NMLR与老年慢性阻塞性肺疾病患者急性加重、肺功能下降的关系

Relationship between NMLR and acute exacerbation and lung function decline in elderly patients with COPD

摘要:

目的 探讨（中性粒细胞+单核细胞）/淋巴细胞比值（NMLR）水平与老年慢性阻塞性肺疾病（COPD）患者急性加重、肺功能下降的关系。方法 选取2020年12月—2023年12月沧州市人民医院收治的235例老年COPD患者作为研究对象，其中141例稳定期患者作为稳定期组，94例急性加重期患者作为急性加重期组。比较两组患者NMLR水平及临床资料。采用Pearson相关性分析老年COPD患者NMLR水平与疾病进展、肺功能的相关性。绘制受试者工作特性（ROC）曲线评估NMLR对老年COPD患者急性加重的诊断效能，采用多因素逐步Logistic回归模型分析影响COPD患者急性加重的因素。结果 两组患者性别构成、年龄、体质量指数、COPD病程、吸烟史、饮酒史、糖尿病率、高血压率、高脂血症率比较，差异均无统计学意义（P >0.05）。急性加重期组患者入院急性生理与慢性健康（APACHEⅡ）评分≥ 20分、哮喘率、NMLR均高于稳定期组患者（P <0.05），用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、第1秒用力呼气容积占用力肺活量的百分比（FEV₁/FVC）均低于稳定期组患者（P <0.05）。Pearson相关性分析结果显示，老年COPD患者NMLR水平与FVC水平、FEV₁水平、FEV₁/FVC水平均呈负相关（r =-0.541、-0.434和-0.340，均P <0.05），NMLR水平与COPD病情呈正相关（r =0.589，P <0.05）。ROC曲线分析结果显示，以NMLR=3.62为最佳截断值，NMLR诊断COPD患者进入急性加重期的曲线下面积为0.916（95% CI：0.872，0.961），特异性为89.38%（95% CI：0.876，0.953），敏感性为89.71%（95% CI：0.879，0.948）。多因素逐步Logistic回归分析结果显示，哮喘史［O^R=3.758（95% CI：1.523，9.277）］、入院APACHEⅡ评分≥ 20分［O^R=3.168（95% CI：1.410，7.117）］、NMLR水平［O^R=4.522（95% CI：1.951，10.484）］是老年COPD患者急性加重的危险因素（P <0.05）。结论 NMLR水平升高与老年COPD患者急性加重、肺功能损害密切相关，有望作为评估老年COPD患者急性加重风险、肺功能下降的生物标志物。

Abstract:

Objective To investigate the relationship between the (neutrophil + monocyte)/lymphocyte ratio (NMLR) and acute exacerbation and lung function decline in elderly patients with chronic obstructive pulmonary disease (COPD).Methods The 235 elderly patients with COPD in our hospital from December 2020 to December 2023 were selected, among which 141 cases were in the stable stage (stable stage group) and 94 were in the acute exacerbation stage (acute exacerbation stage group). The NMLR and clinical characteristics were compared between the two groups. The associations of NMLR with the disease progression and lung function in elderly COPD patients were determined using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of NMLR for acute exacerbation in elderly COPD patients. Factors affecting acute exacerbation in elderly COPD patients were analyzed by multivariable stepwise Logistic regression.Results The comparison of sex composition, age, body mass index, COPD duration, smoking history, alcohol consumption history, diabetes rate, hypertension rate, and hyperlipidemia rate between the two groups showed no statistically significant differences, as determined by χ2/ t - tests (P > 0.05). Patients in the acute exacerbation stage had a higher proportion of those with an Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score ≥ 20 at admission, a higher asthma rate, and higher NMLR compared to patients in the stable stage group (P < 0.05). The forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and the FEV₁/FVC ratio in the acute exacerbation stage group were all lower compared to the stable stage group (P < 0.05). Pearson correlation analysis exhibited that the NMLR in elderly COPD patients was negatively correlated with FVC (r = -0.541), FEV₁ (r = -0.434), and the FEV₁/FVC ratio (r = -0.340) (P < 0.05), but was positively correlated with the severity of COPD (r = 0.589, P < 0.05). The ROC curve analysis demonstrated that an NMLR of 3.62 was the optimal cutoff value, with which the area under the curve of NMLR for predicting acute exacerbation in COPD patients was 0.916 (95% CI: 0.872, 0.961), with a specificity of 89.38% (95% CI: 0.876, 0.953), and a sensitivity of 89.71% (95% CI: 0.879, 0.948). Multivariable stepwise Logistic regression analysis showed that a history of asthma [O^R = 3.758 (95% CI: 1.523, 9.277) ], APACHE II score ≥ 20 at admission [O^R = 3.168 (95% CI: 1.410, 7.117) ], and high NMLR [O^R = 4.522 (95% CI: 1.951, 10.484) ] were all risk factors for acute exacerbation in elderly patients with COPD (P < 0.05).Conclusions The increased NMLR is closely related to acute exacerbation and lung function impairment in elderly patients with COPD, and may be used as biomarkers to evaluate the risk of acute exacerbation and the lung function in these patients.