摘要
目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者痰细胞学和预后的关系,为COPD针对不同炎症表型进行精准诊疗提供理论依据。方法选取2016年2月至2018年7月,我院呼吸与危重症医学科新收入院的AECOPD患者共291例。其诊断符合慢阻肺全球倡议(GOLD)指南2016版急性加重诊断标准,无合并其他呼吸系统疾病。所有患者入院当天进行诱导痰细胞分类及计数,计算血液中性淋巴细胞比率(NLR),病情稳定后进行肺功能测定。在每位入组患者出院3个月、1年及2年时进行随访,记录了解患者出院后病情、治疗、复查、死亡时间等情况,对数据进行统计分析。结果 (1)诱导痰中性粒细胞、痰巨噬细胞百分数在GOLD1级、2级和GOLD3级、4级之间差异有统计学意义(P <0.05)。(2)出院3个月内及1年内再次发生急性加重的COPD患者与未发生患者比较,痰中性粒细胞、痰巨噬细胞百分比,血淋巴细胞数以及NLR差异有统计学意义(P <0.05)。出院2年随访期死亡的COPD患者与存活患者比较,痰中性细胞、痰巨噬细胞百分比,血中性粒细胞数、血淋巴细胞数以及NLR差异有统计学意义(P <0.05)。(3)ROC曲线分析提示NLR预测患者出院两年内发生死亡的AUC为0.676(95%CI:0.597-0.756,P <0.05),截断点为2.6,灵敏度80.7%,特异度50.2%。痰中性粒细胞预测的AUC为0.635(95%CI:0.557-0.712,P <0.05),截断点为90.6%,灵敏度61.4%,特异度62.0%。结论 AECOPD诱导痰中性粒细胞与痰巨噬细胞百分比可能是评估COPD患者病情严重程度的指标;急性加重期诱导痰中性粒细胞百分比和血NLR对评估COPD患者预后有一定价值。
Objective To study the relationship between sputum cytology and prognosis in patients with acute exacerbation of COPD and provide theoretical basis for accurate diagnosis and treatment of different inflammatory phenotype in COPD. Methods A retrospective observational cohort study was carried out in a tertiary teaching hospital from February 2016 to July 2018. A total of 291 COPD patients with acute exacerbation were admitted in department of pulmonary and critical care medicine. The diagnosis met the requirements described in the Global Initiative for Chronic Obstructive Lung Disease(GOLD)2016 Updated edition and the patients had no other respiratory diseases. Sputum inflammatory cells counts and blood routine tests,NLR were conducted and performed on the day of admission and lung functions were measured when the disease was stabilized. The follow-up records were made 3 months,1 year and 2 years after the discharge respectively. Statistical analysis of the patient′s condition,treatment,readmission,and time of death were also made. Results The percentage of sputum neutrophils and sputum macrophages was statistically different between GOLD stage 1 and 2 group and GOLD stage 3 and 4 group(P < 0.05). The recurrence of acute exacerbation in patients within 3 months or 1 year after discharge,the percentage of sputum macrophages,the neutrophil count,blood lymphocyte and NLR were statistically different(P < 0.05);the percentage of sputum neutrophils,sputum macrophages,blood neutrophils,blood lymphocyte and NLR were statistically different between COPD patients with acute exacerbation who died during the 2-year follow-up period and those COPD survivals(P < 0.05). ROC curve analysis suggested that the AUC of NLR for predicting death within two years of discharge was 0.676(95%CI:0.597 - 0.756,P < 0.05);the cut-off point2.6;the sensitivity 80.7% and the specificity 50.2%. The AUC of sputum neutrophils was 0.635(95%CI:0.557 -0.712,P < 0.05);the cut-off point 90.6%;the sensitivity 61.4% and the specificity 62.0%. Conclusion The percentage of sputum neutrophils and sputum macrophages induced by acute exacerbation may be an indicator to evaluate the severity of COPD. The percentage of sputum neutrophils and blood NLR induced by acute exacerbation have certain value in evaluating the prognosis of COPD patients.
作者
谭燕
彭玉兰
张云辉
王盛兰
TAN Yan;PENG Yulan;ZHANG Yunhui;WANG Shenglan(The First People′s Hospital of Yunnan Province,Department of Pulmonary and Critical Care Medicine,the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)
出处
《实用医学杂志》
CAS
北大核心
2021年第23期3014-3019,共6页
The Journal of Practical Medicine
基金
云南省科技厅昆医联合项目-面上项目计划(编号:202001AY070001-290)。
关键词
慢性阻塞性肺疾病
急性加重期
痰中性粒细胞
血中性淋巴比
预后
chronic obstructive pulmonary disease
acute exacerbation
sputum neutrophils
neutrophil-to-lymphocyte ratio
prognosis
