Abstract:

Objective　To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) and interleukin-10 (IL-10) combined detection for the prognosis in patients with chronic obstructive pulmonary disease (COPD). Methods　A total of 216 COPD patients were collected from Weihai Central Hospital Affiliated to Qingdao University from January 2017 to July 2019, and they were divided into a stable COPD group [122 cases, including 76 males and 46 females, aged (68.7±7.1) years] and an acute exacerbation of COPD (AECOPD) group [94 cases, including 58 males and 36 females, aged (69.7±7.6) years] based on their clinical conditions. The levels and correlations of NLR, IL-10, and pulmonary function parameters [forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC] were compared between the two groups. The receiver operating characteristic curve (ROC) was used to predict the severity of COPD, and the diagnostic value of combined detection of NLR and IL-10 in AECOPD was evaluated. Stratified analysis based on the cutoff values of NLR and IL-10 levels was performed to assess their predictive values for the prognosis in COPD patients. t test, χ² test, Pearson correlation analysis, Kaplan-Meier curve analysis, and Log-rank test were used. Results　The level of NLR in the AECOPD group [(9.96±2.87)] was higher than that in the stable COPD group [(4.15±2.84)], and the levels of IL-10 [(46.06±8.42) ng/L], FEV1 [(1.58±0.31)L], FVC [(2.06±0.34) L], and FEV1/FVC [(65.02±9.27)%] were lower than those in the stable COPD group [(68.53±7.49) ng/L, (2.14± 0.45)L, (3.56±0.38) L, and (72.37±5.08)%], with statistically significant differences (all P<0.05). Pearson correlation analysis showed that FEV1, FVC, and FEV1/FVC had a negative correlation with NLR and a positive correlation with IL-10 (all P<0.05). ROC analysis showed that both NLR and IL-10 had good diagnostic values for AECOPD [area under the curve (AUC) of 0.803 and 0.826], and the diagnostic efficiency of combined detection was superior to that of single detection (AUC of 0.875). According to the cut-off values of NLR and IL-10, the 216 COPD patients were divided into group A (NLR >9.15, IL-10 ≤45.72 ng/L) with 64 cases, group B (NLR >9.15, IL-10 >45.72 ng/L) with 72 cases, group C (NLR ≤9.15, IL-10 ≤45.72 ng/L) with 49 cases, and group D (NLR ≤9.15, IL-10 >45.72 ng/L) with 31 cases. Survival analysis using the ROC during the follow-up period showed that the mortality rates of group A, group B, group C, and group D were 35.9% (23/64), 29.2% (21/72), 12.2% (6/49), and 9.7% (3/31), respectively, and the median survival periods were (9.22±0.48) months, (10.04±0.51) months, (13.54±0.60) months, and (16.02±0.76) months, respectively, with statistically significant differences among the four groups (both P<0.05). Conclusions　NLR and IL-10 levels are closely associated with the pulmonary function in COPD patients. The combined detection of NLR and IL-10 has good diagnostic value for AECOPD and can predict the prognosis to a certain extent.

Key words:

Chronic obstructive pulmonary disease, Neutrophil-to-lymphocyte ratio, Interleukin-10, Prognosis

摘要：

目的　探讨中性粒细胞淋巴细胞比值（NLR）与白细胞介素-10（IL-10）联合检测对慢性阻塞性肺疾病（COPD）患者预后的预测价值。方法　回顾性收集2017年1月至2019年7月期间在青岛大学附属威海市中心医院住院治疗的COPD患者216例为研究对象，根据患者病情分为稳定COPD组122例［男76例、女46例，年龄（68.7±7.1）岁］和慢性阻塞性肺疾病急性加重期（AECOPD）组94例［男58例、女36例，年龄（69.7±7.6）岁］。比较两组NLR、IL-10水平及肺功能指标［第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1/FVC］的差异及其相关性；用受试者工作特征曲线（ROC）预测COPD病情，评估NLR、IL-10联合检测对AECOPD的诊断价值；根据NLR、IL-10水平截断值分层分析不同NLR、IL-10水平对COPD患者预后的预测价值。采用t检验、χ²检验、Pearson相关性分析、Kaplan-Meier曲线、Log-rank检验。结果　AECOPD组NLR水平［（9.96±2.87）］高于稳定COPD组［（4.15±2.84）］，IL-10［（46.06±8.42）ng/L］、FEV1［（1.58±0.31）L］、FVC［（2.06±0.34）L］、FEV1/FVC水平［（65.02±9.27）%］均低于稳定COPD组［（68.53±7.49）ng/L、（2.14±0.45）L、（3.56±0.38）L、（72.37±5.08）%］，差异均有统计学意义（均P<0.05）。Pearson相关性分析显示，患者NLR水平与肺功能指标FEV1、FVC、FEV1/FVC水平均呈负相关（均P<0.05），IL-10与FEV1、FVC、FEV1/FVC水平均呈正相关（均P<0.05）。ROC分析发现，NLR、IL-10均对AECOPD有较好诊断价值［曲线下面积（AUC）为0.803、0.826］，而两者联合检测的诊断效能优于单独检测（AUC为0.875）。根据NLR、IL-10的截断值将216例COPD患者分为A组（NLR >9.15，IL-10 ≤45.72 ng/L）64例、B组（NLR >9.15，IL-10 >45.72 ng/L）72例、C组（NLR ≤9.15，IL-10 ≤45.72 ng/L）49例、D组（NLR ≤9.15，IL-10 >45.72 ng/L）31例。用ROC对各组进行生存分析发现，随访期间，A组、B组、C组、D组患者病死率分别为35.9%（23/64）、29.2%（21/72）、12.2%（6/49）、9.7%（3/31），中位生存期分别为（9.22±0.48）个月、（10.04±0.51）个月、（13.54±0.60）个月、（16.02±0.76）个月，4组比较差异均有统计学意义（均P<0.05）。结论　NLR、IL-10水平与COPD患者肺功能密切相关，两者联合检测对AECOPD具有较好的诊断价值，且对患者预后有一定的预测价值。

关键词:

慢性阻塞性肺疾病, 中性粒细胞淋巴细胞比值, 白细胞介素-10, 预后