基于NLR/ALB构建的列线图预测模型在慢性阻塞性肺疾病急性加重期患者短期预后中的应用价值

doi:10.3877/cma.j.issn.1674-6902.2026.05.016

目的

分析慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)患者短期预后的影响因素，构建基于中性粒细胞与淋巴细胞比值/白蛋白比值(neutrophil-to-lymphocyte ratio/albumin ratio, NLR/ALB)的列线图预测模型。

方法

选取2023年7月至2026年1月我院收治的220例AECOPD患者为研究对象，根据短期预后结局分为病情危重65例为观察组，病情平稳155例为对照组。收集患者临床资料，采用单因素及多因素Logistic回归分析筛选短期预后的独立影响因素，通过R软件构建列线图预测模型。通过受试者工作特征(receiver operating characteristic, ROC)曲线、校准曲线及决策曲线评估模型的预测性能与临床效用。

结果

观察组平均年龄(69.47±8.25)岁、查尔森合并症指数(charlson comorbidity index, CCI)评分(3.21±1.02)分、降钙素原(procalcitonin, PCT)(0.82±0.31)μg/L、红细胞分布宽度(red blood cell distribution width, RDW)(14.82±2.45)%、NLR/ALB(3.62±1.25)比较对照组平均年龄(65.29±9.76)岁、(2.54±1.00)分、(0.62±0.33)μg/L、(13.19±2.32)%、(2.76±1.02)，差异均有统计学意义(P<0.05)；多因素Logistic回归分析显示，年龄(OR＝1.083，95%CI：1.029~1.141，P＝0.002)、CCI评分(OR＝1.613，95%CI：1.131~2.300，P＝0.008)、PCT(OR＝3.819，95%CI：1.237~11.792，P＝0.020)、RDW(OR＝1.318，95%CI：1.136~1.531，P<0.001)及NLR/ALB(OR＝1.940，95%CI：1.401~2.687，P<0.001)是AECOPD患者短期预后的影响因素。所构建的列线图模型AUC为0.838(95%CI：0.780~0.896)，灵敏度为72.31%，特异度为83.23%；校准曲线与理想对角线重合性良好(Hosmer-Lemeshow检验χ²＝3.280，P＝0.772)；在5%~89%阈值概率范围内，模型具有较高的临床净获益。

结论

年龄、CCI评分、PCT、RDW、NLR/ALB是AECOPD患者短期预后的影响因素。本研究构建的列线图预测模型具有良好的预测效能和临床实用性，可为早期识别AECOPD短期不良预后高风险患者、优化临床干预策略提供参考。

关键词: 急性加重期，肺疾病，慢性阻塞性, 列线图, 中性粒细胞与淋巴细胞比值/白蛋白, 短期预后, 预测模型

Objective

To analyze the independent influencing factors for short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to construct a nomogram prediction model based on the neutrophil-to-lymphocyte ratio/albumin ratio (NLR/ALB).

Methods

A total of 220 patients with AECOPD admitted to our hospital from July 2023 to January 2026 were enrolled as the research subjects, and they were divided into a critical illness group and a stable condition group according to their short-term prognosis outcomes. The clinical data of the patients were collected, univariate and multivariate Logistic regression analyses were adopted to screen out the independent influencing factors for short-term prognosis, and a nomogram prediction model was constructed by using R software. The predictive performance and clinical utility of the model were evaluated via the receiver operating characteristic (ROC) curve, calibration curve and decision curve.

Results

The observation group had a mean age of (69.47±8.25) years, Charlson Comorbidity Index (CCI) score of (3.21±1.02), procalcitonin (PCT) of (0.82±0.31) μg/L, red blood cell distribution width (RDW) of (14.82±2.45)%, and NLR/ALB of (3.62±1.25), compared with (65.29±9.76) years, (2.54±1.00), (0.62±0.33) μg/L, (13.19±2.32)%, and (2.76±1.02) in the control group, with statistically significant differences (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.083, 95%CI: 1.029~1.141, P=0.002), CCI score (OR=1.613, 95%CI: 1.131~2.300, P=0.008), PCT(OR=3.819, 95%CI: 1.237~11.792, P=0.020), RDW (OR=1.318, 95%CI: 1.136~1.531, P<0.001), and NLR/ALB (OR=1.940, 95%CI: 1.401~2.687, P<0.001) were independent influencing factors for short-term prognosis in AECOPD patients. The constructed nomogram model achieved an AUC of 0.838(95%CI: 0.780~0.896), with a sensitivity of 72.31% and a specificity of 83.23%. The calibration curve showed good agreement with the ideal diagonal line (Hosmer-Lemeshow test: χ²=3.280, P=0.772). Within the threshold probability range of 5% to 89%, the model demonstrated a high clinical net benefit.

Conclusion

Age, CCI score, PCT, RDW, and NLR/ALB are independent influencing factors for short-term prognosis in AECOPD patients. The nomogram prediction model constructed in this study has good predictive performance and clinical utility, providing a reference for early identification of high-risk patients with poor short-term prognosis in AECOPD and for optimizing clinical intervention strategies.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Nomogram, Neutrophil-to-lymphocyte ratio/albumin ratio, Short-term prognosis, Prediction Model

表1 病情危重组与病情平稳组患者的临床资料比较[n(%)，(

±s)]

临床资料	观察组(n＝65)	对照组(n＝155)	t/χ²值	P值
年龄(岁)	69.47±8.25	65.29±9.76	3.028	0.003
性别：男/女(例)	47/18	117/38	0.243	0.622
BMI(kg/m²)	21.82±3.21	22.46±3.50	1.267	0.206
吸烟史(例)	39	90	0.071	0.790
近1年发作次数			3.783	0.052
≤2次	28(43.08)	89(57.42)
>2次	37(56.92)	66(42.58)
CCI评分	3.21±1.02	2.54±1.00	4.507	0.001
入院时特征
SBP(mmHg)	128.45±15.32	130.21±14.87	0.794	0.428
DBP(mmHg)	78.32±9.54	79.15±9.21	0.603	0.547
PaO₂(mmHg)	68.23±8.45	70.12±7.87	1.590	0.113
PaCO₂(mmHg)	52.34±6.21	50.87±5.96	1.649	0.101
入院时实验室指标
PCT(μg/L)	0.82±0.31	0.62±0.33	4.224	0.001
CRP(mg/L)	19.42±6.34	18.76±6.11	0.723	0.471
RDW(%)	14.82±2.45	13.19±2.32	4.676	0.001
Hb(g/L)	132.45±15.23	135.21±14.56	1.265	0.207
WBC(×10⁹/L)	9.12±2.34	8.67±2.21	1.354	0.177
PLT(×10⁹/L)	198.34±45.23	204.56±42.17	0.977	0.330
NLR/ALB	3.62±1.25	2.76±1.02	5.327	0.001
入院时影像学指标
肺气肿[n(%)]	44(67.69)	93(60.00)	1.153	0.283
斑片渗出/实变/炎性改变[n(%)]	43(66.15)	82(52.90)	3.277	0.070
肺大疱[n(%)]	35(53.85)	66(42.58)	2.340	0.126

表1 病情危重组与病情平稳组患者的临床资料比较[n(%)，(

±s)]

临床资料	观察组(n＝65)	对照组(n＝155)	t/χ²值	P值
年龄(岁)	69.47±8.25	65.29±9.76	3.028	0.003
性别：男/女(例)	47/18	117/38	0.243	0.622
BMI(kg/m²)	21.82±3.21	22.46±3.50	1.267	0.206
吸烟史(例)	39	90	0.071	0.790
近1年发作次数			3.783	0.052
≤2次	28(43.08)	89(57.42)
>2次	37(56.92)	66(42.58)
CCI评分	3.21±1.02	2.54±1.00	4.507	0.001
入院时特征
SBP(mmHg)	128.45±15.32	130.21±14.87	0.794	0.428
DBP(mmHg)	78.32±9.54	79.15±9.21	0.603	0.547
PaO₂(mmHg)	68.23±8.45	70.12±7.87	1.590	0.113
PaCO₂(mmHg)	52.34±6.21	50.87±5.96	1.649	0.101
入院时实验室指标
PCT(μg/L)	0.82±0.31	0.62±0.33	4.224	0.001
CRP(mg/L)	19.42±6.34	18.76±6.11	0.723	0.471
RDW(%)	14.82±2.45	13.19±2.32	4.676	0.001
Hb(g/L)	132.45±15.23	135.21±14.56	1.265	0.207
WBC(×10⁹/L)	9.12±2.34	8.67±2.21	1.354	0.177
PLT(×10⁹/L)	198.34±45.23	204.56±42.17	0.977	0.330
NLR/ALB	3.62±1.25	2.76±1.02	5.327	0.001
入院时影像学指标
肺气肿[n(%)]	44(67.69)	93(60.00)	1.153	0.283
斑片渗出/实变/炎性改变[n(%)]	43(66.15)	82(52.90)	3.277	0.070
肺大疱[n(%)]	35(53.85)	66(42.58)	2.340	0.126

表2 变量赋值表

变　量	赋值方式
短期预后结局	病情平稳组＝"0"；病情危重组＝"1"
年龄	实测值
CCI评分	实测值
PCT	实测值
RDW	实测值
NLR/ALB	实测值

表2 变量赋值表

变　量	赋值方式
短期预后结局	病情平稳组＝"0"；病情危重组＝"1"
年龄	实测值
CCI评分	实测值
PCT	实测值
RDW	实测值
NLR/ALB	实测值

表3 AECOPD患者短期预后的多因素Logistic回归分析

因　素	回归系数	标准误	Wald值	P值	OR值	95%置信区间
因　素	回归系数	标准误	Wald值	P值	OR值	下限	上限
年龄	0.080	0.026	9.339	0.002	1.083	1.029	1.141
CCI评分	0.478	0.181	6.956	0.008	1.613	1.131	2.300
PCT	1.340	0.575	5.428	0.020	3.819	1.237	11.792
RDW	0.276	0.076	13.198	<0.001	1.318	1.136	1.531
NLR/ALB	0.663	0.166	15.898	<0.001	1.940	1.401	2.687
常量	－15.057	2.472	37.087	<0.001	<0.001

表3 AECOPD患者短期预后的多因素Logistic回归分析

因　素	回归系数	标准误	Wald值	P值	OR值	95%置信区间
因　素	回归系数	标准误	Wald值	P值	OR值	下限	上限
年龄	0.080	0.026	9.339	0.002	1.083	1.029	1.141
CCI评分	0.478	0.181	6.956	0.008	1.613	1.131	2.300
PCT	1.340	0.575	5.428	0.020	3.819	1.237	11.792
RDW	0.276	0.076	13.198	<0.001	1.318	1.136	1.531
NLR/ALB	0.663	0.166	15.898	<0.001	1.940	1.401	2.687
常量	－15.057	2.472	37.087	<0.001	<0.001

图1 NLR/ALB预测AECOPD患者短期预后的ROC曲线

图2 AECOPD患者短期预后的列线图预测模型注：若某位患者年龄为80岁、CCI评分为2分、PCT为1.2 μg/L、RDW为12.0%、NLR/ALB为3.5，其对应的分数分别为45、10、36、30、50分，总分合计为171分，总分值对应的预测值是0.4。也就是短期预后不良的风险为40.00%

图3 图A为ROC曲线；图B为校准曲线

图4 决策曲线注：若某位患者年龄为80岁、CCI评分为2分、PCT为1.2 μg/L、RDW为12.0%、NLR/ALB为3.5，其对应的分数分别为45、10、36、30、50分，总分合计为171分，总分值对应的预测值是0.4。也就是短期预后不良的风险为40.00%

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Application value of a nomogram prediction model based on NLR/ALB for short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

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Application value of a nomogram prediction model based on NLR/ALB for short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease