Application Value of HBP and PLR in AECOPD
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摘要:
目的 探讨肝素结合蛋白（HBP）和血小板与淋巴细胞的比值（PLR）与慢性阻塞性肺疾病急性加重（AECOPD）的相关性，并分别评估其在AECOPD的预测和辅助诊断中的临床应用价值。 方法 选取2022年11月至2023年12月昆明医科大学附属甘美医院呼吸与危重症医学科住院部及门诊就诊的慢性阻塞性肺疾病患者146例作为研究对象，以因咳嗽、咳痰、喘息等症状加重，需要住院治疗或改变治疗方案的COPD患者为慢阻肺急性加重组（AECOPD组，n = 96），以同时期门诊复诊的、无呼吸道症状加重的COPD患者为慢阻肺稳定组（SCOPD组，n = 50）。收集入院当天测定所得的淋巴细胞数和血小板数值，通过计算得出PLR值，使用免疫荧光干式定量法测出HBP的值，比较2组间HBP和PLR水平的高低以及组间有无差异，通过二元Logistic回归分析的方法分析HBP和PLR是否是AECOPD发生的独立危险因素，并依据ROC曲线分析HBP和PLR在AECOPD发生的预测和辅助诊断中是否有应用价值。 结果 2组患者的性别、年龄、吸烟情况及高血压、糖尿病、冠心病等一般资料比较，差异均无统计学意义；AECOPD组患者血清中HBP和PLR的水平明显高于SCOPD组患者的水平，且HBP和PLR均为AECOPD发生的独立危险因素（P < 0.05）；HBP取截断值30.09 ng/mL时，灵敏度和特异度分别是97.9%、98%；PLR取截断值 164.0835 时，灵敏度和特异度分别是57.3%、90%；HBP和PLR联合检测时，AUC值较单个指标时更高（P < 0.05）。结论 HBP和PLR对AECOPD有预测和辅助诊断的作用，二者联合检测时对AECOPD的预测和辅助诊断价值更高。 -
关键词:
- 慢性阻塞性肺疾病急性加重 /
- 肝素结合蛋白 /
- PLR
Abstract:Objective To investigate the relationship between heparin binding protein （HBP） and platelet-to-lymphocyte ratio （PLR） and acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, and evaluate their clinical value in the prediction and diagnosis of AECOPD. Methods Patients with chronic obstructive pulmonary disease （COPD） who visited the inpatient department and outpatient department of Respiratory and Critical Care Medicine of Ganmei Hospital Affiliated to Kunming Medical University from November 2022 to December 2023 were selected as the study objects. Symptoms such as cough, sputum and wheezing were aggravated. COPD patients requiring hospitalization or change of treatment regimen were classified as acute COPD plus recombination （AECOPD group）, and COPD patients with no exacerbation of respiratory symptoms were classified as COPD stabilization group （SCOPD group）. Lymphocyte count and platelet values measured on the day of admission were collected, PLR values were calculated, and HBP values were measured by immunofluorescence dry quantification. The levels of HBP and PLR between the two groups and whether there were differences between the two groups were compared. Binary logistic regression analysis was used to analyze whether HBP and PLR were independent risk factors for the occurrence of AECOPD, and whether HBP and PLR had application value in predicting the occurrence of AECOPD and assisting diagnosis according to ROC curve. Results There were no significant differences in gender, age, smoking status, hypertension, diabetes, coronary heart disease and other general data between the two groups. Serum levels of HBP and PLR in AECOPD group were significantly higher than those in SCOPD group, and both HBP and PLR were independent risk factors for AECOPD. When the truncation value of HBP was 30.09 ng/mL, the sensitivity and specificity were 97.9% and 98%, respectively. When PLR truncation value is 164.0835 , the sensitivity and specificity are 57.3% and 90%, respectively. The AUC value of HBP and PLR combined detection is higher than that of single index.Conclusions HBP and PLR can predict and assist the diagnosis of AECOPD, and the combined detection of HBP and PLR has a higher value in predicting and assisting the diagnosis of AECOPD. -
图 1 各指标在AECOPD组、SCOPD组2组间差异分析
A：HBP在2组间的差异 ； B：PLR在2组间的差异。****P < 0.0001。
Figure 1. Difference analysis of each index between AECOPD group and SCOPD group
图 2 HBP、PLR及HBP联合PLR对预测和辅助诊断AECOPD的ROC曲线
Figure 2. ROC curves of HBP，PLR and HBP combined PLR for prediction and auxiliary diagnosis of AECOPD
表 1 AECOPD组、SCOPD组2组患者一般资料比较 （$ \bar x \pm s $，n，M（P25，P75））
Table 1. Comparison of general data between AECOPD group and SCOPD group （$ \bar x \pm s $，n，M（P25，P75））
组别 AECOPD组 SCOPD组 χ2/t/Z P n 96 50 性别 男 79 42 0.068 0.795 女 19 8 年龄（岁） 73.48 ± 9.70 76.20 ± 11.10 −1.530 0.128 吸烟情况 现在吸烟 22 5 3.690 0.158 过去吸烟 54 32 从不吸烟 20 13 合并症[n（%）] 冠心病 28 16 0.125 0.723 高血压 49 32 2.235 0.135 糖尿病 37 17 0.291 0.590 *P < 0.05。 
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表 2 各指标在AECOPD组和SCOPD组的2组间水平[M（P25，P75）]
Table 2. Inter-group level of each indicator in AECOPD group and SCOPD group[M（P25，P75）]
标志物 AECOPD组 SCOPD组 Z P HBP 66.78（44.05，112.16） 12.70（7.89，20.39） −9.793 < 0.001* PLR 174.81（123.28，253.83） 112.36（82.70，143.82） −5.310 < 0.001* *P < 0.05。
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表 3 单因素logistics回归分析
Table 3. One-way logistics regression analysis
因素 B SE Wald P OR（95%CI） HBP 0.366 0.102 12.923 < 0.001* 1.442（1.181，1.760） PLR 0.017 0.004 17.859 < 0.001* 1.017（1.009，1.026） *P < 0.05。
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表 4 多因素logistics回归分析
Table 4. Multi-factor logistics regression analysis
因素 B SE Wald P OR（95%CI） HBP 0.747 0.341 4.801 0.028* 2.111（1.082，4.120） PLR 0.050 0.023 4.814 0.028* 1.052（1.005，1.100） *P < 0.05。
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表 5 HBP和PLR对AECOPD的诊断价值
Table 5. Diagnostic value of HBP and PLR in AECOPD
标志物 AUC Cut-off值 灵敏度 特异度 95%CI P 下限 上限 HBP 0.995 30.09 0.979 0.98 0.986 1.000 < 0.001* PLR 0.768 164.0835 0.573 0.90 0.693 0.844 < 0.001* HBP+PLR 0.998 0.51 0.99 0.98 0.994 1.000 < 0.001* *P < 0.05。
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