| 高栋材,杨慧俐,郎伟宇,等.单核细胞计数与高密度脂蛋白比值联合单核细胞 /大血小板比率检测对老年慢性阻塞性肺疾病急性加重期肺栓塞危险分层诊断效能[J].安徽医药,2024,28(3):608-613. |
| 单核细胞计数与高密度脂蛋白比值联合单核细胞 /大血小板比率检测对老年慢性阻塞性肺疾病急性加重期肺栓塞危险分层诊断效能 |
| Diagnostic efficacy of monocyte count to high-density lipoprotein ratio combined with monocyte/large platelet ratio test for risk stratification of pulmonary embolism during acute exacerbation of chronic obstructive pulmonary disease in elderly |
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| DOI：10.3969/j.issn.1009-6469.2024.03.040 |
| 中文关键词: 肺疾病，慢性阻塞性 肺栓塞 危险分层 单核细胞计数与高密度脂蛋白比值 单核细胞 /大血小板比率 |
| 英文关键词: Pulmonary disease, chronic obstructive Pulmonary embolism Risk stratification Monocyte count to high-density li. poprotein ratio Monocyte/large platelet ratio |
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| 中文摘要: |
| 目的探讨单核细胞计数与高密度脂蛋白比值( MHR)联合单核细胞 /大血小板比率( MLPR)检测对老年慢性阻塞性肺疾病急性加重期(AECOPD)肺栓塞危险分层诊断效能。方法回顾 2018年 5月至 2022年 5月长治市人民医院收治的 233例老年 AECOPD并发肺栓塞病人的临床资料，比较不同危险分层病人 MHR、MLPR水平，并分析 MHR、MLPR与危险分层的相关性。采用多元有序 logistic回归分析明确 MHR、MLPR与 AECOPD肺栓塞危险分层的关系，并评估其对危险分层的预测价值。结果高危组病人 MHR、MLPR分别为 0.74(0.70，0.86)、 1.83(1.52，2.10)高于非高危组的 0.55(0.39，0.62)、 0.80(0.59，1.27)(P<0.05)；中高危组和中低危组的 MHR分别为 0.62(0.57，0.71)、 0.39(0.31.56)，MLPR分别为 1.32(0.75，1.61)、 0.64(0.55，0.90)，高危组 MHR、MLPR高于中高危组，中高危组高于中低危组( P<0.05)。 Spearman分析显示， MHR、MLPR水平与危险分层均呈正相关( P<0.001)。多元有序 logistic结果显示年龄 >80岁、白蛋白降低、血肌酐升高、 MHR升高、 MLPR升高均是老年 AECOPD伴肺栓塞中高危和高危分层的独立危险因素(P<0.05)。 ROC分析显示， MHR、MLPR对肺栓塞高危与非高危分层诊断 AUC及其 95%CI为 0.92(0.88，0.95)、 0.93(0.89，0.96)低于二者联合诊断效能 0.97(0.94，0.99)(P<0.05)； MHR、MLPR单独对肺栓塞中，0，危病人分层诊断 AUC及其 95%CI为 0.89(0.83，0，.93)、 0.84(0.78，0.89)低于二者联合诊断效能 0.95(0.91，0.98)(P<0.05)。结论 MHR、MLPR可作为老年 AECOPD肺栓塞病人早期危险分层的可靠参，考指标。 |
| 英文摘要: |
| Objective To investigate the diagnostic efficacy of the monocyte count to high-density lipoprotein ratio (MHR) combinedwith the monocyte/large platelet ratio (MLPR) assay for the risk stratification of pulmonary embolism in elderly people with acute exac.erbation of chronic obstructive pulmonary disease (AECOPD).Methods The clinical data of 233 elderly patients with AECOPD com.plicated by pulmonary embolism admitted to Changzhi People's Hospital from May 2018 to May 2022 were reviewed. The MHR andMLPR levels of patients in different risk strata were analyzed, and the correlation between MHR and MLPR and risk stratification wasanalyzed. Multiple ordered logistic regression analysis was used to clarify the relationship between MHR, MLPR and risk stratificationof AECOPD pulmonary embolism, and to assess their predictive value for risk stratification.Results MHR and MLPR in high-risk group were 0.74 (0.70, 0.86) and 1.83 (1.52, 2.10), respectively, which were higher than those in non-high-risk group [0.55 (0.39, 0.62) and 0.80 (0.59, 1.27)] (P<0.05). The MHR of the medium-high risk and low-risk groups were 0.62 (0.57, 0.71) and 0.39 (0.31, 0.56), re.spectively, and the MLPR were 1.32 (0.75, 1.61) and 0.64 (0.55, 0.90), MHR and MLPR were higher in the high-risk group than in the medium-high-risk group, and in the medium-high risk group than in the medium-low risk group (P<0.05). Spearman analysis showed that MHR and MLPR levels were all positively correlated with risk stratification (P<0.001). Multivariate ordered logistic results showedthat age >80 years, decreased albumin, elevated blood creatinine, elevated MHR, and elevated MLPR were all independent risk factorsfor high risk and high risk stratification in elderly AECOPD with pulmonary embolism (P<0.05). ROC analysis showed that the diagnos. tic AUC 95%CI of MHR and MLPR for high-risk and non-high-risk stratification of pulmonary embolism was 0.92 (0.88, 0.95) and 0.93 (0.89, 0.96), which was lower than the diagnostic efficacy of 0.97 (0.94, 0.99) for the combination of the two (P<0.05). The stratified di. agnostic AUC (95% CI) for MHR and MLPR alone for intermediate-risk patients of pulmonary embolism was 0.89 (0.83, 0.93) and 0.84(0.78, 0.89), which was lower than the combined diagnostic efficacy of 0.95 (0.91, 0.98) (P<0.05).Conclusion MHR and MLPR can be used as reliable reference indicators for early risk stratification in elderly patients with pulmonary embolism in AECOPD. |
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