改良格拉斯哥预后评分及计算炎症指标在煤工尘肺病中的含量及作用分析

摘要/Abstract

摘要： 目的评估改良格拉斯哥预后评分（modified glasgow prognostic score,mGPS）,计算的炎症指标中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）和血小板/淋巴细胞比值（platelet/lymphocyteratio,PLR）在诊断煤工尘肺（coal workers' pneumoconiosis,CWP）中的作用,为CWP防治提供帮助。方法收集2022年1—12月湖南省职业病防治院154名CWP和120例健康对照者,采用受试者工作特征曲线（receiver operating characteristic curve,ROC）评估PLR、NLR和mGPS预测CWP严重程度中的作用。分析CWP患者PLR、NLR、mGPS指标和肺功能指标之间的相关性。结果 CWP Ⅲ组的患者白细胞[（8.20±3.30）×10⁹/L]、中性粒细胞百分比值[（67.85±10.90）%]、中性粒细胞绝对值[（5.75±3.30）×10⁹/L]和用力肺活量（77.29±18.49）水平相对于CWP Ⅱ组、Ⅰ组和对照组都明显增高,另外,CWP Ⅲ 组的淋巴细胞百分比值[（21.67±9.38）%]、淋巴细胞绝对值[（1.62±0.70）×10⁹/L]水平相对于其他3组水平降低。CWP Ⅲ期组相对于CWPⅠ组红细胞沉降率[（23.43±17.71）mm/h]和C-反应蛋白[（12.15±7.12）mg/L]水平增高,差异均有统计学意义（均P<0.05）。与其他3组相比,CWP Ⅲ期患者的血清NLR（5.32±2.64）和PLR（196.01±51.01）浓度显著升高（P<0.05）。同时,与CWPⅠ期及Ⅱ期患者相比,CWP Ⅲ患者的血清mGPS浓度显著升高（0.81±0.67）（P<0.05）。PLR、NLR、mGPS和FVC之间均呈负相关（r=-0.244、-0.197、-0.298,均P<0.05）,PLR、NLR、mGPS和第1秒用力呼气量/用力肺活量的比值（forced expiratory flow in 1 s/forced vital capacity,FEV1/FVC）之间均呈负相关（r=-0.300、-0.225、-0.349,均P<0.05）。CWP组中NLR和PLR的ROC曲线下面积分别为0.767（95%CI：0.698~0.837,P<0.01）和0.626（95%CI：0.551~0.702,P<0.01）。结论 PLR、NLR和mGPS可作为指示煤工尘肺患者炎症状态和病情严重程度的指标。与PLR相比,NLR对评估疾病的活动度更敏感。

关键词: 煤工尘肺, 血小板/淋巴细胞比值, 中性粒细胞/淋巴细胞比值, 改良格拉斯哥预后评分

Abstract: Objective To evaluate modified glasgow prognostic score（mGPS）,calculated inflammatory markers such as neutrophil/lymphocyte ratio（NLR） and platelet/lymphocyte ratio（PLR） in the diagnosis of coal workers' pneumoconiosis（CWP）,and to provide assistance for the prevention and treatment of CWP. Methods A total of 154 CWP patients and 120 healthy controls from Hunan Prevention and Treatment Institute for Occupational Diseases were collected from January to December 2022. The value of PLR,CAR,NLR and mGPS for predicting the prognosis of CWP were evaluated by receiver operating characteristic curve（ROC） and the correlation between the PLR,NLR,mGPS and lung function indicators of CWP patients were analyzed. Results The levels of leukocytes[（8.20±3.3）×10⁹/L],percentage of neutrophils[（67.85±10.9）%],absolute value of neutrophils[（5.75±3.30）×10⁹/L] and forced vital capacity（77.29±18.49） in patients in CWP Ⅲ group were significantly increased compared with CWP Ⅱ group,Ⅰgroup and control group. In addition,the percentage of lymphocytes[（21.67±9.38）%] and the absolute value of lymphocytes[（1.62±0.70）×10⁹/L] in CWP Ⅲ group were lower than those in the other three groups. Erythrocyte sedimentation rate[（23.43±17.71）mm/h] and C-reactive protein[（12.15±7.12）mg/L] levels in CWP stage Ⅲ group were higher than those in CWPⅠ group,and the differences were statistically significant（both P<0.05）. Compared with the other three groups,the serum concentrations of NLR（5.32±2.64） and PLR（196.01±51.01） concentrations in CWP stage Ⅲ patients were significantly increased（both P<0.05）. Meanwhile,compared with CWPⅠ stage and Ⅱ stage patients,the serum mGPS concentration in CWPⅢ patients was significantly increased（0.81±0.67）（both P<0.05）. There was a negative correlation between PLR,NLR,mGPS and FVC（r=-0.244、-0.197、-0.298,all P<0.05）,Meanwhile, PLR,NLR,mGPS and FEV₁/FVC were negatively correlated（r=-0.300、-0.225、-0.349,all P<0.05）. The areas under the ROC curves of NLR and PLR were 0.767（95%CI：0.698-0.837） and 0.626（95%CI：0.551-0.702）（both P<0.01）. Conclusion PLR,NLR and mGPS can be used as indicators of inflammatory status and severity in clinical prognosis of patients with CWP. NLR is more sensitive to assessing disease activity compared with PLR.

Key words: Coal workers' pneumoconiosis, Platelet/lymphocyte ratio, Neutrophil/lymphocyte ratio, Modified glasgow prognostic score

中图分类号:

R135.2

贺腊姑, 杨露祺. 改良格拉斯哥预后评分及计算炎症指标在煤工尘肺病中的含量及作用分析. [J]职业与健康, 2024, 40(15): 2026-2031.

HE Lagu, YANG Luqi. Analysis on content and effect of modifiedglasgow prognostic score and calculated inflammatory index in coal workers' pneumoconiosis. [J]OCCUPATION AND HEALTH, 2024, 40(15): 2026-2031.

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