转化医学杂志

目的 探讨血小板平均体积/淋巴细胞比值(MPVLR)对老年社区获得性肺炎(CAP)合并肺栓塞的鉴别诊断价值。方法 回顾性选取2020年4月至2023年10月长沙市中心医院收治的178例老年CAP患者作为CAP组，35例老年CAP合并肺栓塞患者作为合并肺栓塞组。采用全自动血细胞分析仪检测两组患者外周血中血小板平均体积(MPV)和淋巴细胞计数(LYM)，并计算MPVLR。采用受试者工作特征(ROC)曲线评估各项指标对老年CAP合并肺栓塞的鉴别诊断价值，采用多因素Logistic回归分析探讨老年CAP合并肺栓塞的影响因素。结果 合并肺栓塞组患者外周血MPV、MPVLR水平高于CAP组，外周血LYM水平低于CAP组(P<0.05)。外周血MPV、LYM、MPVLR鉴别老年CAP合并肺栓塞的曲线下面积(AUC)(95%CI)分别为0.871(0.820～0.923)、0.762(0.711～0.814)、0.904(0.853～0.956)，截断值分别为10.41 fl、1.47×10⁹、10.79，特异度分别为0.680、0.569、0.869，灵敏度分别为0.909、0.908、0.886。合并肺栓塞组年龄大于CAP组，感染累及全肺叶占比、胸腔积液占比、肺不张占比、D-二聚体、纤维蛋白原水平高于CAP组(P<0.05)。年龄越大、有胸腔积液、D-二聚体水平升高、MPV≥10.41 fl、MPVLR≥10.79是老年CAP合并肺栓塞的独立危险因素(P<0.05)。结论 MPVLR在老年CAP合并肺栓塞患者中升高，其对老年CAP合并肺栓塞具有较好的鉴别诊断价值，可作为潜在的生物标志物。

Objective To investigate the clinical value of mean platelet volume/lymphocyte ratio(MPVLR) in differentiating elderly patients with community-acquired pneumonia(CAP) complicated with pulmonary embolism. Methods A total of 178 elderly patients with CAP admitted to the Changsha Central Hospital from April 2020 to October 2023 were retrospectively selected as the CAP group, and 35 elderly patients with CAP combined with pulmonary embolism were selected as the combined pulmonary embolism group. The mean platelet volume(MPV) and lymphocyte(LYM) levels in peripheral blood of patients in the two groups were detected by automatic blood cell analyzer, and the MPVLR was calculated. The differentiating value of MPV, LYM, and MPVLR in peripheral blood for elderly patients with CAP complicated with pulmonary embolism was evaluated using ROC curves. The influencing factors of CAP and pulmonary embolism in elderly patients were explored by multivariate Logistic regression. Results The level of MPV and MPVLR in peripheral blood of patients in the pulmonary embolism group was higher than that of the CAP group, and the level of peripheral blood LYM was lower than that of the CAP group with statistical difference(P<0.05). The area under the curve(AUC) [95% confidence interval(CI)] of MPV, LYM and MPVLR in peripheral blood for differentiating CAP with pulmonary embolism in elderly patients were 0.871(0.820-0.923), 0.762(0.711-0.814) and 0.904(0.853-0.956), respectively. Cut-off values were 10.41 fl, 1.47×10⁹, and 10.79, with specificity of 0.680, 0.569, 0.869, and sensitivity of 0.909, 0.908, 0.886, respectively. The age of patients in the pulmonary embolism group was higher than that of the CAP group, and the proportion of total pulmonary lobar involvement, pleural effusion, atelectasis, as well as D-D and FIB levels were higher than those of the CAP group with statistical difference(P<0.05). Older age, pleural effusion, increased D-D level, MPV ≥ 10.41 fl, and MPVLR ≥ 10.79 were independent risk factors for CAP combined with pulmonary embolism(OR>1)(P<0.05). Conclusion MPVLR is elevated in elderly patients with CAP complicated with pulmonary embolism, and it has good diagnostic value in the differential diagnosis of pulmonary embolism in elderly patients with CAP, which can be used as a potential biomarker.