FeNO与Eos对AECOPD患者糖皮质激素反应性及预后的评估价值研究

valuation value of FeNO and Eos on glucocorticoid reactivity and prognosis in patients with AECOPD

目的探究呼出气一氧化氮(FeNO)和嗜酸性粒细胞(Eos)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的预后影响,并对糖皮质激素给药的指导价值。方法选取2017年1月—2021年12月首都医科大学附属北京潞河医院呼吸内科收治的279例AECOPD患者,根据入院时测定的FeNO、Eos水平,将患者分为高FeNO组(n=103)与低FeNO组(n=176),Eos组(n=95)和非Eos组(n=184)。比较每组患者激素反应性。根据患者住院期间不同预后分为死亡组(36例)与生存组(243例),以多因素Logistic回归分析模型确定AECOPD患者的死亡因素,并以受试者工作特征曲线(ROC)对其预后效能检测。结果高FeNO组肺部及全身激素的使用率、激素总量低于低FeNO组(P<0.05),激素疗程、住院时间短于低FeNO组(P<0.05);Eos组肺部及全身激素的使用率、激素总量低于非Eos组(P<0.05),且激素疗程、住院时间短于非Eos组(P<0.05);死亡组吸烟患者占比、加重频次、超敏C反应蛋白(hs-CRP)、中性粒细胞的绝对值(NE绝对值)均高于生存组,高FeNO、Eos%≥2%低于生存组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,加重频次、高hs-CRP水平、高FeNO、Eos%≥2%均是导致患者死亡的危险因素(P<0.05);ROC曲线分析显示,高FeNO、Eos%≥2%及二者联合预测AECOPD患者住院期间死亡的AUC(95%CI)分别为0.738(0.682~0.789)、0.766(0.712~0.815)、0.876(0.831~0.912),二者联合预测效能高于单项检测。结论高FeNO、Eos水平与AECOPD患者的预后密切相关,二者联合检测有助于对AECOPD患者的病情判断,可更好的指导糖皮质激素的应用。

Objective To explore the prognostic effects of exhaled nitric oxide(FeNO)and eosinophils(Eos)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and the guiding value of glucocorticoid administration.Methods 279 patients with AECOPD admitted to respiratory Department of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2017 to December 2021 were selected.According to FeNO and Eos levels measured at admission,the patients were divided into high FeNO group(n=103)and low FeNO group(n=176),Eos group(n=95)and non-EOS group(n=184).The hormone reactivity of each group was compared.Patients were divided into death group(36 cases)and survival group(243 cases)according to different prognosis during hospitalization.Multiple Logistic regression analysis model was used to determine the death factors of AECOPD patients,and receiver operating characteristic curve(ROC)was used to detect the prognostic efficacy of AecopD patients.Results The utilization rate and total hormone amount of lung and body in high FeNO group were lower than those in low FeNO group(P<0.05),and the duration of hormone treatment and hospital stay were shorter than those in low FeNO group(P<0.05).The utilization rate and total hormone volume of lung and body hormones in Eos group were lower than those in non-EOS group(P<0.05),and the duration of hormone treatment and hospital stay were shorter than those in non-EOS group(P<0.05).The proportion,frequency of exacerbation,hypersensitive C-reactive protein(hs-CRP)and absolute value of neutrophils(NE absolute value)in death group were higher than those in survival group,while those with high FeNO and Eos%≥2%were lower than those in survival group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that aggravation frequency,high hs-CRP level,high FeNO and Eos%≥2%were all risk factors for death(P<0.05).ROC curve analysis showed that the AUC(95%CI)of high FeNO,Eos%≥2%and their combination in predicting in-hospital death of AECOPD patients were 0.738(0.682~0.789),0.766(0.712~0.815)and 0.876(0.831~0.912),respectively.The combined prediction efficiency is higher than that of single detection.Conclusion High FeNO and Eos levels are closely related to the prognosis of patients with AECOPD,and the combined detection of the two can help to judge the condition of patients with AECOPD and better guide the application of glucocorticoid.