肺泡动脉血氧分压差联合单核细胞与大血小板比率在AECOPD合并肺栓塞中的临床意义

Clinical significance of alveolar-arterial oxygen partial pressure difference combined with monocyte-to-large platelet ratio in patients with AECOPD complicated by pulmonary embolism

摘要:

目的 探讨肺泡动脉血氧分压差（PA-aDO₂）联合单核细胞与大血小板比率（MLPR）在急性加重期慢性阻塞性肺疾病（AECOPD）合并肺栓塞（PE）患者中的临床意义。方法 选取2022年1月—2024年12月在秦皇岛市第一医院确诊的AECOPD合并PE患者96例作为研究对象，另从该院同期收治的单纯AECOPD患者中选取80例未合并PE者作为合并PE组，50例同期健康人群纳入对照组。比较合并PE组与非合并PE组的临床资料、实验室资料，比较3组的PA-aDO₂、单核细胞与大血小板比率（MLPR）水平。采用多因素一般Logistic回归分析AECOPD患者合并PE的影响因素，并绘制受试者工作特征（ROC）曲线评估PA-aDO₂、MLPR单独及联合预测AECOPD合并PE的效能。结果 合并PE组咳嗽率和呼吸困难率均高于非合并PE组（P 0.05）。合并PE组PaCO₂、D-D、降钙素原（PCT）水平均高于非合并PE组，PaO₂水平低于非合并PE组（P 0.05）。合并PE组的PA-aDO₂与MLPR水平均高于非合并PE组和对照组，非合并PE组亦高于对照组（P 0.05）。多因素一般Logistic回归分析结果显示：PaO₂水平高［O^R =0.227（95% CI：0.056，0.924）］为AECOPD合并PE的保护因素（P 0.05），PaCO₂水平高［O^R =7.218（95% CI：1.064，48.959）］、D-D水平高［O^R =3.530（95% CI：1.027，12.135）］、PCT水平高［O^R =26.208（95% CI：2.468，278.254）］、PA-aDO₂水平高［O^R =9.567（95% CI：2.189，41.818）］及MLPR水平高［O^R =10.908（95% CI：2.082，57.155）］均为AECOPD合并PE的危险因素（P 0.05）。ROC曲线结果显示，PA-aDO₂与MLPR联合预测AECOPD合并PE的敏感性为83.3%（95% CI：0.744，0.902），特异性为98.8%（95% CI：0.932，1.000）。结论 PA-aDO₂及MLPR在AECOPD合并PE患者中显著升高，与疾病严重程度密切相关，联合检测可提高早期诊断及风险评估的准确性，可为临床评估患者病情、指导治疗决策提供有益参考。

Abstract:

Objective To investigate the clinical significance of the alveolar–arterial oxygen partial pressure difference (PA-aDO₂) combined with the monocyte-to-large platelet ratio (MLPR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by pulmonary embolism (PE).Methods Ninety-six patients diagnosed with AECOPD complicated by PE between January 2022 and December 2024 were enrolled. Another 80 AECOPD patients without PE served as the non-PE group, and 50 healthy individuals were included as the control group. Levels of PA-aDO₂ and MLPR were measured and compared among the three groups, and their correlations with D-dimer, arterial partial pressure of oxygen (PaO₂), and carbon dioxide (PaCO₂) were analyzed. Logistic regression was used to identify independent risk factors for PE in AECOPD patients. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of PA-aDO₂ and MLPR alone and in combination.Results The incidence of cough and dyspnea was higher in the combined PE group than in the non-PE group (P 0.05). PaCO₂, D-dimer, and procalcitonin (PCT) levels were significantly higher in the combined PE group, while PaO₂ was significantly lower (P 0.05). PA-aDO₂ and MLPR levels were significantly elevated in the combined PE group compared with the non-PE and control groups, and were also higher in the non-PE group than in controls (P 0.05). Higher PaO? level [O^R = 0.227 (95% CI: 0.056, 0.924) ] was identified as a protective factor for AECOPD complicated with PE (P 0.05), whereas elevated PaCO₂ [O^R = 7.218 (95% CI: 1.064, 48.959) ], D-dimer [O^R = 3.530 (95% CI: 1.027, 12.135) ], PCT [O^R = 26.208 (95% CI: 2.468, 278.254) ], PA-aDO₂ [O^R = 9.567 (95% CI: 2.189, 41.818) ], and MLPR [O^R = 10.908 (95% CI: 2.082, 57.155) ] were independent risk factors for PE in AECOPD patients (P 0.05). The combined detection of PA-aDO₂ and MLPR yielded a sensitivity of 83.3% (95% CI: 0.744, 0.902) and a specificity of 98.8% (95% CI: 0.932, 1.000).Conclusion PA-aDO₂ and MLPR are markedly elevated in AECOPD patients with PE and closely associated with disease severity. Their combined detection enhances the accuracy of early diagnosis and risk assessment, providing valuable reference for clinical evaluation and treatment decision-making.