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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (02) : 227 -233. doi: 10.3877/cma.j.issn.1674-6902.2026.02.007

论著

83例慢性阻塞性肺疾病急性加重期D-二聚体与白蛋白比值、CT参数和肺功能相关性分析
郑旭峰1, 陈法桂2, 高永槟1, 郑锦镇2, 朱慈燕2, 张庆武1, 林黛英1,†()   
  1. 1515000　汕头，汕头市中心医院放射科
    2515000　汕头，汕头市中心医院呼吸与危重症医学科
  • 收稿日期:2025-09-25 出版日期:2026-04-25
  • 通信作者: 林黛英
  • 基金资助:
    广东省医学科研基金立项项目(B2023426); 汕头市医疗卫生科技计划(221118176491192)

Correlation between D-dimer-to-albumin ratio, chest CT indicators and pulmonary function in 83 patients with acute exacerbation of chronic obstructive pulmonary disease

Xufeng Zheng1, Fagui Chen2, Yongbin Gao1, Jinzhen Zheng2, Ciyan Zhu2, Qingwu Zhang1, Daiying Lin1,†()   

  1. 1Department of Radiology, Shantou Central Hospital, Shantou 515000, China
    2Department of Respiratory and Critical Care Medicine, Shantou 515000, China
  • Received:2025-09-25 Published:2026-04-25
  • Corresponding author: Daiying Lin
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引用本文：

郑旭峰, 陈法桂, 高永槟, 郑锦镇, 朱慈燕, 张庆武, 林黛英. 83例慢性阻塞性肺疾病急性加重期D-二聚体与白蛋白比值、CT参数和肺功能相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 227-233.

Xufeng Zheng, Fagui Chen, Yongbin Gao, Jinzhen Zheng, Ciyan Zhu, Qingwu Zhang, Daiying Lin. Correlation between D-dimer-to-albumin ratio, chest CT indicators and pulmonary function in 83 patients with acute exacerbation of chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 227-233.

目的

探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)D-二聚体与白蛋白比值(D-dimer and albumin ratio, DAR)和计算机断层扫描(computed tomography, CT)参数与肺功能的关系。

方法

回顾性纳入2019年3月至2024年12月我院收治的83例AECOPD患者为观察组、82例COPD患者为对照组。比较两组肺功能、DAR、CT参数。采用Spearman秩相关分析DAR、胸部CT和肺功能的关系。

结果

观察组DAR高于对照组[17.90(12.17，38.93)比8.39(6.27，13.73)，P<0.001]。DAR诊断AECOPD受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under the curve, AUC)0.827高于C反应蛋白AUC 0.803、中性粒细胞计数AUC 0.647、淋巴细胞计数AUC 0.639、单核细胞计数AUC 0.637。观察组肺容积小于对照组[(3.58±0.93) L比(4.77±1.14) L，t＝7.351，P<0.001]，肺气肿指数(emphysema index, EI)[19.36(10.62，30.46)% 比6.03(3.83，12.08)%，Z＝－6.965，P<0.001]和空气潴留指数(air trapping index, ATI)[0.97±0.02比0.91±0.02，t＝19.270，P<0.001]高于对照组，第1秒用力呼气容积(forced expiratory volume in one second, FEV1)[53.00(42.00，69.00)% 比62.50(50.00，74.00)%，Z＝－2.259，P＝0.024]、FEV1/用力肺活量百分比(forced vital capacity, FVC)[58.22(51.87，65.48)% 比63.71(55.23，68.77)%，Z＝－2.720，P＝0.007]、最大呼气中段流量速(maximum mid-expiratory flow, MMEF)[25.00(15.25，34.50)% 比29.55(21.05，41.00)%，Z＝－2.030，P＝0.042]、一氧化碳弥散量(carbon monoxide dispersion capacity, DLCO)[63.00(45.50，77.50)% 比75.00(55.25，89.00)%，Z＝－3.222，P＝0.001]低于对照组(P<0.05)。Spearman及多元线性回归分析显示，DAR与FEV1(Rho＝－0.287，P<0.001)、FEV1/FVC(Rho＝－0.264，P<0.001)、MMEF(Rho＝－0.267，P<0.001)呈负相关。肺容积与FEV1(Rho＝0.336，P<0.001)、FEV1/FVC(Rho＝0.281，P<0.001)、MMEF(Rho＝0.215，P＝0.001)、DLCO(Rho＝0.195，P＝0.011)呈正相关，ATI与FEV1(Rho＝－0.311，P<0.001)、FEV1/FVC(Rho＝－0.309，P<0.001)、MMEF(Rho＝－0.286，P<0.001)、DLCO(Rho＝－0.299，P<0.001)呈负相关，EI与FEV1(Rho＝－0.281，P<0.001)、FEV1/FVC(Rho＝－0.289，P<0.001)、DLCO(Rho＝－0.162，P＝0.038)呈负相关。DAR预测AECOPD再入院或死亡AUC为0.783(95%CI：0.575~0.992)，最佳截断值为16.448，Kaplan-Meier生存曲线显示，DAR<16.448(n＝18)AECOPD无事件生存率高于DAR≥16.448(n＝19)患者(88.89% 比47.37%，χ2＝6.973，P＝0.008)。

结论

AECOPD患者DAR、肺容积、EI和ATI与肺功能指标存在相关性。

关键词: 急性加重期，肺疾病，慢性阻塞性, D-二聚体与白蛋白比值, 胸部计算机断层扫描, 肺功能
Objective

To investigate the relationship between the D-dimer to albumin ratio (DAR), chest computed tomography (CT) parameters, and pulmonary function in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A retrospective analysis was conducted on 83 patients with AECOPD (observation group) and 82 patients with COPD (control group) admitted to our hospital from March 2019 to December 2024. Pulmonary function, DAR, and CT parameters were compared between the two groups. Spearman′s rank correlation analysis was used to evaluate the relationships among DAR, chest CT parameters, and pulmonary function.

Results

The DAR in the observation group was significantly higher than that in the control group [17.90 (12.17, 38.93) vs. 8.39 (6.27, 13.73), P<0.001]. The area under the receiver operating characteristic (ROC) curve (AUC) for DAR in diagnosing AECOPD was 0.827, which was higher than that of C-reactive protein (AUC 0.803), neutrophil count (AUC 0.647), lymphocyte count (AUC 0.639), and monocyte count (AUC 0.637). The lung volume in the observation group was significantly lower than that in the control group [(3.58±0.93)L vs. (4.77±1.14)L, t=7.351, P<0.001], while the emphysema index (EI) [19.36(10.62, 30.46)% vs. 6.03(3.83, 12.08)%, Z=-6.965, P<0.001] and air trapping index (ATI) [0.97±0.02 vs. 0.91±0.02, t=19.270, P<0.001] were significantly higher. The forced expiratory volume in one second (FEV1) [53.00 (42.00, 69.00)% vs. 62.50 (50.00, 74.00)%, Z=-2.259, P=0.024], FEV1/forced vital capacity (FVC) [58.22 (51.87, 65.48)% vs. 63.71 (55.23, 68.77)%, Z=-2.720, P=0.007], maximum mid-expiratory flow (MMEF) [25.00 (15.25, 34.50)% vs. 29.55 (21.05, 41.00)%, Z=-2.030, P=0.042], and carbon monoxide diffusing capacity (DLCO) [63.00 (45.50, 77.50)% vs. 75.00 (55.25, 89.00)%, Z=-3.222, P=0.001] were significantly lower in the observation group compared to the control group (P<0.05). Spearman′s rank correlation and multiple linear regression analyses showed that DAR was negatively correlated with FEV1 (Rho=-0.287, P<0.001), FEV1/FVC (Rho=-0.264, P<0.001), and MMEF (Rho=-0.267, P<0.001). Lung volume was positively correlated with FEV1(Rho=0.336, P<0.001), FEV1/FVC (Rho=0.281, P<0.001), MMEF (Rho=0.215, P=0.001), and DLCO (Rho=0.195, P=0.011). ATI was negatively correlated with FEV1 (Rho=-0.311, P<0.001), FEV1/FVC (Rho=-0.309, P<0.001), MMEF (Rho=-0.286, P<0.001), and DLCO (Rho=-0.299, P<0.001). EI was negatively correlated with FEV1 (Rho=-0.281, P<0.001), FEV1/FVC (Rho=-0.289, P<0.001), and DLCO (Rho=-0.162, P=0.038). The AUC of DAR for predicting readmission or death in AECOPD was 0.783 (95%CI: 0.575~0.992), with an optimal cutoff value of 16.448. Kaplan-Meier survival curve analysis showed that the event-free survival rate of AECOPD patients with DAR<16.448 (n=18) was significantly higher than that of patients with DAR ≥16.448(n=19) (88.89% vs. 47.37%, χ2=6.973, P=0.008).

Conclusion

DAR, lung volume, EI, and ATI in AECOPD patients are correlated with pulmonary function parameters.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, D-dimer-to-albumin ratio, Chest computed tomography, Pulmonary function
表1 两组COPD患者临床资料结果比较
临床资料 观察组(n＝83) 对照组(n＝82) t/Z/χ2值 P值
合并症[n(%)]        
高血压 21(25.30) 13(15.85) 2.250 0.134
糖尿病 6(7.23) 4(4.88) － 0.746a
冠状动脉疾病 9(10.84) 6(7.32) 0.621 0.431
GOLD分级[n(%)]     0.334 0.564
Ⅰ~Ⅱ级 67(80.72) 69(84.15)    
Ⅲ~Ⅳ级 16(19.28) 13(15.85)    
用药史[n(%)]        
吸入性糖皮质激素 79(95.18) 74(90.24) 1.491 0.222
长效β2受体激动剂 73(87.95) 70(85.37) 0.239 0.625
长效毒蕈碱拮抗剂 59(71.08) 61(74.39) 0.227 0.634
实验室检查[M50(Q25，Q75)]        
CPR(mg/L) 32.20(9.97，94.66) 4.58(1.65，13.37) －6.714 0.000
NEU(×109/L) 5.55(3.97，8.65) 4.40(3.23，6.07) －3.269 0.001
LYM(×109/L) 0.97(0.63，1.39) 1.31(0.96，1.82) －3.090 0.002
MON(×109/L) 0.50(0.39，0.70) 0.43(0.27，0.53) －3.041 0.002
丙氨酸氨基转移酶(U/L) 15.26(11.71，23.94) 14.57(11.63，21.15) －0.319 0.749
门冬氨酸氨基转移酶(U/L) 22.80(18.44，35.34) 20.27(16.71，26.49) －0.575 0.610
甘油三酯(mmol/L) 1.03(0.73，1.44) 1.00(0.72，1.49) －0.223 0.823
血清肌酐(μmol/L) 66.88(56.36，86.51) 63.25(52.73，72.70) －1.216 0.127
血清尿素氮(mmol/L) 6.68(4.84，8.92) 6.23(4.87，7.21) －1.042 0.141
DAR 17.90(12.17，38.93) 8.39(6.27，13.73) －7.251 0.000
肺功能指标[M50(Q25，Q75)]        
FEV1(%) 53.00(42.00，69.00) 62.50(50.00，74.00) －2.259 0.024
FEV1/FVC(%) 58.22(51.87，65.48) 63.71(55.23，68.77) －2.720 0.007
MMEF(%) 25.00(15.25，34.50) 29.55(21.05，41.00) －2.030 0.042
DLCO(%) 63.00(45.50，77.50) 75.00(55.25，89.00) －3.222 0.001
表2 AECOPD患者的ROC曲线结果分析
生物标志物 AUC(95%CI) 精确度(95%CI) 灵敏度(95%CI) 特异度(95%CI) 阳性预测值(95%CI) 阴性预测值(95%CI) 截断值
DAR 0.827(0.764~0.889) 0.752(0.678~0.815) 0.671(0.569~0.772) 0.831(0.751~0.912) 0.797(0.702~0.892) 0.719(0.629~0.809) 10.538
CRP 0.803(0.736~0.870) 0.733(0.659~0.799) 1.000(1.000~1.000) 0.470(0.363~0.577) 0.651(0.568~0.734) 1.000(1.000~1.000) 40.81 mg/L
NEU 0.647(0.563~0.731) 0.636(0.558~0.710) 0.805(0.719~0.891) 0.470(0.363~0.577) 0.600(0.508~0.692) 0.709(0.589~0.829) 6.36×109/L
LYM 0.639(0.554~0.724) 0.370(0.296~0.448) 0.256(0.162~0.351) 0.482(0.374~0.589) 0.328(0.213~0.443) 0.396(0.301~0.491) 0.98×109/L
MON 0.637(0.552~0.722) 0.606(0.527~0.681) 0.427(0.320~0.534) 0.783(0.694~0.872) 0.660(0.533~0.788) 0.580(0.489~0.672) 0.39×109/L
图1 73岁男性(GOLD Ⅲ级)AECOPD胸部CT扫描。图A为CT横断位平扫显示，支气管壁增厚且界限不清，气管内黏液，毛玻璃样混浊，伴有轻度纵隔淋巴结病；图B为CT矢状位平扫显示小叶中央型肺气肿征象，胸廓膨胀，左下叶异常低密度，其间血管影稀疏
表3 DAR、CT参数与肺功能的相关性分析
临床指标 FEV1 FEV1/FVC MMEF DLCO DAR
Rho P值 Rho P值 Rho P值 Rho P值 Rho P值
DAR －0.287 0.000 －0.264 0.000 －0.267 0.000 －0.137 0.080 － －
肺容积 0.336 0.000 0.281 0.000 0.215 0.001 0.195 0.011 －0.273 0.000
ATI －0.311 0.000 －0.309 0.000 －0.286 0.000 －0.299 0.000 0.489 0.000
EI －0.281 0.000 －0.289 0.000 －0.132 0.090 －0.162 0.038 0.240 0.000
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