PIV、HCAR、PCT/PLT在老年COPD肺部感染中的应用价值

doi:10.11958/20241377

摘要/Abstract

摘要：

目的探究泛免疫炎症值（PIV）、超敏C反应蛋白（hs-CRP）/白蛋白（ALB）比值（HCAR）、降钙素原/血小板计数比值（PCT/PLT）在老年慢性阻塞性肺疾病（COPD）肺部感染患者中的应用价值。方法选取143例老年COPD伴肺部细菌感染患者为感染组，另选取同期就诊的143例老年COPD不伴肺部细菌感染患者作为未感染组。另依据感染程度将感染组分为轻度组47例、中度组51例和重度组45例；依预后情况分为预后良好组112例和预后不佳组31例。比较各组血生化指标、PIV、HCAR及PCT/PLT水平，分析上述指标与肺部感染、感染程度及预后的关系。结果感染组中性粒细胞（NEU）、单核细胞（MON）、hs-CRP、PCT水平高于未感染组，淋巴细胞（LYM）、ALB水平低于未感染组（P<0.05）；感染组、预后不佳组PIV、HCAR、PCT/PLT水平分别高于未感染组、预后良好组（P<0.05）；轻度组、中度组、重度组PIV、HCAR及PCT/PLT水平依次升高（P<0.05）。Spearman相关性分析显示，PIV、HCAR及PCT/PLT均与肺部感染程度呈正相关（P<0.05）。多因素Logistic回归分析显示，高水平PIV、HCAR及PCT/PLT是老年COPD患者发生肺部感染的独立危险因素（P<0.05），亦是肺部感染患者预后不佳的独立危险因素（P<0.05）。PIV、HCAR及PCT/PLT三指标联合诊断老年COPD肺部感染及患者预后不佳的曲线下面积（AUC）分别为0.980和0.910（P<0.05）。结论 PIV、HCAR及PCT/PLT与老年COPD伴肺部感染有关，有助于识别肺部感染、判断肺部感染病情及评估患者预后。

关键词: 肺疾病, 慢性阻塞性, 感染, ROC曲线, 血小板计数, 泛免疫炎症值, 降钙素原

Abstract:

Objective To investigate the application value of pan-immune-inflammation value (PIV), hypersensitive C-reactive protein (hs-CRP)/albumin (ALB) ratio (HCAR) and procalcitonin/platelet count ratio (PCT/PLT) in pulmonary infection in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 143 elderly patients with COPD and pulmonary bacterial infection were selected as the infected group. Meanwhile, 143 elderly patients with COPD and without pulmonary infection were selected as the uninfected group. Patients in the infected group were furthrer divided into the mild group (47 cases), the moderate group (51 cases) and the severe group (45 cases) according to the degree of pulmonary infection. They were divided into the favorable prognosis group (112 cases) and the poor prognosis group (31 cases) according to the prognosis. Blood biochemical indicators, PIV, HCAR and PCT/PLT were compared between groups. The relationship between above indicators and pulmonary infection, infection degree and the prognosis was analyzed. Results Compared with the uninfected group, neutrophil (NEU), monocyte (MON), hs-CRP and PCT levels were higher, while lymphocyte (LYM) and ALB levels were lower in the infected group (P<0.05). PIV, HCAR and PCT/PLT were higher in the infected group and the poor prognosis group than those in the uninfected group and the favorable prognosis group, respectively (P<0.05). PIV, HCAR and PCT/PLT in the mild group, the moderate group and the severe group increased in sequence (P<0.05). Spearman correlation analysis showed that PIV, HCAR and PCT/PLT were positively correlated with the degree of pulmonary infection (P<0.05). Multivariate Logistic regression analysis showed that high levels of PIV, HCAR and PCT/PLT were independent risk factors for pulmonary infection in elderly patients with COPD (P<0.05), and also independent risk factors for poor prognosis in patients with pulmonary infection (P<0.05). The areas under the curve (AUC) of PIV combined with HCAR and PCT/PLT for diagnosing pulmonary infection in elderly patients with COPD and predicting poor prognosis in patients with pulmonary infection were 0.980 and 0.910 (P<0.05). Conclusion PIV, HCAR and PCT/PLT are related to COPD with pulmonary infection in the elderly. They can help to identify pulmonary infection, judge the condition of pulmonary infection and evaluate the prognosis in patients with pulmonary infection.

Key words: pulmonary disease, chronic obstructive, infections, ROC curve, platelet count, pan-immune inflammatory value, procalcitonin

中图分类号:

R563.9

图/表 10

参考文献 22

[1]	SULAIMAN I, WU B G, CHUNG M, et al. Lower airway dysbiosis augments lung inflammatory injury in mild-to-moderate chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2023, 208(10):1101-1114. doi:10.1164/rccm.202210-1865OC.
[2]	RITCHIE A I, WEDZICHA J A. Definition,causes,pathogenesis,and consequences of chronic obstructive pulmonary disease exacerbations[J]. Clin Chest Med, 2020, 41(3):421-438. doi:10.1016/j.ccm.2020.06.007.
[3]	DEMIRÖZ TAŞOLAR S, ÇIFTÇI N. Role of pan immune inflammatory value in the evaluation of hepatosteatosis in children and adolescents with obesity[J]. J Pediatr Endocrinol Metab, 2022, 35(12):1481-1486. doi:10.1515/jpem-2022-0494.
[4]	付志彬, 李赵忠, 强仲惪, 等. HCAR与临床指标对COPD并发呼吸衰竭患者预后的预测作用研究[J]. 国际呼吸杂志, 2022, 42(12):922-927.
	FU Z B, LI Z Z, QIANG Z D, et al. Study on the predictive effeet of high-sensitivity C-reactive protein/albumin ratio and clinical indexes on the prognosis of chronic obstructive pulmonary disease patients with respiratory failure[J]. Int J Respir, 2022, 42(12):922-927. doi:10.3760/cma.j.cn131368-20220302-00152.
[5]	刘梦婷, 钟文宏, 文茵, 等. PCT/PLT比值对脓毒症心肌损伤的预警价值[J]. 中华急诊医学杂志, 2022, 31(8):1071-1076.
	LIU M T, ZHONG W H, WEN Y, et al. Early-warning value of PCT/PLT ratio on sepsis-induced myocardial injury[J]. Chin J Emerg Med, 2022, 31(8):1071-1076. doi:10.3760/cma.j.issn.1671-0282.2022.08.010.
[6]	徐慧, 赵登峰, 王淼, 等. 肺部感染对慢性阻塞性肺疾病患者呼吸功能状态与细胞因子表达的影响[J]. 中华医院感染学杂志, 2019, 29(7):1011-1014.
	XU H, ZHAO D F, WANG M, et al. Effects of pulmonary infection on respiratory function and cytokine expression in patients with chronic obstructive pulmonary disease[J]. Chin J Nosocomiol, 2019, 29(7):1011-1014.
[7]	REHMAN A U, SHAH S, ABBAS G, et al. Assessment of risk factors responsible for rapid deterioration of lung function over a period of one year in patients with chronic obstructive pulmonary disease[J]. Sci Rep, 2021, 11(1):13578. doi:10.1038/s41598-021-92968-5.
[8]	LEE S H, KIM K U, LEE H, et al. Factors associated with low-level physical activity in elderly patients with chronic obstructive pulmonary disease[J]. Korean J Intern Med, 2018, 33(1):130-137. doi:10.3904/kjim.2016.090.
[9]	王远珍, 魏红艳, 常丽仙, 等. 原发性肝癌干预前并发肺部感染风险预测模型的建立与验证[J]. 天津医药, 2024, 52(9):940-945.
	WANG Y Z, WEI H Y, CHANG L X, et al. Establishment and validation of a risk prediction model for primary liver cancer complicated with pulmonary infection before intervention[J]. Tianjin Med J, 2024, 52(9):940-945. doi:10.11958/20240147.
[10]	孙皎琳, 曹霞, 李婷婷, 等. 感染对慢性阻塞性肺疾病系统性炎症反应的影响[J]. 武汉大学学报(医学版), 2022, 43(5):768-773.
	SUN J L, CAO X, LI T T, et al. Effects of infection on systemic inflammatory response in patients with chronic obstructive pulmonary disease[J]. Med J Wuhan Univ, 2022, 43(5):768-773. doi:10.14188/j.1671-8852.2021.0277.
[11]	陈学梅, 祁蕙燕, 成志飞. 老年COPD合并肺部感染患者呼出气一氧化氮水平与EOS、PCT、CRP水平相关性分析[J]. 中国急救复苏与灾害医学杂志, 2022, 17(4):482-485.
	CHEN X M, QI H Y, CHENG Z F. Correlation analysis of exhaled nitric oxide level and EOS,PCT,CRP levels in elderly patients with COPD complicated with pulmonary infection[J]. Chin J Emerg Resusc Disaster Med, 2022, 17(4):482-485. doi:10.3969/j.issn.1673-6966.2022.04.015.
[12]	余莹, 罗琳琳, 李洁, 等. 老年COPD患者下呼吸道微生物定植与肺部感染的炎症指标及TGFβ1/Smads信号通路[J]. 中华医院感染学杂志, 2023, 33(12):1804-1808.
	YU Y, LUO L L, LI J, et al. Inflammatory indicators of microbial colonization of the lower respiratory tract and lung infection in elderly patients with COPD and TGFβ1/Smads signaling pathway[J]. Chin J Nosocomiol, 2023, 33(12):1804-1808. doi:10.11816/cn.ni.2023-221939.
[13]	康李蕊, 肖漓. 慢性阻塞性肺疾病急性加重相关的免疫细胞及因子研究进展[J]. 解放军医学杂志, 2023, 48(11):1353-1358.
	KANG L R, XIAO L. Research progress of immunocytes and immunologic factors related to acute exacerbation of chronic obstructive pulmonary disease[J]. Med J Chin PLA, 2023, 48(11):1353-1358. doi:10.11855/j.issn.0577-7402.1493.2023.0413.
[14]	WANG M D, DUAN F F, HUA X, et al. A novel albumin-related nutrition biomarker predicts breast cancer prognosis in neoadjuvant chemotherapy:a two-center cohort study[J]. Nutrients, 2023, 15(19):4292. doi:10.3390/nu15194292.
[15]	ECKART A, STRUJA T, KUTZ A, et al. Relationship of nutritional status,inflammation,and serum albumin levels during acute illness:a prospective study[J]. Am J Med, 2020, 133(6):713-722. doi:10.1016/j.amjmed.2019.10.031.
[16]	张辉, 伍冬冬, 马东波, 等. 血小板平均体积与血小板计数比值预测老年人慢性阻塞性肺疾病急性加重期近期预后的临床价值[J]. 中华老年医学杂志, 2020, 39(6):627-631.
	ZHANG H, WU D D, MA D B, et al. Clinical value of mean platelet volume/platelet count ratio in predicting short-term prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Geriatr, 2020, 39(6):627-631. doi:10.3760/cma.j.issn.0254-9026.2020.06.005.
[17]	和军辉, 万大国, 董静, 等. 泛免疫炎症值、全身免疫炎症指数与急性冠脉综合征患者易损斑块的相关性研究[J]. 中国全科医学, 2024, 27(24):2976-2981.
	HE J H, WAN D G, DONG J, et al. Correlation analysis between pan-immune inflammatory value,systemic immune-inflammatory index,and vulnerable plaques in patients with acute coronary syndrome[J]. Chin Gen Prac, 2024, 27(24):2976-2981. doi:10.12114/j.issn.1007-9572.2023.0679.
[18]	INAN D, ERDOGAN A, PAY L, et al. The prognostic impact of inflammation in patients with decompensated acute heart failure,as assessed using the pan-immune inflammation value (PIV)[J]. Scand J Clin Lab Invest, 2023, 83(6):371-378. doi:10.1080/00365513.2023.2233890.
[19]	HAO X, WANG X, WEI H, et al. Development and validation of the prediction model of sepsis in patients after percutaneous nephrolithotomy and sepsis progresses to septic shock[J]. J Endourol, 2023, 37(4):377-386. doi:10.1089/end.2022.0384.
[20]	郭红玲, 欧阳艳红, 王圣, 等. 急性ST段抬高型心肌梗死患者的hs-CRP/ALB变化对预后的预测价值[J]. 中国急救医学, 2020, 40(2):102-107.
	GUO H L, OUYANG Y H, WANG S, et al. Prognostic value of hs-CRP/ALB changes in the patients with acute ST-segment elevation myocardial infarction[J]. Chin J Crit Care Med, 2020, 40(2):102-107. doi:10.3969/j.issn.1002-1949.2020.02.003.
[21]	杨金强, 张仁敏. 降钙素原与血小板比值评估发热伴血小板减少综合征预后的价值[J]. 临床荟萃, 2023, 38(4):346-351.
	YANG J Q, ZHANG R M. Prognostic value of procalcitonin to platelet ratio in patients with fever with thrombocytopenia syndrome[J]. Clinical Focus, 2023, 38(4):346-351. doi:10.3969/j.issn.1004-583X.2023.04.010.
[22]	王勇飞, 朱勤贤, 曹旭, 等. 加味瓜蒌枳实汤联合哌拉西林钠他唑巴坦钠对痰热蕴肺型卒中相关性肺炎患者的免疫功能和血清炎症因子水平的影响[J]. 中国实验方剂学杂志, 2023, 29(21):140-146.
	WANG Y F, ZHU Q X, CAO X, et al. Effect of modified Gualou Zhishitang combined with piperacillin sodium and tazobactam sodium on immune function and serum levels of inflammatory cytokines in patients with stroke-associated pneumonia with syndrome of phlegm-heat accumulation in lung[J]. Chin J Exp Tradit Med Formulae, 2023, 29(21):140-146. doi:10.13422/j.cnki.syfjx.

组别		n	男性		年龄/岁	病程/年
未感染组		143	112（78.3）		66.66±3.50	8.37±2.27
感染组		143	115（80.4）		67.01±3.61	8.65±2.50
χ²或t			0.192		0.815	0.990
组别	BMI/ （kg/m²）		高血压	糖尿病	Gold分级（1/2/3/4级）
未感染组	23.10±2.26		18（12.6）	62（43.4）	28/36/46/33
感染组	23.44±2.05		24（16.8）	71（49.7）	23/34/45/41
χ²或t	1.347		1.005	1.138	1.131

组别		n	男性		年龄/岁	病程/年
未感染组		143	112（78.3）		66.66±3.50	8.37±2.27
感染组		143	115（80.4）		67.01±3.61	8.65±2.50
χ²或t			0.192		0.815	0.990
组别	BMI/ （kg/m²）		高血压	糖尿病	Gold分级（1/2/3/4级）
未感染组	23.10±2.26		18（12.6）	62（43.4）	28/36/46/33
感染组	23.44±2.05		24（16.8）	71（49.7）	23/34/45/41
χ²或t	1.347		1.005	1.138	1.131

组别	NEU/（×10⁹/L）		PLT/（×10⁹/L）	MON/（×10⁹/L）			LYM/（×10⁹/L）
未感染组	7.02±1.22		193.29±33.80	0.73±0.22			1.37±0.35
感染组	8.42±1.22		189.32±34.65	0.93±0.20			1.01±0.21
t	9.692^＊＊		0.980	7.765^＊＊			10.496^＊＊
组别			hs-CRP（mg/L）	ALB/（g/L）		PCT/（μg/L）
未感染组			86.46±19.21	49.09±1.34		2.02（1.38，2.48）
感染组			126.32±22.31	39.45±4.91		3.60（2.66，4.26）
t或Z			16.187^＊＊	22.680^＊＊		10.730^＊＊
组别		PIV			HCAR	PCT/PLT
未感染组		706.20（496.04，1007.36）			1.76±0.39	0.01（0.01，0.01）
感染组		1 367.26（1 051.93，1 856.15）			3.27±0.81	0.02（0.01，0.02）
Z或t		10.555^＊＊			19.986^＊＊	10.675^＊＊

组别	NEU/（×10⁹/L）		PLT/（×10⁹/L）	MON/（×10⁹/L）			LYM/（×10⁹/L）
未感染组	7.02±1.22		193.29±33.80	0.73±0.22			1.37±0.35
感染组	8.42±1.22		189.32±34.65	0.93±0.20			1.01±0.21
t	9.692^＊＊		0.980	7.765^＊＊			10.496^＊＊
组别			hs-CRP（mg/L）	ALB/（g/L）		PCT/（μg/L）
未感染组			86.46±19.21	49.09±1.34		2.02（1.38，2.48）
感染组			126.32±22.31	39.45±4.91		3.60（2.66，4.26）
t或Z			16.187^＊＊	22.680^＊＊		10.730^＊＊
组别		PIV			HCAR	PCT/PLT
未感染组		706.20（496.04，1007.36）			1.76±0.39	0.01（0.01，0.01）
感染组		1 367.26（1 051.93，1 856.15）			3.27±0.81	0.02（0.01，0.02）
Z或t		10.555^＊＊			19.986^＊＊	10.675^＊＊

变量	β	SE	Waldχ²	P	OR（95%CI）
PIV	0.001	0.001	6.516	0.011	1.001（1.000~1.003）
HCAR	4.840	0.730	43.928	<0.001	126.422（30.219~528.896）
PCT/PLT	0.087	0.042	4.295	0.038	1.091（1.005~1.185）
常数项	-14.110	1.900	55.160	<0.001	0.000