慢性阻塞性肺疾病频繁加重的多因素分析
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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、χ~2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, PaCO_2)的OR(95%CI)值为1.124(1.053～1.201),NLR和PaCO_2是慢阻肺频繁加重的危险因素,随着NLR和PaCO_2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PaCO_2水平高于非频繁加重型,NLR和PaCO_2可能作为慢阻肺频繁加重的危险因素。
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, 47 patients), 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, χ~2 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(PaCO_2) was 1.124(1.053-1.201).NLR and PaCO_2 were risk factors for frequent exacerbation of COPD. Increase of NLR and PaCO_2 led to an increasing risk of frequent exacerbation of COPD( All P<0.05). Conclusions The levels of NLR and PaCO_2 in COPD patients with frequent exacerbation are higher than those in patients with infrequent exacerbation. As a consequent, NLR and PaCO_2 could be considered risk factors for frequent exacerbation of COPD.
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, 47 patients), 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, χ~2 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(PaCO_2) was 1.124(1.053-1.201).NLR and PaCO_2 were risk factors for frequent exacerbation of COPD. Increase of NLR and PaCO_2 led to an increasing risk of frequent exacerbation of COPD( All P<0.05). Conclusions The levels of NLR and PaCO_2 in COPD patients with frequent exacerbation are higher than those in patients with infrequent exacerbation. As a consequent, NLR and PaCO_2 could be considered risk factors for frequent exacerbation of COPD.
引文
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[7] Casanova C, de Tortes JP, Aguirre Jaime A, et a1. The progression of chronic obstructive pulmonary disease is heterogeneous: the experience of the BODE cohort [J]. Am J Respir Crit Care Med, 2011,184(9):1015-1021. DOI: 10.1164/rccm.201105-0831OC.
[8] Gunay E, Sarinc Ulasli S, Akar O, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study [J]. Inflammation. 2014, 37(2):374-380.DOI: 10.1007/s10753-013-9749-1.
[9] S?rensen AK, Holmgaard DB, Mygind LH, et al. Neutrophil-to-lymphocyte ratio, calprotectin and YKL-40 in patients with chronic obstructive pulmonary disease: correlations and 5-year mortality - a cohort study [J]. Journal of Inflammation, 2015, 12(1):20. DOI: 10.1186/s12950-015-0064-5.
[10] Lee H, Um SJ, Kim YS, et al. Association of the neutrophil-to-lymphocyte ratio with lung function and exacerbations in patients with chronic obstructive pulmonary disease [J]. PLoS One. 2016,11(6):e0156511. DOI: 10.1371/journal.pone.0156511.
[11] Furutate R, Ishii T, Motegi T, et al. The neutrophil to lymphocyte ratio is related to disease severity and exacerbation in patients with chronic obstructive pulmonary disease [J]. Intern Med. 2016,55(3):223-229. DOI: 10.2169/internalmedicine.55.5772.
[12] Xiong W, Xu M, Zhao Y, et al. Can we predict the prognosis of COPD with a routine blood test? [J]. Int J Chron Obstruct Pulmon Dis. 2017,12:615-625. DOI: 10.2147/COPD.S124041.
[13] Duman D, Aksoy E, Agca MC, et al. The utility of inflammatory markers to predict readmissions and mortality in COPD cases with or without eosinophilia [J]. Int J Chron Obstruct Pulmon Dis. 2015, 10(1):2469-2478. DOI: 10.2147/COPD.S90330.
[14] Xia W, Ma Z, Nan Y, et al. Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD [J]. Int J Chron Obstruct Pulmon Dis, 2018,13:121-129. DOI:10.2147/COPD.S152826.
[2] Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease(2017REPORT) [EB/OL]. (2016-11-16)[2018-8-10]. http://www.goldcopd.org.
[3] 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年修订版) [S]. 国际呼吸杂志,2017,37(14):1041-1057. DOI:10.3760/cma.j.issn.1673-436X.2017.14.001. Expert group on the diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Expert consensus on the diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in China (revised edition in 2017) [S].International Journal of Respiration,2017,37(14):1041-1057. DOI:10.3760/cma.j.issn.1673-436X.2017.14.001.
[4] Soler-Cataluna JJ, Rodriguez-Roisin R. Frequent chronic obstructive pulmonary disease exacerbators: how much real, how much fictitious? [J]. COPD, 2010,7(4):276-284. DOI:10.3109/15412555.2010.496817.
[5] Hurst JR. Evaluation of COPD longitudinally to identify predictive surrogate end-points(ECLIPSE) [J]. Rev Patol Respir,2009,12(1):48-49. DOI: 10.1016/S1576-9895(09)70092-X.
[6] 中华医学会呼吸病学分会. 慢性阻塞性肺疾病诊治指南(2013年修订版) [S]. 中国医学前沿杂志(电子版),2014, 6(2): 67-80. DOI:10.3760/cma.j.issn.1001-0939.2013.04.007. Respiratory medicine branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (revised edition in 2013) [S]. Chinese Journal of The Frontiers of Medical Science(Electronic Version),2014,6(2): 67-80. DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[7] Casanova C, de Tortes JP, Aguirre Jaime A, et a1. The progression of chronic obstructive pulmonary disease is heterogeneous: the experience of the BODE cohort [J]. Am J Respir Crit Care Med, 2011,184(9):1015-1021. DOI: 10.1164/rccm.201105-0831OC.
[8] Gunay E, Sarinc Ulasli S, Akar O, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study [J]. Inflammation. 2014, 37(2):374-380.DOI: 10.1007/s10753-013-9749-1.
[9] S?rensen AK, Holmgaard DB, Mygind LH, et al. Neutrophil-to-lymphocyte ratio, calprotectin and YKL-40 in patients with chronic obstructive pulmonary disease: correlations and 5-year mortality - a cohort study [J]. Journal of Inflammation, 2015, 12(1):20. DOI: 10.1186/s12950-015-0064-5.
[10] Lee H, Um SJ, Kim YS, et al. Association of the neutrophil-to-lymphocyte ratio with lung function and exacerbations in patients with chronic obstructive pulmonary disease [J]. PLoS One. 2016,11(6):e0156511. DOI: 10.1371/journal.pone.0156511.
[11] Furutate R, Ishii T, Motegi T, et al. The neutrophil to lymphocyte ratio is related to disease severity and exacerbation in patients with chronic obstructive pulmonary disease [J]. Intern Med. 2016,55(3):223-229. DOI: 10.2169/internalmedicine.55.5772.
[12] Xiong W, Xu M, Zhao Y, et al. Can we predict the prognosis of COPD with a routine blood test? [J]. Int J Chron Obstruct Pulmon Dis. 2017,12:615-625. DOI: 10.2147/COPD.S124041.
[13] Duman D, Aksoy E, Agca MC, et al. The utility of inflammatory markers to predict readmissions and mortality in COPD cases with or without eosinophilia [J]. Int J Chron Obstruct Pulmon Dis. 2015, 10(1):2469-2478. DOI: 10.2147/COPD.S90330.
[14] Xia W, Ma Z, Nan Y, et al. Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD [J]. Int J Chron Obstruct Pulmon Dis, 2018,13:121-129. DOI:10.2147/COPD.S152826.