新疆医科大学学报

目的 探讨血清C反应蛋白/白蛋白比值(CAR)及嗜酸性粒细胞/淋巴细胞比值(ELR)与慢性阻塞性肺疾病急性加重(AECOPD)合并肺部感染患者预后的相关性。方法 2019年1月-2022年6月募集180例AECOPD患者，依据是否合并肺部感染将180例AECOPD患者分为感染组(105例)和非感染组(75例),105例感染组患者依据入院治疗后预后情况，分为预后良好组(62例)和预后不良组(43例)。检测所有受试者的血清CAR和ELR水平，Logistic回归模型分析影响AECOPD合并肺部感染患者预后的危险因素，绘制ROC曲线分析CAR、ELR单独和联合检测对AECOPD合并肺部感染患者预后的影响。结果 与非感染组相比，感染组患者血清CAR(t=45.25,P<0.001)、ELR(t=20.11,P<0.001)水平升高。与预后良好组相比，预后不良组患者血清CAR、ELR水平升高(均P<0.05),且患者年龄较大、病程较长、合并肺心病比例、无创呼吸机治疗比例高，FEV1、FEV1/FVC、FVC水平低(P<0.05)。Logistic结果显示，病程、无创呼吸机治疗、CAR、ELR是影响AECOPD合并肺部感染患者预后不良的独立危险因素。ROC结果显示，血清CAR、ELR单独预测AECOPD合并肺部感染患者预后的AUC为0.778、0.787,二者联合预测的AUC为0.875,二者联合检测的AUC显著大于CAR、ELR单独检测(Z=2.128,3.236,P<0.05)。结论 AECOPD合并肺部感染患者血清CAR、ELR水平升高，二者联合检测能提高对AECOPD合并肺部感染患者预后评估的水平。

Objective To explore the predictive value of C-reactive protein to albumin ratio(CAR) and eosinophil to lymphocyte ratio(ELR) for the prognosis of the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary infection. Methods From January 2019 to June 2022, 180 AECOPD patients were recruited. Based on the presence of pulmonary infection, the 180 AECOPD patients were divided into infection group(105 cases) and non-infection group(75 cases). Among the infection group, 105 patients were further categorized into good prognosis group(62 cases) and poor prognosis group(43 cases) based on their prognosis after hospitalization. The serum CAR and ELR levels of all subjects were measured, and Logistic regression analysis was conducted to identify the risk factors influencing the prognosis of AECOPD patients with pulmonary infection. ROC curve analysis was performed to assess the predictive value of CAR and ELR, both individually and in combination, for the prognosis of AECOPD patients with pulmonary infection. Results Compared with non-infected group, the serum levels of CAR(t=45.25, P<0.001) and ELR(t=20.11, P<0.001) in infected group patients were increased. Compared with good prognosis group, the serum levels of CAR and ELR in the poor prognosis group patients were increased(all P<0.05), and the patients had higher age, longer course, higher proportion of combined pulmonary heart disease and non-invasive ventilator treatment, as well as lower levels of FEV1, FEV1/FVC and FVC(P<0.05). The Logistic results showed that the course, non-invasive ventilator treatment, CAR and ELR were independent risk factors affecting the poor prognosis of AECOPD patients with pulmonary infection. The ROC results showed that the AUC for serum CAR and ELR separately predicting the prognosis of AECOPD patients with pulmonary infection was 0.778 and 0.787, respectively, and the AUC for their combined prediction was 0.875, significantly greater than the AUC for CAR and ELR separately(Z=2.128, 3.236, P<0.05). Conclusion The serum levels of CAR and ELR in AECOPD patients with pulmonary infection were increased, and their combined detection can improve the level of prognosis evaluation for AECOPD patients with pulmonary infection.