周玲,涂兴蕊,冯隽,黄红莉
ZHOU Ling,TU Xingrui,FENG Jun,HUANG Hongli

• 1:铜仁市中医医院呼吸内科
• 2:铜仁市中医医院心病科

摘要(Abstract)：

目的 探究慢性阻塞性肺疾病急性加重期（AECOPD）患者中性粒细胞计数（NEUT）、淋巴细胞计数（LY）、血小板计数（PLT）与血清 C-反应蛋白（CRP）的相关性及对患者预后的诊断价值。 方法 200 例接受治疗的 AECOPD 患者，根据住院治疗 15 d 内转归分为预后不良组（n= 113）及预后良好组（n= 87）；记录患者年龄、性别等一般资料及临床常规监测指标（心率、血压、呼吸频率及血气分析），检测红细胞计数、红细胞积压、NEUT、LY、PLT、血红蛋白、谷丙转氨酶（ ALT）、谷草转氨酶（ AST）、尿素氮（ BUN）、白蛋白及血清 CRP 水平；采用Spearman 或 Pearson 法分析 NEUT、LY、PLT 与 CRP 的相关性，采用受试者工作曲线（ROC） 下面积（AUC） 评价NEUT、LY、PLT 单一或联合对 AECOPD 患者预后的诊断能力。 结果 预后良好组除血压及红细胞积压、预后不良组除血压与治疗前比较差异无统计学意义（P> 0. 05） 外，其余指标与治疗前比较差异有统计学意义（P<0. 05）；治疗后，除血压及 ALT、AST 差异两组无统计学意义（P> 0. 05）外，其余指标两组比较差异有统计学意义（P< 0. 05）；血清 NEUT 水平与血清 CRP 水平呈正相关（r= 0. 613,P< 0. 001），血清 LY 和 PLT 水平与血清 CRP水平负相关（r= - 0. 469、 - 0. 790,P< 0. 001）；血清 NEUT 的AUC= 0. 644，特异度及敏感度分别为 0. 598、0. 681,Cut-Off 值为 89. 175 × 10~9/ L；血清 LY 的AUC= 0. 868，特异度及敏感度分别为 0. 713、0. 912,Cut-Off 值为3. 115 × 10~9/ L；血清 PLT 的AUC= 0. 705，特异度及敏感度分别为 0. 690、0. 655,Cut-Off 值为 219. 356 × 10~9/ L；联合诊断的 AUC= 0. 903，特异度及敏感度分别为 0. 816、0. 894；根据 Cut-Off 重新分组可知，血清 NEUT 水平≥Cutoff 值患者共计 112 例，预后不良率为 64. 17% (77 例）；血清 LY 水平≤Cut-off 值患者共计 128 例，预后不良率为69. 53% (89 例）；血清 PLT 水平≤Cut-off 值患者共计 101 例，预后不良率为 69. 31% (70 例）。 结论 血清NEUT、LY、PLT 与 AECOPD 患者临床表现及血清 CRP 水平关系密切，对 AECOPD 患者预后具有一定的诊断价值，3 项指标联合对 AECOPD 患者预后的评估价值更高。
Objective To explore the correlation between neutrophil count ( NEUT), lymphocyte count ( LY), platelet count ( PLT) and serum C-reactive protein ( CRP) of patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) and the value of the prognostic diagnosis of the patients.Methods A total of 200 patients with AECOPD treated were selected as the research objects. According to the outcome within 15 days of hospitalization, they were divided into the poor prognosis group (113 cases) and the good prognosis group (87 cases). The patients' general information such as age, gender and others and the clinical routine indexes were recorded (including heart rate, blood pressure, respiratory rate, blood gas analysis), and the blood routine indexes were detected ( including red blood cell count, red blood cell backlog, neutrophil count, NEUT,lymphocyte count, LY, platelet count, PLT, hemoglobin], alanine aminotransferase, ALT, aspartate aminotransferase, AST, urea nitrogen, BUN, albumin, and serum CRP levels ). The Spearman or Pearson correlation coefficient was used to analyze the relationship between NEUT, LY, PLT, and CRP and ROC was used to detect their ability of prognostic diagnosis of the patients with AECOPD.Results The poor prognosis rate was 56. 50% (113 cases), and the mortality rate was 6. 00% (12cases),while the good prognosis group had no difference in blood pressure and red blood cell backlog,and the poor prognosis group had no difference in blood pressure compared with before treatment.Other indicators were significantly improved compared with before treatment. (P< 0. 05). After treatment, except for sphygmomanometer ALT and AST, there was no difference between the two groups, and the differences in the other indexes between the two groups were statistically significant(P< 0. 05); the serum NEUT level was positively correlated with the serum CRP level(r= 0. 613,P<0. 001), and the serum LY and PLT levels were negatively correlated with the serum CRP levels (r=- 0. 469,r= - 0. 790,P< 0. 001, respectively). The area under the curve (AUC) of serum NEUT was 0. 644, the specificity and sensitivity were 0. 598, 0. 681, Cut-Off value was 89. 175 × 10~9/ L; the AUCof serum LY was 0. 868, the specificity and sensitivity were 0. 713, 0. 912, respectively. Cut-Off was 3. 115 × 10~9/ L;AUCof serum PLT was 0. 705, the specificity and sensitivity were 0. 690, 0. 655,Cut-Off was 219. 356 × 10~9/ L.AUCof combined diagnosis was 0. 903, the spethe cificity and sensitivity were 0. 816 and 0. 894, respectively. According to Cut-Off regrouping, there were 112patients with serum NEUT level≥Cut-off value, with the poor prognosis rate of 64. 17 % (77 cases).There were a total of 128 patients with serum LY level≤Cut-off value, with the poor prognosis rate of69. 53% (89 cases). A total of 101 patients with serum PLT level ≤ Cut-off value, with a poor prognosis rate of 69. 31% (70 cases).Conclusion Serum NEUT,LY, and PLT are closely related to the clinical manifestations and serum CRP levels of AECOPD patients, and the three indicators possess better assessment value for the diagnostic prognosis of patients with AECOPD.

关键词(KeyWords)： 慢性阻塞性肺疾病急性加重期;中性粒细胞计数;淋巴细胞计数;血小板计数;CRP;预后诊断
acute exacerbation of chronic obstructive pulmonary disease(AECOPD);neutrophil count(NEUT);lymphocyte count(LY);platelet count(PLT);CRP;prognostic diagnosis

Abstract:

Keywords:

基金项目(Foundation): 贵州省科学技术基金（黔科合LH[2017]2029号）

作者(Author): 周玲,涂兴蕊,冯隽,黄红莉
ZHOU Ling,TU Xingrui,FENG Jun,HUANG Hongli

DOI: 10.19367/j.cnki.2096-8388.2022.04.012

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