Pascual-González Yuliana, López-Sánchez Marta, Dorca Jordi, Santos Salud
Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
Biomedical Research Networking Center Consortium - Respiratory Diseases (CIBERES), Barcelona, Spain,
Int J Chron Obstruct Pulmon Dis. 2018 Nov 5;13:3651-3662. doi: 10.2147/COPD.S178068. eCollection 2018.
COPD is characterized by a pulmonary and systemic inflammatory process. Several authors have reported the elevation of multiple inflammatory markers in patients with COPD; however, their use in routine clinical practice has limitations. The neutrophil-to-lymphocyte ratio (NLR) is a useful and cost-effective inflammatory marker derived from routine complete blood count. We performed a systematic literature review using the PRISMA statement. Twenty-two articles were included, recruiting 7,601 COPD patients and 784 healthy controls. Compared with controls, COPD patients had significantly higher NLR values. We found a significant correlation between the NLR and clinical/functional parameters (FEV, mMRC, and BODE index) in COPD patients. Elevation of the NLR is associated with the diagnosis of acute exacerbation of COPD (pooled data propose a cut-off value of 3.34 with a median sensitivity, specificity, and area under the curve of 80%, 86%, and 0.86, respectively). Additionally, increased NLR is also associated with the diagnosis of a bacterial infection in exacerbated patients, with a cut-off value of 7.30, although with a low sensitivity and specificity. The NLR is an independent predictor of in-hospital and late mortality after exacerbation. In conclusion, the NLR could be a useful marker in COPD patients; however, further studies are needed to better identify the clinical value of the NLR.
慢性阻塞性肺疾病（COPD）的特征是肺部和全身的炎症过程。几位作者报告了COPD患者多种炎症标志物的升高；然而，它们在常规临床实践中的应用存在局限性。中性粒细胞与淋巴细胞比值（NLR）是一种从常规全血细胞计数得出的有用且经济高效的炎症标志物。我们使用PRISMA声明进行了系统的文献综述。纳入了22篇文章，招募了7601例COPD患者和784例健康对照。与对照组相比，COPD患者的NLR值显著更高。我们发现COPD患者的NLR与临床/功能参数（FEV、mMRC和BODE指数）之间存在显著相关性。NLR升高与COPD急性加重的诊断相关（汇总数据提出的截断值为3.34，中位敏感性、特异性和曲线下面积分别为80%、86%和0.86）。此外，NLR升高也与加重患者细菌感染的诊断相关，截断值为7.30，尽管敏感性和特异性较低。NLR是加重后住院和晚期死亡率的独立预测因子。总之，NLR可能是COPD患者的一个有用标志物；然而，需要进一步研究以更好地确定NLR的临床价值。
