【摘要】 目的:探讨CT定量参数联合中性粒细胞/淋巴细胞比值(NLR)与慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者肺功能的相关性及预后预测价值。方法:将2021年1月-2022年12月在本院诊治的122例COPD合并II型呼吸衰竭患者作为研究对象。治疗前所有患者行1.0 mm薄层胸部CT扫描，使用Philips IntelliSpacePortal工作站内的COPD软件，测量并记录肺总容量、肺气肿容量、最大吸气末容积(MIV)、最大呼气末容积(MEV),并计算肺体积百分比(LVP)。对患者血液内的中性粒细胞和淋巴细胞浓度进行检测，计算并记录两者的比值(NLR)。采用耶格肺功能检测仪对患者的肺功能进行评估，记录用力肺活量(FVC)和一秒用力呼气容积(FEV1)。观察患者自入院治疗起90天内是否发生难以纠正的呼吸衰竭、心绞痛、心肌梗死、心力衰竭、心源性猝死、多脏器功能障碍及死亡等不良事件，将患者分为预后不良组和预后良好组。采用t检验方法比较2组间CT定量参数及NLR的差异，应用Pearson相关性分析评估CT定量参数、NLR与肺功能指标的相关性，采用受试者工作特征(ROC)曲线评估CT定量参数和NLR在患者预后预测中的效能。结果:MIV、MEV、NLR分别与FVC、FEV1呈负相关(P均<0.05),而肺体积百分比与FVC、FEV1均无统计学相关性(P均>0.05)。预后良好者89例，预后不良者33例。预后良好组的MIV、MEV和NLR显著低于预后不良组，差异均有统计学意义(P<0.05);而肺体积在两组间比较差异无统计学意义(P>0.05)。CT定量参数(MIV、MEV)及NLR预测患者COPD合并II型呼吸衰竭患者预后的AUC分别为0.709(95%CI:0.601～0.816)、0.820(95%CI:0.744～0.895)和0.895(95%CI:0.825～0.965),三者联合预测患者预后的AUC达0.935(95%CI:0.882～0.988)。结论:CT定量参数(MIV、MEV)及NLR与COPD合并II型呼吸衰竭患者的肺功能具有相关性，且三者联合对预测患者预后具有较的效能。更多还原

【Abstract】 Objective:To investigate the correlation and prognostic value of CT quantitative parameters combined with neutrophil/lymphocyte ratio(NLR) and lung function in patients with chro-nic obstructive pulmonary disease(COPD) complicated with type Ⅱ respiratory failure.Methods:A total of 122 patients with COPD combined with type Ⅱ respiratory failure were studied in our hospital from January 2021 to December 2022.All underwent thin-silce(1.0mm) chest CT scan before treatment, and COPD analysis software at the Philips IntelliSpacePortal workstation was used to measure and record the quantitative functional indexes of the lung, including total lung volume, emphysema vo-lume, maximal inspiratory volume(MIV),maximum expiratory volume(MEV) and lung volume percentage(LVP).The concentrations of neutrophils and lymphocytes in the patient’s blood were mea-sured, and the ratio of the two indexes(NLR) was calculated and recorded.The patients’ lung function was assessed using the Jaeger pulmonary function tester, and forced vital capacity(FVC) and forced expiratory volume in one second(FEV1) were recorded.Adverse events such as difficult to correct respiratory failure, angina pectoris, myocardial infarction, heart failure, sudden cardiac death, multiple organ dysfunction, and death were observed within 90 days of admission to evaluate the prognosis of patients.If the above conditions occurred, they were classified into the poor prognosis group, otherwise they were included into the good prognosis group.t-test was used to compare the differences in CT quantitative parameters and NLR between the two groups.Pearson correlation analysis was used to evaluate the correlation between CT quantitative parameters, NLR and pulmonary function indicators.The efficacy of the CT quantitative parameters and NLR in predicting patients’ prognosis was evaluated by subject work characteristic curve.Results:MIV,MEV and NLR were negatively correlated with FVC and FEV1 respectively(all P<0.05),while lung volume percentage was not statistically correlated with FVC and FEV1(all P>0.05).There were 89 cases with good prognosis and 33 cases with poor prognosis.MIV,MEV and NLR in the good prognosis group were significantly lower than those in the poor prognosis group with statistical significance(all P<0.05).There was no significant diffe-rence in lung volume between the two groups(P>0.05).The AUC of CT quantitative parameters(MIV,MEV) and NLR to predict the prognosis of COPD patients with type Ⅱ respiratory failure were 0.709(95%CI:0.601～0.816),0.820(95%CI:0.744～0.895) and 0.895(95%CI:0.744～0.895),respectively.The combined prediction of AUC was 0.935(95%CI:0.882～0.988).Conclusion:CT quantitative parameters(MIV,MEV) and NLR are correlated with pulmonary function in COPD patients with type Ⅱ respiratory failure, and the combination of these three parameters is effective in predicting the prognosis of patients.更多还原