血嗜酸性粒细胞增多型慢性阻塞性肺疾病急性加重患者临床特点及预后Meta分析

Meta-analysis of clinical features and prognosis of acute exacerbations of chronic obstructive pulmonary disease patients with eosinophilia

目的评价外周血嗜酸性粒细胞(eosinophil,EOS)增多与慢性阻塞性肺疾病(简称慢阻肺)急性加重患者临床特征及再入院率、病死率的相关性。方法检索PubMed、Embase、Web of science、Cochrane Library、中国期刊全文数据库、万方数据库、中文科技期刊数据库和中国生物医学文献数据库,检索时间均从建库至2021年10月31日。由2名研究员独立筛选文献,提取资料,并对纳入研究进行偏倚风险评估。采用Rev Man v.5.4进行Meta分析。结果共纳入76篇观察性研究,其中15篇英文文献,61篇中文文献。EOS增多组(EOS≥2%)8240例(34.2%),EOS正常组(EOS<2%)15854例(65.8%)。Meta分析结果示:(1)炎性指标:EOS增多组患者C反应蛋白[MD=-8.44,95%CI(-10.59,-6.29),P<0.05]、中性粒细胞与淋巴细胞比值[MD=-2.47,95%CI(-3.13,-1.81),P<0.05]均低。(2)住院情况:EOS患者住院时间短[MD=-2.23,95%CI(-2.64,-1.81),P<0.05],院内病死率[OR=0.41,95%CI(0.31,0.53),P<0.05]、机械通气率[OR=0.59,95%CI(0.47,0.75),P<0.05]与糖皮质激素使用比例[OR=0.91,95%CI(0.85,0.96),P<0.05]均低。(3)随访结果:EOS增多组患者随访1年再入院比例[OR=0.78,95%CI(0.66,0.92),P<0.05]与病死率[OR=0.78,95%CI(0.62,0.97),P<0.05]较低。结论EOS增多型慢阻肺急性加重患者具有C反应蛋白低、中性粒细胞与淋巴细胞比值低、住院时间短、院内病死率及机械通气率低、糖皮质激素使用比例低、急性加重再入院比例低及病死率低等特点。该类患者病情较轻,治疗效果较好,急性加重风险较低。

Objective To evaluate the correlation between blood eosinophilia and clinical characteristics,readmission rate and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP,and CBM databases were searched until October 31,2021.Two researchers independently screened the literature,extracted the data,and evaluated the bias risk of the included studies.Meta-analysis was conducted by Rev Man v.5.4.Results Finally,76 observational studies met the inclusion criteria,including 15 English literatures and 61 Chinese literatures.There were 8240 patients(34.20%)in the eosinophilia group(EOS≥2%)and 15854 cases(65.8%)in the eosinophil normal group(EOS<2%).Results of meta-analysis:(1)Inflammatory Index:eosinophilia group had lower Creactive protein[MD=-8.44,95%CI(-10.59,-6.29),P<0.05],and lower neutrophil to lymphocyte ratio[MD=-2.47,95%CI(-3.13,-1.81),P<0.05].(2)Hospitalization:eosinophilia group had shorter hospital stay[MD=-2.23,95%CI(-2.64,-1.81),P<0.05]and lower in-hospital mortality[OR=0.41,95%CI(0.31,0.53),P<0.05],lower mechanical ventilation rate[OR=0.59,95%CI(0.47,0.75),P<0.05],lower hormone use rate[OR=0.91,95%CI(0.85,0.96),P<0.05].(3)Follow-up results:eosinophilia group had a lower rate of readmission at 1 year[OR=0.78,95%CI(0.66,0.92),P<0.05]and a lower rate of death at 1 year[OR=0.78,95%CI(0.62,0.97),P<0.05].Conclusions AECOPD patients with eosinophilia group were characterized by lower inflammatory indicators,shorter hospital stay,shorter in-hospital mortality,lower mechanical ventilation rate,lower hormone use rate,lower rate of acute exacerbation readmission,lower mortality rate and lower rate of follow-up after 1 year.This kind of patients with mild disease,good treatment effect,low risk of acute exacerbation.