目的: 探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）伴肺部感染老年患者外周血细胞形态学变化及对预后的预测价值。方法: 选取2020年1月—2022年10月我院收治的140例COPD伴肺部感染患者,均于入院次日检测外周血细胞形态学、肺功能[第1秒用力呼气量占预计值百分比（FEV1%pred）、第1秒用力呼气量/用力肺活量（FEV1/FVC）]及感染相关炎症因子[血清C-反应蛋白（CRP）、触珠蛋白（HPT）、可溶性白细胞分化抗原14（sCD14）、膜联蛋白A1（ANXA1）]。随访30 d,根据预后分为生存组（n=121）与死亡组（n=19）,比较两组外周血细胞形态学检查结果（白细胞形态异常、红细胞形态异常）、外周血感染相关炎症因子水平,比较不同COPD分级患者外周血细胞形态学、感染相关炎症因子,并分析外周血细胞形态学与肺功能、感染相关炎症因子的相关性,外周血细胞形态学变化对老年COPD伴肺部感染患者预后的预测价值。结果: 生存组白细胞形态和红细胞形态异常率均低于死亡组;生存组FEV1%pred、FEV1/FVC水平高于死亡组,CRP、sCD14、ANXA1、HPT水平低于死亡组;COPDⅠ级、Ⅱ级、Ⅲ级患者白细胞形态异常率、红细胞形态异常率的差异有统计学意义;COPDⅠ级患者FEV1%pred、FEV1/FVC水平高于Ⅱ级、Ⅲ级,COPDⅠ级患者CRP、sCD14、ANXA1、HPT水平低于Ⅱ级、Ⅲ级;白细胞形态异常与FEV1%pred（rs=-0.629,P<0.05）、FEV1/FVC（rs=-0.723,P<0.05）呈负相关,红细胞形态异常与CRP水平（rs=0.594,P<0.05）、sCD14水平（rs=0.621,P<0.05）、ANXA1水平（rs=0.638,P<0.05）和HPT水平（rs=0.680,P<0.05）呈正相关;白细胞形态异常、红细胞形态异常联合预测的AUC最大,为0.873（95%CI：0.806~0.923）,敏感度为89.47%、特异度为85.12%。结论: 外周血细胞形态学异常改变与老年COPD伴肺部感染患者肺功能、感染病情有关,对患者预后有较高预测价值。
Abstract
Objective To investigate the morphological changes of peripheral blood cells in elderly patients with chronic obstructive pulmonary disease (COPD) and pulmonary infection and its prognostic value. Methods 140 patients with COPD and pulmonary infection admitted to our hospital from January 2020 to October 2022 were selected. Peripheral blood cell morphology, lung function [Percentage of forced expiratory volume in the 1s to the expected value (FEV1%pred), forced expiratory volume in the 1s/forced vital capacity (FEV1/FVC) ] and infection-related inflammatory factors [serum C-reactive protein (CRP), touchglobin (HPT), soluble leukocyte differentiation antigen 14(sCD14), and membranin A1(ANXA1) ] were detected on the day after admission. After 30 days of follow-up, the patients were divided into survival group (n=121) and death group (n=19) according to prognosis. Peripheral blood cell morphological examination results (abnormal white blood cell morphology, red blood cell morphology and platelet count) and peripheral blood infection-related inflammatory factors were compared between the two groups, and peripheral blood cell morphology and infection-related inflammatory factors were compared in patients with different COPD grades. The correlation of peripheral blood cell morphology with lung function and infection-related inflammatory factors was analyzed, and the prognostic value of peripheral blood cell morphology in elderly patients with COPD and pulmonary infection was analyzed. Results The comparison of abnormal rates of white blood cell morphology and red blood cell morphology between the survival group and the death group showed that the survival group was lower than the death group; The comparison of FEV1% pred, FEV1/FVC, CRP, sCD14, ANXA1, and HPT between the survival group and the death group showed that the levels of FEV1% pred, FEV1/FVC in the survival group were higher than those in the death group, while the levels of CRP, sCD14, ANXA1, and HPT were lower than those in the death group; The difference in the rates of abnormal white blood cell morphology and abnormal red blood cell morphology among COPD grade I, II, and III patients is statistically significant; Comparison of FEV1% pred, FEV1/FVC, CRP, sCD14, ANXA1, and HPT levels in COPD grade I, II, and III patients; the FEV1%pred and FEV1/FVC levels of patients with COPD grade I were higher than those of patients with COPD grades II and III, while the CRP, sCD14, ANXA1, and HPT levels of patients with COPD grade I were lower than those of patients with COPD grades II and III. The abnormal morphology of white blood cells was negatively correlated with FEV1%pred (rs=-0.629, P<0.05) and FEV1/FVC (rs=-0.723, P<0.05), while the abnormal morphology of red blood cells was positively correlated with CRP level (rs=0.594, P<0.05), sCD14 level (rs=0.621, P<0.05), ANXA1 level (rs=0.638, P<0.05), and HPT level (rs=0.680, P<0.05); the AUC of the combined prediction of abnormal morphology of white blood cells and red blood cells was the largest, with an AUC of 0.873(95%CI: 0.806-0.923), a sensitivity of 89.47%, and a specificity of 85.12%. Conclusion Abnormal morphological changes of peripheral blood cells are related to pulmonary function and infection in elderly patients with COPD and pulmonary infection, and have high prognostic value for patients.
关键词
慢性阻塞性肺疾病 /
肺部感染 /
血细胞形态学 /
COPD分级 /
预后
Key words
chronic obstructive pulmonary disease /
lung infection /
blood cell morphology /
COPD classification /
prognosis
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基金
2020年北京市通州区科委 “慢性阻塞性肺疾病急性加重住院患者的病例注册登记研究”（KJ2020CX004-07）
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