目的：探讨外周血中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio，NLR)对慢性阻塞性肺病(chronic obstructive pulmonary disease，COPD)相关肺动脉高压患者预后的评判价值。方法：选择2013年1月至2014年3月收治入上海交通大学医学院附属新华医院急诊科的200例COPD相关肺动脉高压(pulmonary hypertension，PH)患者为研究对象，对其进行至少2年的生存随访，随访终点为全因死亡，按照生存情况分为生存组和死亡组；记录各组入院24 h的一般临床资料，血常规[C反应蛋白(C-reactive protein，CRP)、中性粒细胞计数(neutrophils count，NEU)及淋巴细胞计数(lymphocyte count，LYM)并计算两者间比值(NLR)]、肌酐、尿素氮、胆红素、WHO肺动脉高压功能分级、肺动脉收缩压等；绘制受试者工作特征(receiver operating characteristic，ROC)曲线，分析NLR预测患者预后的临床价值；并以Kaplan-Meier法绘制观察指标不同水平下的生存曲线，进行生存分析。COX回归分析各指标提示预后的价值。结果：死亡组患者NLR，CRP，WHO肺动脉高压功能分级、肺动脉收缩压、尿素氮、肌酐、中性粒细胞计数高于生存组，淋巴细胞计数低于生存组，差异均具有统计学意义(P<0.05)。根据ROC曲线分析，NLR的ROC曲线下面积(AUC)为0.720(P<0.01)，高于肌酐(AUC=0.716)、中性粒细胞计数(AUC=0.655)、肺动脉收缩压(AUC=0.652)及CRP(AUC=0.643)。当NLR截断值为4.7时，其灵敏度为74.2%，特异度为72.0%。Kaplan-Meier生存曲线分析显示，NLR值水平较高组预后明显差于水平较低组(P<0.01)。单因素Cox回归分析提示NLR是提示患者不良预后的危险因素，多因素Cox回归分析(P>0.05)。结论：NLR水平与COPD相关肺动脉高压患者临床预后呈明显相关；NLR水平越高则提示病情较重，预后较差。
Assessment of prognosis for neutrophil/lymphocyte ratio in peripheral blood of pulmonary hypertension patients induced by chronic obstructive pulmonary disease
Objective: To assess the value of neutrophil/lymphocyte ratio (NLR) for clinical prognosis in pulmonary hypertension patients induced by chronic obstructive pulmonary disease (COPD). Methods: A total of 200 pulmonary hypertension patients induced by COPD enrolled in the emergency department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected as the research subjects from January 2013 to March 2014. All patients were followed up for at least 2 years until the endpoint of all-cause death. According to survival situation, the patients were divided into survival group and death group. The clinical data including neutrophils count (NEU), lymphocyte count (LYM), NLR, CRP, creatinine (Cr), bilirubin, blood urea nitrogen (BUN), WHO functional class (WHO-FC), pulmonary artery systolic pressure (PASP) were recorded in 24 h after admission. Receiver-operating characteristic curve (ROC) was plotted for evaluating the value of NLR on the clinical prognosis, and a Kaplan-Meier survival curve was drawn to analyze the survival situation under different levels of the index. Cox regressions analyze the value of the index in predicting prognosis. Results: NLR, CRP, NEU, Cr, BUN, WHO-FC, PASP in the death group were significantly higher than those in the survival group, while LYM was significantly lower than those of the survival group (P<0.05). It was shown by ROC curve that the maximum area under the ROC curve (AUC) of NLR was 0.720 (P<0.01), the result was higher than Cr (AUC=0.716), neutrophil count (AUC=0.655), PASP (AUC=0.652) and CRP (AUC=0.643). When the cut-off value of NLR was 4.7, the sensitivity was 74.2%, and the specificity was 72.0%. The Kaplan-Meier survival curve showed that the prognosis in the group with higher levels of NLR was worse than the group with lower levels of NLR (P<0.01). NLR was a significant predictor of long-term mortality in the univariate analysis; the multivariate Cox regression analysis did not support its significance in the prediction of long-term mortality. Conclusion: The levels of NLR were significantly correlated to the clinical outcomes for pulmonary hypertension patients induced by COPD. A higher level of NLR may indicate a more serious illness and a poorer prognosis.