【摘要】 目的 探讨血清红细胞分布宽度(RDW)、B型利钠肽(BNP)联合那不勒斯预后评分(NPS)对慢性阻塞性肺疾病急性加重期(AECOPD)住院患者院内临床转归的预测价值。方法 回顾性分析2019年1月至2024年12月新乡医学院第一附属医院收治的110例AECOPD住院患者的临床资料，根据院内临床转归分为好转组(n=72)和不良组(n=38)。比较两组患者的基线资料和血清RDW、BNP水平及NPS评分的差异，通过多因素Logistic回归分析AECOPD住院患者院内临床转归不良的独立危险因素，并采用受试者工作特征(ROC)曲线评估各指标的预测价值。结果 不良组患者的年龄高于好转组，差异有统计学意义(P<0.05)，两组患者其余的性别、COPD病程、合并症、急性加重次数等基线资料比较差异均无统计学意义(P>0.05)；不良组患者的RDW、BNP及NPS分别为(15.83±1.42)%、[880.25(502.50,1 500.75)] pg/m L、(2.85±0.62)分，明显高于好转组的(13.36±1.48)%、[206.50(97.25,421.50)] pg/mL、(1.43±0.23)分，差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，RDW、BNP、NPS和年龄均是AECOPD住院患者院内临床转归不良的独立预测因素(P<0.05)，其中，NPS的OR值最高(2.307)，表明其对转归不良的关联性最强；BNP(OR=2.031)的关联性次之；而RDW(OR=1.684)和年龄(OR=1.531)的关联性相对较小。模型Hosmer-Lemeshow检验χ~2=6.825,P=0.556，表明模型拟合良好。联合模型AUC=0.902(95%CI:0.827～0.952)，表明其预测能力优于单项指标RDW、BNP、NPS及年龄。结论 RDW、BNP及NPS评分均是AECOPD住院患者院内不良转归的独立预测因子，三者联合检测的预测效能更高。更多还原

【Abstract】 Objective To investigate the predictive value of serum red blood cell distribution width(RDW),B-type natriuretic peptide(BNP), and the Naples prognostic score(NPS) for in-hospital clinical outcomes in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A retrospective analysis was conducted on the clinical data of 110 patients hospitalized with AECOPD at the First Affiliated Hospital of Xinxiang Medical University from January 2019 to December 2024. Based on in-hospital clinical outcomes, patients were divided into a improvement group(n=72) and an adverse outcome group(n=38). Baseline data, serum RDW, BNP levels, and NPS scores were compared between the two groups. Multivariate logistic regression analysis was used to identify independent risk factors for adverse in-hospital clinical outcomes in AECOPD patients, and receiver operating characteristic(ROC) curves were employed to evaluate the predictive value of each indicator. Results The age of patients in the adverse outcome group was significantly higher than that in the improvement group(P<0.05). No statistically significant differences were observed in other baseline data, such as gender, COPD duration, comorbidities, and frequency of acute exacerbations between the two groups(P>0.05). The RDW, BNP, and NPS in the adverse outcome group were(15.83±1.42)%, 880.25(502.50, 1 500.75) pg/m L, and(2.85±0.62) points, respectively, which were significantly higher than(13.36±1.48)%, 206.50(97.25, 421.50) pg/m L, and(1.43±0.23) points in the improvement group(P<0.05). Multivariate logistic regression analysis revealed that RDW, BNP, NPS, and age were independent predictors of adverse in-hospital clinical outcomes in AECOPD patients(P<0.05). Among these, NPS had the highest odds ratio(OR=2.307), indicating the strongest association with adverse outcomes, followed by BNP(OR=2.031), while RDW(OR=1.684) and age(OR=1.531) showed relatively weaker associations. The Hosmer-Lemeshow test(χ2=6.825, P=0.556) indicated good model fit. The combined model had an AUC of 0.902(95% CI: 0.827-0.952), demonstrating superior predictive value compared to individual indicators(RDW, BNP, NPS, and age). Conclusion RDW, BNP, and NPS scores are independent predictors of adverse in-hospital outcomes in AECOPD patients, and their combined assessment provides higher predictive efficacy.更多还原