目的 分析外周血红细胞分布宽度（RDW）、中性粒细胞（NEU）和淋巴细胞（LYM）比值（NLR）、纤维蛋白原（FIB）与白蛋白（ALB）比值（FAR）、肺表面活性蛋白A（SP-A）检测对慢性阻塞性肺疾病（chronic obstructive pulmonary disease， COPD）患者病情及急性加重风险的评估价值。 方法 选取2021年1月至2023年12月河北大学附属医院收治的200例COPD患者为研究对象，均在近3个月内于该院门诊复诊，依据有无急性加重分为加重组（n = 96）、未加重组（n = 104），另选择同期体检的健康志愿者50例作为对照组，对比三组外周血RDW、NEU、LY、FIB、ALB、SP-A，并计算NLR、FAR，分析RDW、NLR、FAR、SP-A随AECOPD病情的变化及相关性，绘制ROC曲线分析RDW、NLR、FAR、SP-A评估COPD急性加重风险的价值，多因素logistic回归法分析AECOPD的危险因素，同时比较不同预后者的RDW、NLR、FAR、SP-A差异。 结果 加重组外周血RDW、NEU、NLR、FIB、FAR、SP-A高于未加重组，而LYM、ALB低于未加重组（P < 0.05）；AECOPD Ⅲ级患者RDW、NLR、FAR、SP-A较Ⅱ级、Ⅰ级者更高，Ⅱ级患者RDW、NLR、FAR、SP-A高于Ⅰ级患者（P < 0.05）；AECOPD患者RDW、NLR、FAR、SP-A、病情分级两两呈正相关（P < 0.05）；RDW、NLR、FAR、SP-A联合预测AECOPD的敏感度、ROC曲线下面积分别为0.798、0.830（95%CI：0.738 ~ 0.922），均优于各指标单独诊断；多因素分析发现，吸烟、RDW > 14.33%、NLR > 2.80、FAR > 0.08、SP-A > 2.21 ng/mL为COPD患者病情急性加重的危险因素（P < 0.05）；出院后30 d内再入院组RDW、NLR、FAR、SP-A高于未再入院组（P < 0.05）。 结论 RDW、NLR、FAR、SP-A与COPD病情有密切关系，可预测患者急性加重风险及预后，临床可加以监测。

Objective To analyze the values of peripheral blood red blood cell distribution width （RDW）， neutrophil （NEU） to lymphocyte （LYM） ratio （NLR）， fibrinogen （FIB） to albumin （ALB） ratio （FAR） and surfactant protein A （SP-A） in evaluating patient condition and risks of acute exacerbation of COPD. Methods A total of 200 patients with COPD admitted to Hebei University Affiliated Hospital from January 2021 to December 2023 were selected as study subjects. All the patients had follow-up visits in the outpatient department within the past three months. According to the presence or absence of acute exacerbation， they were divided into exacerbation group （n = 96） and non-exacerbation group （n = 104）. Meanwhile， 50 healthy volunteers were assigned to a control group. Peripheral blood RDW， NEU， LY， FIB， ALB and SP-A in the three groups were compared. NLR and FAR were calculated. The correlation of RDW， NLR， FAR， and SP-A with the severity of AECOPD was analyzed. ROC curves were used to analyze the values of RDW， NLR， FAR， and SP-A in evaluating the risks of acute exacerbation of COPD. Multivariate logistic regression analysis was conducted to identify the risk factors for AECOPD. The differences in RDW， NLR， FAR， and SP-A were compared among the patients with different prognoses. Results Peripheral blood RDW， NEU， NLR， FIB， FAR and SP-A were higher in the exacerbation group than in the non-exacerbation group， whereas LYM and ALB were lower （P < 0.05）. Levels of RDW， NLR， FAR and SP-A were higher in the patients with grade Ⅲ AECOPD than those with grade Ⅱ or grade Ⅰ AECOPD （P < 0.05）. RDW， NLR， FAR， SP-A， and grade of patient condition in patients with AECOPD were positively correlated in pairs （P < 0.05）. The sensitivity， specificity and area under the ROC curve of combined prediction of AECOPD using RDW， NLR， FAR and SP-A were 0.798 and 0.830 （95%CI： 0.738 ~ 0.922）， all of which were superior to prediction using a single indicator. Multivariate analysis found that smoking， RDW > 14.33%， NLR > 2.80， FAR > 0.08， and SP-A > 2.21 ng/mL were risk factors for acute exacerbation of COPD （P < 0.05）. RDW， NLR， FAR， and SP-A in the readmission group within 30 days after discharge were higher than those in the non-readmission group （P < 0.05）. Conclusions RDW， NLR， FAR， and SP-A are closely related to the patient condition of COPD， and can help to predict the risk of acute exacerbation and prognosis. Therefore， they are worthy of monitoring in clinical practice.