合并社区获得性肺炎(CAP)和COPD急性加重期(AECOPD)患者中的鉴别诊断价值及评估预后的潜力。

方法

选择2017年1月至2019年12月在哈尔滨医科大学附属第一医院呼吸内科及重症监护病房(ICU病房)符合条件的1 215例COPD患者为对象，依据诊断标准分为COPD合并CAP组783例和AECOPD组432例。使用Spearman相关分析，分析NLR与其他炎性指标(WBC、PCT、CRP、FIB)的相关性；绘制受试者工作特征(ROC)曲线，分析NLR对于COPD合并CAP与AECOPD的诊断价值及评估预后的潜力。

结果

Spearman相关分析显示：两组的NLR与其他炎性指标均有明显相关性(P<0.001)；ROC曲线分析显示对于3.987的NLR的截断值，鉴别两组的灵敏度为56%，特异性66%，AUC为0.627；NLR在预测ICU入住率、住院期间病死率、有创及无创机械通气使用率方面，COPD合并CAP组AUC分别为：0.79、0.773、0.791、0.726；AECOPD组AUC分别为：0.874、0.915、0.862、0.74。

结论

NLR水平在一定程度上可以鉴别COPD合并CAP与AECOPD，但准确性不高；NLR较其他炎性指标在预测ICU入住率、住院期间病死率、机械通气使用率方面表现出显著优势。

关键词: 中性粒细胞与淋巴细胞比值, 急性加重，肺疾病，慢性阻塞性, 社区获得性肺炎

Objective

To compare and analyze the value of NLR in the differential diagnosis of COPD complicated with CAP and AECOPD patients and its potential in evaluating prognosis.

Methods

The electronic medical records of all eligible 1215 COPD patients hospitalized in the Department of Respiratory Medicine and Intensive Care Unit (ICU) of the First Affiliated Hospital of Harbin Medical University from January, 2017 to December, 2019 were collected. According to the relevant diagnostic criteria, they were divided into COPD complicated with CAP group(783 cases)and AECOPD group (432 cases). By the Spearman correlation analysis, to analyze the correlation between NLR and other inflammatory indexes(WBC, PCT, CRP, FIB); By drawing the work of receiver operating characteristic (ROC) curve, to analyze the potential of NLR in the diagnosis and prognosis of COPD complicated with CAP and AECOPD.

Results

Spearman correlation analysis show that NLR is significantly correlated with other inflammatory indexes (P<0.001). ROC curve analysis show that for the cut-off value of 3.987 NLR, the sensitivity, specificity and AUC of the two groups are 56%, 66% and 0.627 respectively. The AUC of NLR in predicting ICU occupancy rate, in hospital mortality, invasive and noninvasive mechanical ventilation utilization rate are 0.79, 0.773, 0.791 and 0.726 in COPD complicated with CAP group, and 0.874, 0.915, 0.862 and 0.74 in AECOPD group.

Conclusion

NLR level can distinguish COPD complicated with CAP and AECOPD to some extent, but the accuracy is not high. NLR has significant advantages in predicting occupancy rate, in hospital mortality and mechanical ventilation rate of ICU compared with other inflammatory indexes.

Key words: Neutrophil to lymphocyte ratio, Chronic obstructive pulmonary disease, acute exacerbation, Community acquired pneumonia

表1 两组患者炎性指标结果比较

临床资料	AECOPD组(n＝432)	COPD合并CAP组(n＝783)	Z/χ²
WBC(×10⁹/L)	7.35±2.89	8.81±4.50	-5.016
NEU(×10⁹/L)	5.19±2.74	6.90±5.24	-6.148
NLR	5.06±7.01	8.08±10.42	-7.305
PCT(ng/ml)	0.22±2.23	1.30±12.57	-7.086
CRP(mg/L)	19.45±31.49	41.87±63.93	-8.144
FIB(g/L)	3.22±1.19	3.85±1.99	-6.662

表1 两组患者炎性指标结果比较

临床资料	AECOPD组(n＝432)	COPD合并CAP组(n＝783)	Z/χ²
WBC(×10⁹/L)	7.35±2.89	8.81±4.50	-5.016
NEU(×10⁹/L)	5.19±2.74	6.90±5.24	-6.148
NLR	5.06±7.01	8.08±10.42	-7.305
PCT(ng/ml)	0.22±2.23	1.30±12.57	-7.086
CRP(mg/L)	19.45±31.49	41.87±63.93	-8.144
FIB(g/L)	3.22±1.19	3.85±1.99	-6.662

表2 两组患者NLR与各炎性指标的相关性

指　标	AECOPD组		COPD合并CAP组
指　标	r	P值	r	P值
WBC	0.426	0.000	0.534	0.000
CRP	0.348	0.000	0.461	0.000
PCT	0.322	0.000	0.466	0.000
FIB	0.278	0.000	0.259	0.000

表2 两组患者NLR与各炎性指标的相关性

指　标	AECOPD组		COPD合并CAP组
指　标	r	P值	r	P值
WBC	0.426	0.000	0.534	0.000
CRP	0.348	0.000	0.461	0.000
PCT	0.322	0.000	0.466	0.000
FIB	0.278	0.000	0.259	0.000

图1 NLR与WBC、PCT、CRP、FIB在两组鉴别中的ROC曲线

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Diagnostic and prognostic significance of NLR in patients with COPD complicated with CAP and AECOPD

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Diagnostic and prognostic significance of NLR in patients with COPD complicated with CAP and AECOPD