老年慢性阻塞性肺疾病急性加重期病情及短期预后的炎症指标联合评估

doi:10.19983/j.issn.2096-8493.20260069

摘要/Abstract

摘要：

目的: 分析多项炎症指标联合检测对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者病情严重程度及短期预后的评估价值。方法: 采用回顾性研究方法,选取2023年1月至2025年12月武警新疆总队医院收治的60例老年AECOPD患者作为研究对象。将研究对象按照病情严重程度分为轻中度组(32例)和重度及极重度组(28例);按照30d预后分为预后良好组(47例)和不良预后组(13例);按照共病数量分为低共病组(0~1种;27例)和高共病组(≥2种;33例)。收集研究对象入院24h内外周血中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、系统性免疫炎症指数(systemic immune-inflammation index,SII)、嗜酸性粒细胞(eosinophil,EOS)水平资料,比较各组间差异;采用多因素logistic回归分析短期不良预后的独立危险因素,绘制受试者工作特征(receiver operating characteristic, ROC)曲线评估不同模型的预测效能。结果: 重度及极重度组NLR [6.9(6.1,7.9)]和SII [950(880, 1050)]高于轻中度组[分别为3.8(3.1,4.6)和610(560,690)],EOS [0.22(0.18,0.26)×10⁹/L]低于轻中度组[0.39(0.35,0.45)×10⁹/L],差异均有统计学意义(U值分别为48.500、32.000、67.000,P值均<0.001)。不良预后组NLR [8.7(7.9,9.5)]和SII [1120(1010,1280)]高于预后良好组[分别为5.0(4.2,5.9)和760(670,860)],EOS [0.19(0.16,0.22)×10⁹/L]低于预后良好组[0.40(0.35,0.46)×10⁹/L],差异均有统计学意义(U值分别为12.000、10.500、25.000,P值均<0.001)。多因素logistic回归分析显示,高共病负荷(OR=3.25,95%CI:1.12~9.42)、NLR升高(OR=2.10,95%CI:1.35~3.27)、SII升高(OR=1.45,95%CI:1.12~1.88)、EOS降低(OR=2.80,95%CI:1.30~6.02)是老年AECOPD患者30d不良预后的独立危险因素。ROC曲线分析显示,NLR、SII、EOS联合评估短期不良预后的曲线下面积(area under the curve, AUC)为0.914(95%CI:0.847~0.981),明显高于单一指标[NLR:0.782(95%CI:0.674~0.890);SII:0.805(95%CI:0.701~0.909);EOS:0.751(95%CI:0.638~0.864)]。结论: NLR、SII、EOS联合检测可显著提高老年AECOPD患者病情分层及短期预后评估准确性;高共病负荷进一步加剧老年AECOPD患者全身炎症反应,NLR、SII、EOS联合评估可为临床综合评估患者病情并对患者进行早期干预提供客观依据。

关键词: 老年人, 肺疾病,慢性阻塞性, 白细胞, 预后, 回顾性研究

Abstract:

Objective: To analyze the evaluative value of combined detection of multiple inflammatory biomarkers for disease severity and short-term prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A retrospective study was conducted. A total of 60 elderly AECOPD patients admitted to the Hospital of Chinese People’s Armed Police Force Xinjiang Corps from January 2023 to December 2025 were enrolled as study subjects. The patients were divided into a mild-to-moderate group (32 cases) and a severe and very severe group (28 cases) according to disease severity; into a favorable prognosis group (47 cases) and a poor prognosis group (13 cases) based on 30-day prognosis; and into a low comorbidity group (0-1 comorbidity; 27 cases) and a high comorbidity group (≥2 comorbidities; 33 cases) by the number of comorbidities. Data of peripheral blood neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) and eosinophil (EOS) level within 24 hours after admission were collected, and inter-group differences were compared. Multivariate logistic regression was applied to identify independent risk factors for short-term poor prognosis, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of different models. Results: The severe and very severe group had higher NLR (6.9 (6.1, 7.9)) and SII (950 (880, 1050)) than the mild-to-moderate group (3.8 (3.1, 4.6) and 610 (560, 690), respectively), and lower EOS (0.22 (0.18, 0.26)×10⁹/L) than the mild-to-moderate group (0.39 (0.35, 0.45)×10⁹/L). All differences were statistically significant (U=48.500, 32.000, 67.000, respectively; all P<0.001, retained to three decimal places). The poor prognosis group had higher NLR (8.7 (7.9, 9.5)) and SII (1120 (1010, 1280)) than the favorable prognosis group (5.0 (4.2, 5.9) and 760 (670, 860), respectively), and lower EOS (0.19 (0.16, 0.22)×10⁹/L) than the favorable prognosis group (0.40 (0.35, 0.46)×10⁹/L), with statistically significant differences (U=12.000, 10.500, 25.000, respectively; all P<0.001). Multivariate logistic regression analysis showed that high comorbidity burden (OR=3.25, 95%CI: 1.12-9.42), elevated NLR (OR=2.10, 95%CI: 1.35-3.27), elevated SII (OR=1.45, 95%CI: 1.12-1.88) and decreased EOS (OR=2.80, 95%CI: 1.30-6.02) were independent risk factors for 30-day poor prognosis in elderly AECOPD patients. ROC curve analysis revealed that the area under the curve (AUC) of the combined assessment of NLR, SII and EOS for short-term poor prognosis was 0.914 (95%CI: 0.847-0.981), which was significantly higher than that of single indicators (NLR: 0.782 (95%CI:0.674-0.890); SII: 0.805 (95%CI:0.701-0.909); EOS: 0.751 (95%CI:0.638-0.864)). Conclusion: Combined detection of NLR, SII and EOS can significantly improve the accuracy of disease stratification and short-term prognosis evaluation in elderly AECOPD patients. High comorbidity burden further exacerbates the systemic inflammatory response in elderly AECOPD patients. The combined assessment of NLR, SII and EOS can provide objective evidence for comprehensive clinical evaluation of patient conditions and early intervention.

Key words: Aged, Pulmonary disease, chronic obstructive, Leukocytes, Prognosis, Retrospective studies

中图分类号:

R563
R592

胡云衢, 任海波. 老年慢性阻塞性肺疾病急性加重期病情及短期预后的炎症指标联合评估[J]. 结核与肺部疾病杂志,2026, 7(5): 602-607. doi: 10.19983/j.issn.2096-8493.20260069

Hu Yunqu, Ren Haibo. Combined assessment of inflammatory biomarkers for disease severity and short-term prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 602-607. doi: 10.19983/j.issn.2096-8493.20260069

图/表 4

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指标	轻中度组(32例)	重度及极重度组(28例)	统计检验值	P值
年龄(岁,$\bar{x}±s$)	70.8±5.2	72.3±6.0	t=1.040	0.302
性别[例(构成比,%)]			χ²=0.020	0.886
男性	20(62.5)	18(64.3)
女性	12(37.5)	10(35.7)
病程[年,M(Q₁,Q₃)]	11(7,15)	13(9,17)	U=376.000	0.282
吸烟史[例(构成比,%)]			χ²=0.120	0.728
有	18(56.3)	17(60.7)
无	14(43.7)	11(39.3)
共病数量[种,M(Q₁,Q₃)]	1(1,2)	3(2,4)	U=248.000	0.002

变量	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	P值	OR(95%CI)值
高共病负荷(≥2种)	1.180	0.540	4.770	0.029	3.25(1.12~9.42)
NLR(每增加1)	0.740	0.220	11.320	<0.001	2.10(1.35~3.27)
SII(每增加100单位)	0.370	0.130	8.100	0.004	1.45(1.12~1.88)
EOS(每降低0.1×10⁹/L)	1.030	0.380	7.350	0.007	2.80(1.30~6.02)

指标	AUC(95%CI)值	截断值	敏感度(%)	特异度(%)	约登指数
NLR	0.782(0.674~0.890)	7.20	76.9	78.7	0.556
SII	0.805(0.701~0.909)	980.00	76.9	80.9	0.578
EOS(×10⁹/L)	0.751(0.638~0.864)	0.25	69.2	74.5	0.437
联合模型	0.914(0.847~0.981)	-	88.5	85.1	0.736