慢性阻塞性肺疾病频繁加重的多因素分析

陈杰; 孙耕耘

doi:10.16462/j.cnki.zhjbkz.2019.03.020

慢性阻塞性肺疾病频繁加重的多因素分析

doi: 10.16462/j.cnki.zhjbkz.2019.03.020

陈杰^{1, 2},
孙耕耘^1, ,

1.
230022 合肥, 安徽医科大学第一附属医院呼吸与危重症医学科
2.
230041 合肥, 安徽省第二人民医院呼吸内科

详细信息

通讯作者:
孙耕耘, E-mail: sungengy@126.com

中图分类号: R563
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- 被引次数: 0
出版历程
- 收稿日期: 2018-08-18
- 修回日期: 2018-11-27
- 刊出日期: 2019-03-10

Analysis of the indicators of frequent exacerbation of chronic obstructive pulmonary disease

CHEN Jie^{1, 2},
SUN Geng-yun^{1
, ,}

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
2.
Department of Respiratory Medicine, Anhui NO.2 Provincial People's Hospital, Hefei 230041, China

摘要

摘要: 目的探讨多个血液学指标与慢性阻塞性肺疾病（简称慢阻肺）频繁加重的关系。方法采用回顾性研究，选取102例慢阻肺患者，根据1年内急性加重的次数分为频繁加重组（≥2次/年）55例，非频繁加重组（<2次/年）47例。通过独立样本t检验、χ²检验、多因素Logistic回归分析法，探索血常规、血气分析中多个指标与慢阻肺频繁加重之间的关系。结果频繁加重组中性粒细胞计数（neutrophil count，NEUT）、中性粒细胞百分比（neutrophil percentage，NEU%）和中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）高于非频繁加重组，而频繁加重组淋巴细胞计数（lymphocyte count，LY）、淋巴细胞百分比（lymphocyte percentage，LY%）低于非频繁加重组，差异均有统计学意义（均有P<0.05）；NLR的OR（95%CI）值为3.483（1.170~10.373），动脉血二氧化碳分压（partial pressure of carbon dioxide in artery，PaCO₂）的OR（95%CI）值为1.124（1.053~1.201），NLR和PaCO₂是慢阻肺频繁加重的危险因素，随着NLR和PaCO₂的升高，慢阻肺频繁加重的风险升高，差异均有统计学意义（均有P<0.05）。结论慢阻肺频繁加重型患者的NLR和PaCO₂水平高于非频繁加重型，NLR和PaCO₂可能作为慢阻肺频繁加重的危险因素。
- 慢性阻塞性肺疾病 /
- 频繁加重 /
- 中性粒细胞/淋巴细胞比值 /
- 动脉血二氧化碳分压
Abstract: Objective To investigate the relationship between multiple blood indexes and frequent exacerbation of chronic obstructive pulmonary disease (COPD). Methods 102 patients with COPD were selected and divided into frequent exacerbation group (≥ 2 times/year, 55 patients) and infrequent exacerbation group (< 2 times/year, 47patients), according to the frequency of acute exacerbation in one year. The relationship between multiple indicators in blood routine and blood gas analysis and frequent exacerbation of COPD was explored by independent sample t test, χ² test, and multiple Logistic regression analysis. A retrospective study was conducted. Results Neutrophils count (NEU), neutrophils ratio (Neut%), and neutrophil-to-lymphocyte ratio (NLR) of frequent exacerbation group were significantly higher than those of infrequent exacerbation group, while lymphocytes (LY), lymphocytes ratio (LY%) were lower (All P<0.05). OR(95% CI) of NLR was 3.483(1.170-10.373), and OR(95% CI) of partial pressure of carbon dioxide in artery (PaCO₂) was 1.124(1.053-1.201).NLR and PaCO₂ were risk factors for frequent exacerbation of COPD. Increase of NLR and PaCO₂ led to an increasing risk of frequent exacerbation of COPD (All P<0.05). Conclusions The levels of NLR and PaCO₂ in COPD patients with frequent exacerbation are higher than those in patients with infrequent exacerbation. As a consequent, NLR and PaCO₂ could be considered risk factors for frequent exacerbation of COPD.
- Chronic obstructive pulmonary disease /
- Frequent exacerbation /
- NLR /
- PaCO₂

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表 1 频繁加重组和非频繁加重组一般资料

Table 1. The general information of frequent exacerbation group and infrequent exacerbation group

基本特征	频繁加重组(n=55)	非频繁加重组(n=47)	t/χ²值	P值
年龄(岁，x±s)	77.11±8.93	75.43±7.02	1.044	0.299
性别(男/女)	35/20	31/16	0.060	0.807
吸烟史(有/无)	36/19	28/19	0.375	0.540
合并基础疾病(有/无)	29/26	19/28	1.539	0.215
就诊前使用抗生素(有/无)	16/39	14/33	0.006	0.939
稳定期使用ICS(有/无)	32/23	19/28	3.196	0.074

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表 2 频繁加重组和非频繁加重组血液学指标比较[M(P₂₅，P₇₅)]

Table 2. Comparison of hematological indexes between frequent exacerbation group and infrequent exacerbation group[M(P₂₅, P₇₅)]

指标	频繁加重组(n=55)	非频繁加重组(n=47)	Z值	P值
WBC(×10⁹/L)	8.43(5.91，10.23)	7.14(4.73，8.88)	-1.786	0.074
NEUT(×10⁹/L)	6.96(4.61，9.36)	5.02(3.10，6.37)	-2.759	0.006
LY(×10⁹/L)	0.90(0.56，1.10)	1.51(1.03，1.85)	-5.408	<0.001
NEU%	80.49(73.50，88.60)	68.83(61.80，75.24)	-5.502	<0.001
LY%	12.28(6.80，16.90)	22.42(15.20，27.10)	-6.063	<0.001
EOS(×10⁹/L)	0.05(0，0.02)	0.08(0, 0.08)	-1.319	0.187
BASO(×10⁹/L)	0(0，0.01)	0(0，0.01)	-0.325	0.745
EOS%	0.68(0，0.30)	1.14(0，1.90)	-1.617	0.106
BA%	0.09(0，0.20)	0.09(0，0.20)	-0.051	0.959
NLR(N/L)	10.02(4.60，13.05)	3.56(3.56，4.87)	-6.039	<0.001
EBR(E/B)	0(0，1.50)	0(0，3.00)	-1.110	0.267
PLT(×10⁹/L)	184.62(128.00，214.00)	197.43(197.00，271.00)	-0.839	0.401
MPV(fL)	10.89(10.10，11.70)	11.05(10.10，11.80)	-0.333	0.739
PaCO₂(mmHg)	49.00(46.00，49.00)	42.00(35.00，47.00)	-1.956	0.051

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表 3 慢阻肺频繁加重的多因素Logistic分析

Table 3. Multivariate Logistic analysis of frequent exacerbation of COPD

指标	回归系数	sx	χ²值	P值	OR(95% CI)值
WBC(×10⁹/L)	-3.194	3.066	1.086	0.297	0.041(0, 16.677)
NEUT(×10⁹/L)	2.891	3.354	0.743	0.389	18.002(0.025, 12887.489)
LY(%)	5.933	3.833	2.396	0.122	377.438(0.206，691668.658)
NEU(%)	-0.341	0.235	2.111	0.146	0.711(0.449, 1.127)
LY(%)	-0.264	0.229	1.330	0.249	0.768(0.491，1.202)
NLR(N/L)	1.248	0.557	5.023	0.025	3.483(1.170, 10.373)
PaCO₂(mmHg)	0.117	0.034	12.119	0.000	1.124(1.053, 1.201)
常数项	14.052	19.697	0.509

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