AECOPD患者血LAR、HBP/ALB及SIRI水平对病情和预后的影响

doi:10.11958/20260422

摘要/Abstract

摘要：

目的分析血乳酸与白蛋白比值（LAR）、肝素结合蛋白与白蛋白比值（HBP/ALB）、全身炎症反应指数（SIRI）水平对慢性阻塞性肺疾病急性加重期（AECOPD）患者病情判断和预后预测的评估价值。方法将215例AECOPD患者根据入院时简化急性生理评分Ⅱ（SAPS-Ⅱ）分为重症组（SAPS-Ⅱ≥40分）73例和轻症组（SAPS-Ⅱ<40分）142例，根据患者出院后1年的预后情况分为预后不良组（出现急性加重再入院事件或死亡）37例和预后良好组178例。收集患者一般资料（性别、年龄、COPD病程等）及实验室指标（入院时LAR、HBP/ALB、SIRI等）水平；采用多因素Logistic回归分析重症AECOPD的影响因素，使用受试者工作特征（ROC）曲线评估各指标对重症AECOPD的诊断价值及预后不良的预测价值。结果重症组的年龄和COPD病程均大于和长于轻症组（P<0.05），入院时LAR、HBP/ALB及SIRI水平高于轻症组（P<0.05）；多因素Logistic回归分析显示，LAR、HBP/ALB、SIRI水平高是重症AECOPD的独立危险因素（P<0.05）；ROC曲线分析显示，LAR、HBP/ALB、SIRI联合预测重症AECOPD的曲线下面积（AUC）为0.872（95%CI：0.821~0.922），高于各指标单独检测（P<0.05）。预后不良组LAR、HBP/ALB、SIRI水平高于预后良好组（P<0.05）；ROC曲线分析显示，LAR、HBP/ALB、SIRI联合预测患者预后不良的AUC为0.951（95%CI：0.925~0.978），高于各指标单独检测（P<0.05）。结论 AECOPD患者的病情、预后与入院时LAR、HBP/ALB及SIRI水平密切相关，上述指标联合检测能有效辅助评估患者的病情和预后。

关键词: 肺疾病, 慢性阻塞性, 预后, 慢性阻塞性肺疾病急性加重期, 乳酸与白蛋白比值, 肝素结合蛋白与白蛋白比值, 全身炎症反应指数

Abstract:

Objective To analyze the evaluation value of blood lactic acid to albumin ratio (LAR), heparin-binding protein to albumin ratio (HBP/ALB) and systemic inflammatory response index (SIRI) in the judgement of disease condition and prognosis prediction in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 215 patients with AECOPD were divided into the severe group (SAPS-II≥40 points, 73 cases) and the mild group (SAPS-II<40 points, 142 cases) according to the simplified acute physiology score-II (SAPS-II) at admission. Based on the prognosis status at 1 year after discharge, patients were classified into the poor prognosis group (acute exacerbation readmission event or death, 37 cases) and the good prognosis group (178 cases). The general data (gender, age, COPD duration) and laboratory indexes (LAR, HBP/ALB and SIRI at admission) were collected. Multivariate Logistic regression was used to analyze the factor influencing severe AECOPD. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic value of the indexes on severe AECOPD and the predictive value on poor prognosis. Results The age and COPD duration were older or longer in the severe group than those in the mild group (P<0.05), and LAR, HBP/ALB and SIRI at admission were higher in the severe group than those in the mild group (P<0.05). Multivariate Logistic regression analysis showed that high levels of LAR, HBP/ALB and SIRI were independent risk factors for severe AECOPD (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of the combination of LAR, HBP/ALB and SIRI for predicting severe AECOPD was 0.872 (95%CI: 0.821-0.922), which was higher than that of each index (P<0.05). LAR, HBP/ALB and SIRI were higher in the poor prognosis group than those in the good prognosis group (P<0.05). ROC curve analysis showed that the AUC of the combination of LAR, HBP/ALB and SIRI was 0.951 (95%CI: 0.925-0.978) in the predicting poor prognosis, which was higher than that of each index (P<0.05). Conclusion The disease condition and prognosis of patients with AECOPD are closely associated with LAR, HBP/ALB and SIRI at admission. Combined detection of the above indicators can effectively aid in evaluating the disease condition and prognosis.

Key words: pulmonary disease, chronic obstructive, prognosis, acute exacerbation of chronic obstructive pulmonary disease, lactic acid to albumin ratio, heparin-binding protein to albumin ratio, systemic inflammatory response index

中图分类号:

R563

图/表 8

参考文献 26

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组别	n	年龄/岁	男性	COPD病程/年
轻症组	142	63.71±5.21	85（59.86）	10.56±2.08
重症组	73	67.78±6.03	45（61.64）	12.52±2.16
χ2或t		5.135＊＊	0.064	6.451＊＊
组别	吸烟史	高血压病	糖尿病	高脂血症
轻症组	91（64.08）	48（33.80）	34（23.94）	39（27.46）
重症组	56（76.71）	31（42.47）	21（28.77）	27（36.99）
χ²	3.555	1.557	0.589	2.055

组别	n	年龄/岁	男性	COPD病程/年
轻症组	142	63.71±5.21	85（59.86）	10.56±2.08
重症组	73	67.78±6.03	45（61.64）	12.52±2.16
χ2或t		5.135＊＊	0.064	6.451＊＊
组别	吸烟史	高血压病	糖尿病	高脂血症
轻症组	91（64.08）	48（33.80）	34（23.94）	39（27.46）
重症组	56（76.71）	31（42.47）	21（28.77）	27（36.99）
χ²	3.555	1.557	0.589	2.055

组别	n			WBC/（×10⁹/L）			hs-CRP/（mg/L）			PCT/（μg/L）
轻症组	142			7.52±1.64			19.09±6.41			0.17±0.06
重症组	73			13.57±3.48			65.44±22.09			1.61±0.55
t				14.062^＊＊			17.549^＊＊			22.179^＊＊
组别			PLT/（×10⁹/L）			BASO/（×10⁹/L）			EOS/（×10⁹/L）
轻症组			190.83±41.40			0.03±0.02			0.21（0.08，0.30）
重症组			193.21±48.55			0.03±0.01			0.14（0.02，0.22）
t或Z			0.375			1.189			2.991^＊＊
组别		LAR			HBP/ALB			SIRI
轻症组		0.05±0.01			0.38±0.14			2.35（1.74，3.14）
重症组		0.06±0.02			0.48±0.17			4.55（3.20，5.99）
t或Z		5.167^＊＊			4.626^＊＊			7.332^＊＊

组别	n			WBC/（×10⁹/L）			hs-CRP/（mg/L）			PCT/（μg/L）
轻症组	142			7.52±1.64			19.09±6.41			0.17±0.06
重症组	73			13.57±3.48			65.44±22.09			1.61±0.55
t				14.062^＊＊			17.549^＊＊			22.179^＊＊
组别			PLT/（×10⁹/L）			BASO/（×10⁹/L）			EOS/（×10⁹/L）
轻症组			190.83±41.40			0.03±0.02			0.21（0.08，0.30）
重症组			193.21±48.55			0.03±0.01			0.14（0.02，0.22）
t或Z			0.375			1.189			2.991^＊＊
组别		LAR			HBP/ALB			SIRI
轻症组		0.05±0.01			0.38±0.14			2.35（1.74，3.14）
重症组		0.06±0.02			0.48±0.17			4.55（3.20，5.99）
t或Z		5.167^＊＊			4.626^＊＊			7.332^＊＊

指标	β	SE	Wald χ²	P	OR	OR95%CI
年龄	-0.047	0.026	3.268	0.071	0.954	0.907~1.004
COPD病程	0.142	0.085	2.791	0.095	1.153	0.976~1.362
WBC	0.034	0.059	0.332	0.565	1.035	0.922~1.161
hs-CRP	0.005	0.010	0.250	0.617	1.005	0.986~1.025
PCT	0.192	0.248	0.599	0.439	1.212	0.745~1.970
EOS	-1.652	1.117	2.187	0.139	0.192	0.021~1.711
LAR	52.436	13.081	16.069	<0.001	5.926× 10²²	4.344×10¹¹~ 8.080×10³³
HBP/ALB	5.117	1.339	14.604	<0.001	166.834	12.092~2 301.785
SIRI	0.611	0.106	33.225	<0.001	1.842	1.497~2.268
常数项	-8.327	1.225	46.207	<0.001	0.000	-