痰嗜酸粒细胞评估COPD糖皮质激素治疗的有效性研究

Study on Evaluation of Sputum Eosinophil in Curative Effect of Glucocorticoid for Chronic Obstructive Pulmonary Disease

目的论证痰检嗜酸粒细胞阳性的慢性阻塞性肺疾病(COPD)患者是否预示吸入糖皮质激素的临床和功能反应较好,而痰嗜酸粒细胞计数阴性的患者糖皮质激素治疗效果较差。方法28例痰检嗜酸粒细胞阳性的慢性阻塞性肺疾病加重期(AECOPD)患者设为治疗组,按随机配对原则入选痰检嗜酸粒细胞阴性的AECOPD患者28例设为对照组,均用糖皮质激素(静脉予甲基强的松龙40mg/d,0～3d后序贯口服泼尼松治疗后吸入糖皮质激素,出院后院外继续吸入糖皮质激素)及常规治疗共6个月。常规治疗包括:控制性氧疗,抗感染,化痰,止咳,使用支气管舒张剂等。治疗前及治疗后10、30d测FEV1、FEV1占预计值百分比、FEV1/FVC,统计6个月内首次COPD严重急性发作时间和COPD急性加重发生率,结果治疗组FEV1、FEV1占预计值百分比、FEV1/FVC均有明显提高,2组之间差异有统计学意义(P<0.05),治疗组首次COPD严重急性发作时间〔(106.78±42.52)d〕,较对照组〔(71.44±32.62)d〕明显延长(t=3.49,P<0.01),治疗组的COPD急性加重发生率(29.6%)明显少于对照组(43.4%)。结论痰检嗜酸粒细胞阳性患者预示吸入糖皮质激素的临床和功能反应较好,痰检嗜酸粒细胞阳性是临床COPD患者使用糖皮质激素治疗的较好指标,值得临床推广应用。

[ Objective ] To demonstrate the sputum eosinophils-positive of patients with Chronic Obstructive Pulmonary Disease （ COPD） treated by inhaled glucocorticoid indicates a good clinical and functional response, and negative of sputum eosinophils indicates a poor effect. [ Methods ] 28 patients with AECOPD of putum eosinophils-positive were chosen in treatment group, and 28 patients with AECOPD of putum eosinophils-negative were selected as the control group with random pairing principle. Two groups were treated by glucocorticoid （ after intravenous methylprednisolone 40 mg/d for 0 - 3 d, inhaled glucocorticoid were performed after oral prednisone , and continuing inhaled glucocorticoid were carried out after discharge ） and routine treatment for 6 months. The routine treatment included controlled oxygen therapy, anti-infection, resolving phlegm, relieving cough and using bronchodilator. Before and 10 ,30 day after treatment, FEV 1, FEV1%pred and FEV 1/FVC were tested, time of first severe acute attack of COPD and the incidence of acute COPD aggravation were analyzed. [ Results] FEV 1, FEV1% pred and FEV 1/FVC of the treatment group increased significantly, there was significant difference between two groups （ P 〈 0.05 ）. The time of first severe acute COPD attack in the treatment group （ 106.78 ± 42.52） d were longer than that in the control group （ 71.44 ± 32.62 ） d significantly （ t = 3.49, P〈0. 01 ）. The incidence of acute COPD of the treatment group （29.6% ） was lower than that of the control group （43.4% ）. [ Conclusion ] The sputum eosinophils-positive of patients indicates better clinical and functional response of inhaled glucocorticoid, the sputum eosinophils positive is a good indicator for glucocorticoid therapy, it is worth popularizing for clinical application.