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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 (03) : 379 -385. doi: 10.3877/cma.j.issn.1674-6902.2026.03.004

论著

ENR指数预测老年慢性阻塞性肺疾病急性加重期患者无创机械通气疗效临床研究
贺静, 孙雅†(), 徐艳霞, 冯媛, 胡瑞   
  1. 716000　延安，延安大学附属医院呼吸与危重症医学科
  • 收稿日期:2025-12-21 出版日期:2026-06-25
  • 通信作者: 孙雅
  • 基金资助:
    陕西省卫生健康委科研课题(2023PT018)

Clinical study on ENR predicting the efficacy of noninvasive mechanical ventilation in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

Jing He, Ya Sun†(), Yanxia Xu, Yuan Feng, Rui Hu   

  1. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Yan′an University, Yan′an 716000, China
  • Received:2025-12-21 Published:2026-06-25
  • Corresponding author: Ya Sun
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引用本文：

贺静, 孙雅, 徐艳霞, 冯媛, 胡瑞. ENR指数预测老年慢性阻塞性肺疾病急性加重期患者无创机械通气疗效临床研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 379-385.

Jing He, Ya Sun, Yanxia Xu, Yuan Feng, Rui Hu. Clinical study on ENR predicting the efficacy of noninvasive mechanical ventilation in elderly patients with acute exacerbation of chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 379-385.

目的

探讨嗜酸性粒细胞与中性粒细胞比值(eosinophil-to-neutrophil ratio, ENR)预测老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)患者无创正压机械通气(noninvasive positive pressure ventilation, NIPPV)疗效的临床意义。

方法

选取2022年1月至2025年1月我院收治的146例接受NIPPV治疗老年AECOPD患者为对象，将NIPPV治疗失败26例为观察组，治疗成功120例为对照组。比较两组NIPPV启动前(T0)、启动后第2小时(T2)、第6小时(T6)、第12小时(T12)ENR变化及急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ，APACHEⅡ)、Charlson合并症指数(Charlson comorbidity index, CCI)、ROX指数等。采用Spearman相关性分析ENR与动脉血气指标的关系，ROC曲线判断ENR预测NIPPV治疗效果，多因素Logistic回归分析NIPPV失败的影响因素，限制性立方样条(restricted cubic spline, RCS)分析ENR与NIPPV风险的剂量-反应关系。

结果

T0时观察组嗜酸性粒细胞百分比[0.10%(0.00%，0.62%)比0.40%(0.00%，1.50%)]和ENR[0.12×10－2(0.00×10－2，0.79×10－2) 比0.52×10－2(0.00×10－2，2.33×10－2)]低于对照组(P<0.01)；T2时观察组嗜酸性粒细胞百分比[0.17%(0.00%，0.68%)比0.50%(0.10%，1.50%)]和ENR[0.23×10－2(0.00×10－2，0.92×10－2)比0.58×10－2(0.11×10－2，2.33×10－2)]低于对照组(P<0.01)；T6及T12时两组ENR差异无统计学意义(P>0.05)。T0时ENR与PaO2呈显著正相关(r＝0.651，P<0.001)，与pH、PaCO2、HCO3－无显著相关性。T0 ENR预测NIPPV失败的AUC为0.781(95%CI：0.705~0.845)，最佳截断值<0.350×10－2，灵敏度与特异度分别为84.62%和88.33%；T2 ENR的AUC为0.731(95%CI：0.651~0.801)，截断值<0.391×10－2。多因素Logistic回归显示，APACHEⅡ≥15分(OR＝1.148，P＝0.003)、CCI≥4(OR＝1.236，P＝0.013)是NIPPV失败的危险因素，T0 ENR(OR＝0.591，P＝0.004)和ROX指数(OR＝0.783，P＝0.002)是保护因素。RCS分析显示ENR与NIPPV风险呈非线性关系(P非线性＝0.0586)。APACHEⅡ＋CCI＋ROX指数＋T0 ENR联合预测NIPPV失败的AUC为0.907(95%CI：0.845~0.947，P<0.001)，灵敏性84.62%，特异性88.33%。住院期间NIPPV失败26例(17.81%)，观察组院内死亡10例(38.46%)，对照组无死亡。

结论

ENR可预测AECOPD患者NIPPV风险，NIPPV启动前T0 ENR<0.350应谨慎管理。

关键词: 嗜酸性粒细胞与中性粒细胞比值, 急性加重，肺疾病，慢性阻塞性, 无创机械通气, 失败预测
Objective

To investigate the clinical significance of the eosinophil-to-neutrophil ratio (ENR) in predicting the efficacy of noninvasive positive pressure ventilation (NIPPV) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A total of 146 elderly AECOPD patients who received NIPPV treatment in our hospital from January 2022 to January 2025 were enrolled. Twenty-six patients with NIPPV failure were assigned to the observation group and 120 with successful treatment to the control group. The changes in ENR, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, Charlson comorbidity index (CCI), and ROX index were compared between the two groups before NIPPV initiation (T0), and at 2 hours (T2), 6 hours (T6), and 12 hours (T12) after initiation. Spearman correlation analysis was used to assess the relationship between ENR and arterial blood gas parameters. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive value of ENR for NIPPV efficacy. Multivariate logistic regression analysis was performed to identify influencing factors of NIPPV failure, and restricted cubic spline (RCS) analysis was applied to explore the dose-response relationship between ENR and NIPPV failure risk.

Results

At T0, eosinophil percentage [0.10% (0.00%, 0.62%) vs. 0.40% (0.00%, 1.50%)] and ENR [0.12×10-2(0.00×10-2, 0.79×10-2) vs. 0.52×10-2(0.00×10-2, 2.33×10-2)] in the observation group were lower than those in the control group (P<0.01). At T2, eosinophil percentage [0.17% (0.00%, 0.68%) vs. 0.50% (0.10%, 1.50%)] and ENR [0.23×10-2 (0.00×10-2, 0.92×10-2) vs. 0.58×10-2 (0.11×10-2, 2.33×10-2)] remained lower in the observation group (P<0.01). No significant difference in ENR was observed between the two groups at T6 and T12 (P>0.05). At T0, ENR was significantly positively correlated with PaO2 (r=0.651, P<0.001), but not significantly correlated with pH, PaCO2, or HCO2-. The area under the ROC curve (AUC) for T0 ENR to predict NIPPV failure was 0.781 (95% CI: 0.705~0.845), with an optimal cutoff value of <0.350×10-2, yielding a sensitivity of 84.62% and specificity of 88.33%. The AUC for T2 ENR was 0.731 (95%CI: 0.651~0.801), with a cutoff value of <0.391×10-2. Multivariate logistic regression showed that APACHE Ⅱ score ≥15(OR=1.148, P=0.003) and CCI ≥4 (OR=1.236, P=0.013) were risk factors for NIPPV failure, whereas T0 ENR (OR=0.591, P=0.004) and ROX index (OR=0.783, P=0.002) were protective factors. RCS analysis indicated a nonlinear relationship between ENR and NIPPV failure risk (P for nonlinearity=0.0586). The combined model incorporating APACHE Ⅱ, CCI, ROX index, and T0 ENR predicted NIPPV failure with an AUC of 0.907 (95%CI: 0.845~0.947, P<0.001), sensitivity of 84.62%, and specificity of 88.33%. During hospitalization, NIPPV failure occurred in 26 patients (17.81%); 10 patients (38.46%) in the observation group died in-hospital, while no deaths occurred in the control group.

Conclusion

ENR can predict the risk of NIPPV failure in AECOPD patients. A T0 ENR<0.350×10-2 before NIPPV initiation warrants cautious management.

Key words: Eosinophil-to-neutrophil ratio, Acute exacerbation of chronic obstructive pulmonary disease, Noninvasive positive pressure ventilation, Failure prediction
表1 两组AECOPD患者临床资料结果
临床资料 观察组(n＝26) 对照组(n＝120) χ2/t/Z值 P值
APACHE Ⅱ[分，M(Q25，Q75)] 19.50(15.00，26.00) 15.00(11.00，18.00) －4.204 0.000
CCI[M(Q25，Q75)] 3.50(2.00，5.00) 3.00(2.00，4.00) －2.242 0.025
长期吸氧史[n(%)] 9(34.62) 20(16.67) 4.325 0.038
肺功能[M(Q25，Q75)]        
FEV1(L) 0.78(0.58，1.02) 0.84(0.64，1.24) －1.181 0.238
FEV1(%) 39.00(28.75，54.00) 45.00(33.00，65.00) －1.835 0.067
FEV1/FVC(%) 47.50(37.00，60.25) 47.00(37.00，59.00) －0.090 0.928
实验室指标        
CRP[mg/L，Q25，Q75] 4.55(1.03，9.68) 3.20(0.86，9.04) －0.754 0.451
NT-proBNP[pg/ml，M(Q25，Q75)] 1 023.00(419.10，4 552.50) 1 218.00(351.62，4 937.00) －0.529 0.597
动脉血气分析[M(Q25，Q75)]        
pH(±s) 7.26±0.10 7.29±0.06 －2.021 0.045
PaO2(mmHg) 97.90(71.50，136.00) 94.80(67.90，147.00) －0.551 0.581
PaCO2(mmHg) 59.73(46.35，71.65) 57.00(46.08，65.70) －0.569 0.569
HCO3－(mmol/L) 28.50(24.75，33.35) 28.55(23.98，33.68) －0.281 0.779
ROX指数 5.92(3.25，7.20) 8.13(5.26，10.64) －3.230 0.001
住院时长[d，M(Q25，Q75)] 26.50(16.75，51.75) 19.50(14.00，28.00) －2.928 0.003
图1 68岁典型AECOPD患者胸部高分辨率CT影像。图A为冠状位重建影像；图B为轴位薄层重建(肺窗)影像
表2 两组AECOPD患者ENR相关指标变化趋势[M(Q25，Q75)]
临床指标 观察组(n＝26) 对照组(n＝120) Z值 P值
T0        
白细胞计数(×109/L) 10.92(9.08，15.00) 11.30(8.40，15.90) －0.008 0.993
嗜酸性粒细胞百分比(%) 0.10(0.00，0.62) 0.40(0.00，1.50) －3.196 0.002
中性粒细胞百分比(%) 83.60(78.52，87.17) 83.00(74.10，88.80) －0.742 0.458
ENR(×102) 0.12(0.00，0.79) 0.52(0.00，2.33) －5.151 0.001
T2        
白细胞计数(×109/L) 10.50(8.45，14.63) 11.20(8.20，15.10) －0.214 0.830
嗜酸性粒细胞百分比(%) 0.17(0.00，0.68) 0.50(0.10，1.50) －2.992 0.007
中性粒细胞百分比(%) 83.25(78.60，87.77) 83.50(73.80，87.30) －0.740 0.460
ENR(×102) 0.23(0.00，0.92) 0.58(0.11，2.33) －4.478 0.001
T6        
白细胞计数(×109/L) 10.45(7.88，14.54) 10.30(8.40，14.25) －0.363 0.716
嗜酸性粒细胞百分比(%) 0.10(0.00，0.93) 0.10(0.00，0.50) －0.928 0.353
中性粒细胞百分比(%) 87.05(80.47，91.10) 86.80(79.50，91.35) －0.348 0.728
ENR(×102) 0.12(0.00，1.13) 0.11(0.00，0.63) －0.817 0.414
T12        
白细胞计数(×109/L) 10.70(9.20，14.70) 12.20(8.60，16.30) －0.432 0.666
嗜酸性粒细胞百分比(%) 0.60(0.20，1.90) 0.60(0.15，1.60) －0.743 0.457
中性粒细胞百分比(%) 78.70(71.70，86.50) 84.00(72.85，89.75) －1.028 0.304
ENR(×102) 0.84(0.22，2.44) 0.71(0.16，2.13) －0.690 0.490
图2 T0时ENR分别与动脉血气指标相关性散点图。图A为T0时ENR与PaO2相关性散点图；图B为T0时ENR与pH相关性散点图；图C为T0时ENR与PaCO2相关性散点图；图D为T0时ENR与HCO3－相关性散点图。采用Spearman相关性检验，图中实线代表线性回归拟合线
图3 AECOPD患者ENR与NIPPV风险关联的RCS曲线
表3 多变量Logistic回归分析NIPPV失败的影响因素
变　量 β SE Wald值 P值 OR 95%CI
年龄≥65岁 0.644 0.463 1.936 0.164 1.904 0.769~4.715
APACHE Ⅱ≥15分 0.138 0.047 2.936 0.003 1.148 1.047~1.259
CCI≥4 0.212 0.085 2.494 0.013 1.236 1.046~1.460
长期吸氧史 0.693 0.385 1.800 0.072 2.000 0.940~4.253
FEV1(%) －0.021 0.016 －1.313 0.189 0.979 0.949~1.010
ROX指数 －0.245 0.081 9.193 0.002 0.783 0.668~0.917
pH －1.845 1.152 －1.602 0.109 0.158 0.017~1.511
T0 ENR －0.527 0.182 －2.896 0.004 0.591 0.413~0.843
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[9] 潘永良, 郦文捷, 黄晓敏. 外周血EOS、PCT及CRP水平与COPD急性加重期患者预后的关系[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(04): 512-514.
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[11] 焦桂微, 王新婷, 任强, 王瑛, 刘晓民. NLR在COPD合并CAP与AECOPD患者中诊断与预后的意义[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(01): 20-23.
[12] 徐宁, 宋鹏飞, 段圆方, 李勤. 慢性阻塞性肺疾病急性加重期外周血mir-146a、mir-223的表达[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(06): 757-759.
[13] 于晓钧, 孙欣. AECOPD患者细菌和病毒感染类型及其与复发风险的相关性[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(03): 325-328.
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