The relationship between EOS, D-D and NLR in peripheral blood and pulmonary ventilation in patients with AECOPD

doi:10.11958/20240704

Abstract

Abstract:

Objective To investigate changes of peripheral blood eosinophils (EOS), D-dimer (D-D) and neutrophil/lymphocyte ratio (NLR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and their relationship with pulmonary ventilation function. Methods Sixty-five AECOPD patients (the observation group) and 65 COPD patients (the control group) were selected respectively and included in this study. Basic data were collected in the two groups of patients, and laboratory indexes were examined. EOS and D-D levels were determined, and NLR was calculated. The lung function indexes including the first second expiratory volume with exertion (FEV1), the first second expiratory volume with exertion as a percentage of expiratory lung capacity with exertion (FEV1/FVC), and blood gas indexes of arterial blood partial pressure of oxygen [p(O₂)] and arterial blood partial pressure of carbon dioxide [p(CO₂)] were detected. Multifactorial Logistic regression was used to analyze the influencing factors of AECOPD. The nomogram model of AECOPD was established and verified by R4.2.3. Results Compared with the control group, levels of EOS, D-D and NLR were elevated, and FEV1 and FEV1/FVC levels were reduced in the observation group (P<0.05). Multifactorial Logistic regression analysis showed that elevated EOS, D-D and NLR, and reduced FEV1/FVC and FEV1 were independent risk factors for patients with AECOPD (P<0.05). The area under the receiver operating characteristic (ROC) curve of AECOPD nomogram model was 0.817 (95%CI: 0.784-0.904 ), and the Hosmer-Lemeshow test showed goodness of fit of the model (χ²=4.320, P>0.05). EOS, D-D and NLR were positively correlated with FEV1 and FEV1/FVC (P<0.05). Conclusion The elevated levels of EOS, D-D and NLR are risk factors that affect pulmonary ventilation in AECOPD patients, which can be used as an important indicator to evaluate pulmonary ventilation function.

Key words: pulmonary disease, chronic obstructive, pulmonary ventilation, eosinophilia, D-dimer, neutrophil/lymphocyte ratio, acute exacerbation of chronic obstructive pulmonary disease

CLC Number:

R563

Figures/Tables 6

References 20

[1]	BRASSINGTON K, SELEMIDIS S, BOZINOVSKI S, et al. Chronic obstructive pulmonary disease and atherosclerosis: common mechanisms and novel therapeutics[J]. Clin Sci (Lond), 2022, 136(6):405-423. doi: 10.1042/CS20210835.
[2]	DIAZ A A, OREJAS J L, GRUMLEY S, et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease[J]. JAMA, 2023, 329(21):1832-1839. doi: 10.1001/jama.2023.2065.
[3]	苏振磊, 杨万春, 韩天龙. 血清CXCL9和SFRP1在AECOPD合并肺栓塞患者中的表达及对预后的影响[J]. 天津医药, 2023, 51(4):427-431.
	SU Z L, YANG W C, HAN T L. Expression of serum CXCL9 and SFRP1 in patients with AECOPD combined with pulmonary embolism and its effect on prognosis[J]. Tianjin Med J, 2023, 51(4):427-431. doi:10.11958/20221267.
[4]	WU C. Research progress of serum eosinophil in chronic obstructive pulmonary disease and asthma[J]. Open Life Sci, 2023, 18(1):20220779. doi:10.1515/biol-2022-0779.
[5]	ZHANG C, SONG J, WANG J. Meta-analysis of peripheral blood eosinophils in clinical testing of chronic obstructive pulmonary disease patients[J]. Postepy Dermatol Alergol, 2024, 41(2):155-163. doi:10.5114/ada.2024.139124.
[6]	李娜, 朱宏霞, 朱丹, 等. 血清鸢尾素和热休克蛋白27及D-二聚体水平对慢性阻塞性肺疾病急性加重期合并肺栓塞的鉴别价值及其与预后的关系探讨[J]. 临床急诊杂志, 2022, 23(5):337-342,347.
	LI N, ZHU H X, ZHU D, et al. Discussion on the differential value of serum irisin and heat shock protein 27 and D-dimer levels for pulmonary embolism combined with acute exacerbation of chronic obstructive pulmonary disease and its relationship with prognosis[J]. J Clin Emerg, 2022, 23(5):337-342,347. doi:10.13201/j.issn.1009-5918.2022.05.008.
[7]	刘玉花, 马奎军, 樊晓雁, 等. PLR、NLR、CRP与老年AECOPD患者病情严重程度、近期预后的关系[J]. 现代生物医学进展, 2023, 23(15):2947-2950,2995.
	LIU Y H, MA K J, FAN X Y, et al. Relationship between PLR,NLR,CRP and disease severity and recent prognosis of elderly AECOPD patients[J]. Progress in Modern Biomedicine, 2023, 23(15):2947-2950,2995. doi:10.13241/j.cnki.pmb.2023.15.028.
[8]	王凤燕, 张冬莹, 梁振宇, 等. 面向全科医生的《慢性阻塞性肺疾病诊治指南(2021年修订版)》解读[J]. 中国全科医学, 2021, 24(29):3660-3663,3677.
	WANG F Y, ZHANG D Y, LIANG Z Y, et al. Interpretation of the guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2021 revision) for general practitioners[J]. Chin Gen Prac, 2021, 24(29):3660-3663,3677. doi:10.12114/j.issn.1007-9572.2021.01.304.
[9]	RAMYA P A, MOHAPATRA M M, SAKA V K, et al. Haematological and inflammatory biomarkers among stable COPD and acute exacerbations of COPD patients[J]. Sultan Qaboos Univ Med J, 2023, 23(2):239-244. doi:10.18295/squmj.12.2022.062.
[10]	YE M, ZHANG R. Effect of humidified high-flow nasal cannula oxygen therapy with a pulmonary infection control window as a ventilation switching indication in combination with atomizing inhalation of terbutaline on the lung function of patients with acute exacerbation of COPD[J]. Acta Med Okayama, 2024, 78(3):271-279. doi: 10.18926/AMO/67202.
[11]	康睿, 刘慧霞. 肺部感染控制窗序贯通气在慢性阻塞性肺疾病急性加重期合并呼吸衰竭治疗中的应用价值研究[J]. 陕西医学杂志, 2022, 51(3):342-346.
	KANG R, LIU H X. Study on the application value of sequential ventilation with lung infection control window in the treatment of combined respiratory failure during acute exacerbation of chronic obstructive pulmonary disease[J]. Shaanxi Medical Journal, 2022, 51(3):342-346. doi:10.3969/j.issn.1000-7377.2022.03.018.
[12]	YANG I A, JENKINS C R, SALVI S S. Chronic obstructive pulmonary disease in never-smokers:risk factors,pathogenesis,and implications for prevention and treatment[J]. Lancet Respir Med, 2022, 10(5):497-511. doi:10.1016/S2213-2600(21)00506-3.
[13]	WEI T, WANG X, LANG K, et al. Low eosinophil phenotype predicts noninvasive mechanical ventilation use in patients with hospitalized exacerbations of COPD[J]. J Inflamm Res, 2022, 15:1259-1271. doi:10.2147/JIR.S343918.
[14]	陈娟, 关微, 徐蕊华. 百令胶囊联合鲮甲司坦治疗AECOPD的疗效及对EOS、PCT、肺功能及应激反应指标的影响[J]. 中国医药导刊, 2023, 25(10):1045-1050.
	CHEN J, GUAN W, XU R H. The efficacy of Bailing capsule combined with pangolinan in the treatment of AECOPD and its effect on EOS,PCT,lung function and stress response indexes[J]. Chin J Med Guide, 2023, 25(10):1045-1050. doi:10.3969/j.issn.1009-0959.2023.10.016.
[15]	RYDELL N, NAGAO M, MOVÉRARE R, et al. Serum eosinophilic cationic protein is a reliable biomarker for childhood asthma[J]. Int Arch Allergy Immunol, 2022, 183(7):744-752. doi: 10.1159/000521890.
[16]	SUNG E A, PARK M H, HENEGARIU O, et al. Dickkopf1 promotes pulmonary fibrosis upon bleomycin-induced lung injury[J]. Am J Pathol, 2023, 193(9):1130-1142. doi: 10.1016/j.ajpath.2023.05.009.
[17]	赖育庭, 申严, 叶春幸, 等. 不同程度AECOPD患者血清25-(OH)Vit D和IGF-1及SF水平及其与肺功能相关性[J]. 热带医学杂志, 2023, 23(7):1007-1010.
	LAI Y T, SHEN Y, YE C X, et al. Serum 25-(OH)Vit D and IGF-1 and SF levels and their correlation with lung function in patients with different degrees of AECOPD[J]. Journal of Tropical Medicine, 2023, 23(7):1007-1010. doi:10.3969/j.issn.1672-3619.2023.07.026.
[18]	左艳华, 刘靓, 许化恒, 等. NLR、MLR、PLR在结缔组织病相关性间质性肺炎诊治中变化情况及临床意义[J]. 临床军医杂志, 2022, 50(3):286-288.
	ZUO Y H, LIU L, XU H H, et al. Changes and clinical significance of NLR,MLR and PLR in the diagnosis and treatment of connective tissue disease-associated interstitial pneumonia[J]. Clinical Journal of Medical Officers, 2022, 50(3):286-288. doi:10.16680/j.1671-3826.2022.03.17.
[19]	HU T, LIU X, LIU Y. Usefulness of glucose to lymphocyte ratio to predict in-hospital mortality in patients with AECOPD admitted to the intensive care unit[J]. COPD, 2022, 19(1):158-165. doi: 10.1080/15412555.2022.2052272.
[20]	李术环, 徐慧莲, 郝秋红. PCT、D-D、NLR、Cys-C与慢性阻塞性肺疾病急性加重期患者的相关性及对预后的预测价值[J]. 中华保健医学杂志, 2023, 25(4):426-428.
	LI S H, XU H L, HAO Q H. Correlation of PCT,D-D,NLR and Cys-C with patients with acute exacerbation of chronic obstructive pulmonary disease and its predictive value for prognosis[J]. Chin J Heal Care Med, 2023, 25(4):426-428. doi:103969/j.issn.1674-3245.2023.04.016.

组别	n		性别（男/女）	年龄/岁		BMI/（kg/m²）		高血压		糖尿病	吸烟		心率/（次/min）		尿酸/（μmoL/L）		TC/（mmoL/L）		HDL-C/（mmoL/L）
对照组	65		41/24	59.31±8.51		24.17±1.16		41（63.07）		39（60.00）	52（80.00）		77.65±19.83		365.49±49.42		4.59±1.08		1.34±0.30
观察组	65		42/23	57.49±8.80		24.04±1.23		39（60.00）		36（55.38）	54（83.07）		79.15±20.18		379.48±46.12		4.25±1.27		1.28±0.32
χ²或t			0.033	1.199		0.620		0.130		0.284	0.204		0.427		1.669		1.644		0.929
组别		LDL-C/（mmoL/L）			TG/（mmoL/L）		EOS/（×10⁹/L）		D-D/（mg/L）			NLR		FEV1/FVC/%		p（CO₂）/mmHg		p（O₂）/mmHg		FEV1/%
对照组		2.62±1.98			1.56±0.68		0.39±0.06		244.28±25.41			7.96±1.08		51.25±4.89		45.08±13.24		73.68±15.34		55.04±8.64
观察组		2.76±1.07			1.59±0.86		0.45±0.08		265.40±28.45			9.59±2.52		47.29±4.26		46.57±14.08		69.59±15.07		48.84±7.74
t		0.480			0.293		4.898^＊		4.462^＊			4.793^＊		4.918^＊		0.626		1.537		4.316^＊

组别	n		性别（男/女）	年龄/岁		BMI/（kg/m²）		高血压		糖尿病	吸烟		心率/（次/min）		尿酸/（μmoL/L）		TC/（mmoL/L）		HDL-C/（mmoL/L）
对照组	65		41/24	59.31±8.51		24.17±1.16		41（63.07）		39（60.00）	52（80.00）		77.65±19.83		365.49±49.42		4.59±1.08		1.34±0.30
观察组	65		42/23	57.49±8.80		24.04±1.23		39（60.00）		36（55.38）	54（83.07）		79.15±20.18		379.48±46.12		4.25±1.27		1.28±0.32
χ²或t			0.033	1.199		0.620		0.130		0.284	0.204		0.427		1.669		1.644		0.929
组别		LDL-C/（mmoL/L）			TG/（mmoL/L）		EOS/（×10⁹/L）		D-D/（mg/L）			NLR		FEV1/FVC/%		p（CO₂）/mmHg		p（O₂）/mmHg		FEV1/%
对照组		2.62±1.98			1.56±0.68		0.39±0.06		244.28±25.41			7.96±1.08		51.25±4.89		45.08±13.24		73.68±15.34		55.04±8.64
观察组		2.76±1.07			1.59±0.86		0.45±0.08		265.40±28.45			9.59±2.52		47.29±4.26		46.57±14.08		69.59±15.07		48.84±7.74
t		0.480			0.293		4.898^＊		4.462^＊			4.793^＊		4.918^＊		0.626		1.537		4.316^＊

变量	β	SE	Wald χ²	P	OR（95%CI）
EOS	11.139	3.742	8.862	0.003	68 831.167（11.935~ 1 054 350.339）
D-D	0.025	0.010	6.506	0.011	1.025（1.006~1.045）
NLR	0.393	0.138	8.109	0.004	1.481（1.130~1.941）
FEV1/FVC	-0.176	0.054	10.527	0.001	0.839（0.755~0.933）
FEV1	-0.112	0.032	12.138	<0.001	0.894（0.839~0.952）
常数项	0.160	4.235	0.001	0.970	1.173

变量	β	SE	Wald χ²	P	OR（95%CI）
EOS	11.139	3.742	8.862	0.003	68 831.167（11.935~ 1 054 350.339）
D-D	0.025	0.010	6.506	0.011	1.025（1.006~1.045）
NLR	0.393	0.138	8.109	0.004	1.481（1.130~1.941）
FEV1/FVC	-0.176	0.054	10.527	0.001	0.839（0.755~0.933）
FEV1	-0.112	0.032	12.138	<0.001	0.894（0.839~0.952）
常数项	0.160	4.235	0.001	0.970	1.173