NLR、RDW、CRP、NT-proBNP的动态监测对于COPD-PH的应用价值研究

Research on the Application Value of Dynamic Monitoring of NLR, RDW, CRP, NT-proBNP for COPD-PH

摘要: 目的：通过动态监测慢性阻塞性肺疾病(慢阻肺，COPD)合并肺动脉高压(PH)患者的中性粒细胞/淋巴细胞的比值(NLR)、红细胞体积分布宽度(RDW)、C反应蛋白(CRP)及氨基末端脑钠肽前体(NT-proBNP)的变化，探讨其在慢阻肺合并肺动脉高压(COPD-PH)中的应用价值。方法：回顾性分析自2018年1月1日至2020年6月30日在青岛大学附属医院住院的COPD患者的临床资料，通过入院后24小时内行心脏超声检查估测肺动脉收缩压(PASP)，选取105例COPD-PH患者(心超检查结果示PASP ≥ 35 mmHg)，根据PASP结果将患者分为轻度PH组(A组，30例，35 mmHg ≤ PASP < 50 mmHg)，中度PH组(B组，37例，50 mmHg ≤ PASP < 70 mmHg)，重度PH组(C组，38例，PASP ≥ 70 mmHg)，分别于入院第1 d、入院第3 d、入院第6 d、出院前1 d抽取清晨空腹静脉血，检测NLR、RDW、CRP、NT-proBNP在治疗前后的差异，观察其对COPD-PH的影响。结果：B、C两组NLR、RDW、CRP、NT-proBNP入院第1 d数值均高于A组，各组入院第3 d、第6 d、出院前1 d数值与入院第1 d对比绝大部分各项指标明显降低，差异有统计学意义(P < 0.05)，但C组NLR数值入院第3 d与入院第1 d对比差异无统计学意义，而入院第6 d、出院前1 d数值与入院第1 d对比差异有统计学意义(P < 0.05)。结论：NLR、RDW、CRP、NT-proBNP具有检测快捷、简便的特点，并随着COPD-PH患者的PASP升高呈上升趋势，治疗过程中均显著下降，可作为治疗效果及预后评价指标。

Abstract: Objective: To dynamically monitor the neutrophil/lymphocyte ratio (NLR), red blood cell volume distribution width (RDW), and C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients suffer from chronic obstructive pulmonary disease (COPD) with pulmonary hypertension (PH), and to explore its application value in COPD with pulmonary hypertension (COPD-PH). Methods: A retrospective analysis of the clinical data of COPD patients hospitalized in Qingdao University Affiliated Hospital from January 1, 2018 to June 30, 2020, was performed to estimate the pulmonary artery systolic pressure (PASP) through cardiac ultrasound within 24 hours after admission. 105 COPD-PH patients were selected (PASP ≥ 35 mmHg). According to PASP results, the patients were divided into mild PH group (group A, 30 cases, 35 mmHg ≤ PASP < 50 mmHg), moderate PH group (group B, 37 cases, 50 mmHg ≤ PASP < 70 mmHg), severe PH group (group C, 38 cases, PASP ≥ 70 mmHg). Early morning fasting venous blood was drawn on the first day of admission, the third day of admission, the sixth day of admission, and the 1 day before discharge to detect the difference of NLR, RDW, CRP, and NT-proBNP before and after treatment, and observe its effect on COPD-PH. Results: The values of NLR, RDW, CRP, and NT-proBNP on the first day of admission in groups B and C were higher than those in group A. The values on the 3 day of admission, 6 day of admission, and 1 day before discharge of each group were significantly lower than those on the first day of admission, the difference was statistically significant (P < 0.05), but there was no significant difference between the NLR values of group C on the 3rd day of admission and the 1st day of admission, and the values on the 6th day of admission and 1d before discharge were compared to the first day of admission, the contrast difference was statistically significant (P < 0.05). Conclusion: NLR, RDW, CRP, NT-proBNP have the characteristics of quick and easy detection, and with the increase of PASP in COPD-PH patients, they tend to rise, and they all decrease significantly during the treatment process. They can be used as evaluation indicators for treatment effects and prognosis.