中性粒细胞/淋巴细胞比率及血小板平均体积在慢性阻塞性肺病急性加重期细菌感染的诊断价值

doi:10.3969/j.issn.1006-6233.2022.10.027

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摘要 目的: 探究中性粒细胞/淋巴细胞比率(NLR)、血小板平均体积(MPV)对慢性阻塞性肺病(COPD)急性加重期细菌感染的诊断价值。方法: 回顾性分析2019年2月至2022年2月101例老年COPD急性加重期患者临床资料,以痰液细菌学培养结果为金标准分为感染组62例和非感染组39例,比较两组入院时白细胞(WBC)计数、血小板(PLT)计数、NLR及MPV水平,绘制受试者工作特征曲线(ROC曲线)探究上述指标对COPD急性加重期细菌感染的诊断价值;治疗1周后,观察患者WBC、PLT、NLR、MPV变化。结果: 感染组WBC、NLR、MPV分别为(10.48±3.53)×10⁹个/L、(9.89±3.14)、(12.48±3.74)fl,均显著高于非感染组的(7.90±2.11)×10⁹个/L、(6.05±1.70)、(7.82±2.50)fl(t=4.131、6.998、6.866,P<0.001),但两组PLT水平[(256.50±96.06)×10⁹个/L vs (272.62±49.75)×10⁹个/L]比较差异无统计学意义(t=-0.968,P>0.05)。WBC、NLR、MPV诊断COPD急性加重期细菌感染的ROC曲线下面积分别为0.743、0.855、0.849(P<0.001),临界值分别为10.5×10⁹/L、8.5、9.5 fl。NLR联合MPV串联时特异度最高,误诊率为2.6%(1/39);NLR联合MPV并联时敏感度最高,漏诊率为9.7%(6/62)。治疗1周后,COPD急性加重期患者WBC、NLR、MPV分别为(7.15±2.04)10⁹个/L、(5.18±1.16)、(7.54±1.38)fl,均较治疗前的(9.49±3.30)×10⁹个/L、(8.41±3.26)、(10.68±4.02)fl降低(t=8.808、14.688、11.688,P<0.001),但PLT治疗前后[(262.72±81.43)×10⁹个/L vs (273.74±48.65)×10⁹个/L]比较差异无统计学意义(t=-1.703,P>0.05)。结论: NLR、MPV可作为预测COPD急性加重期合并细菌感染的敏感指标,在患者早期诊疗中有一定应用价值。

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	陈家翠
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关键词 ：慢性阻塞性肺疾病, 急性加重期, 细菌感染, 中性粒细胞/淋巴细胞, 血小板平均体积

Abstract：Objective: To explore the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) on bacterial infection during acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: Clinical data of 101 elderly patients with acute exacerbation of COPD admitted between February 2019 and February 2022 were retrospectively analyzed.According to sputum bacteriological culture results,the patients were divided into infected group (n=62) and non-infected group (n=39).The white blood cell (WBC) count,platelet (PLT) count,NLR and MPV were compared between the two groups at admission. Receiver operating characteristic curve (ROC curve) was plotted to explore the diagnostic value of the aforementioned indicators on bacterial infection during acute exacerbation of COPD.After 1 week of treatment,patients were observed for changes in WBC,PLT,NLR and MPV. Results: WBC,NLR and MPV of (10.48±3.53) ×10⁹ cell/L,(9.89±3.14) and (12.48±3.74) fl in infected group were significantly higher than (7.90±2.11) ×10⁹ cell/L,(6.05±1.70) and (7.82±2.50) fl in non-infected group (t=4.131,6.998,6.866,P<0.001).However,there was no statistical significance in PLT level between the two groups [(256.50±96.06) ×10⁹ cell/L vs (272.62±49.75) ×10⁹ cell/L] (t=-0.968,P>0.05).The areas under ROC curves of WBC,NLR and MPV were 0.743,0.855 and 0.849 in the diagnosis of bacterial infection during acute exacerbation of COPD (P<0.001),and the critical values were 10.5×10⁹ cell/L,8.5 and 9.5 fl respectively.The specificity of NLR combined with MPV in series was the highest,with the misdiagnosis rate of 2.6% (1/39).The sensitivity of NLR combined with MPV in parallel was the highest,with the missed diagnosis rate of 9.7% (6/62).After 1 week of treatment,WBC,NLR and MPV of (7.15±2.04) ×10⁹ cell/L,(5.18±1.16) and (7.54±1.38) fl in patients with acute exacerbation of COPD were reduced compared with (9.49±3.30) ×10⁹ cell/L,(8.41±3.26) and (10.68±4.02) fl before treatment (t=8.808,14.688,11.688,P<0.001),However,there was no statistical difference before and after PLT treatment [(262.72±81.43) ×10⁹ cell /L vs (273.74±48.65) ×10⁹ cell/L] (t=-1.703,P>0.05). Conclusion: NLR and MPV can be used as sensitive indicators to predict bacterial infection during COPD acute exacerbation,and have certain application value in the early diagnosis and treatment of patients.

Key words： Chronic obstructive pulmonary disease Acute exacerbation Bacterial infection Neutrophil/lymphocyte ratio Mean platelet volume

基金资助:安徽省自然科学基金,(编号:2008085QH379)

引用本文:

陈家翠, 彭松, 余志艳. 中性粒细胞/淋巴细胞比率及血小板平均体积在慢性阻塞性肺病急性加重期细菌感染的诊断价值[J]. 河北医学, 2022, 28(10): 1726-1730.
CHEN Jiacui, PENG Song, YU Zhiyan. Diagnostic Value of Neutrophil/Lymphocyte Ratio and Mean Platelet Volume on Bacterial Infections During Acute Exacerbation of Chronic Obstructive Pulmonary Disease. HeBei Med, 2022, 28(10): 1726-1730.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.10.027 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I10/1726

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