慢性阻塞性肺疾病急性加重期嗜酸性粒细胞水平与预后关系的分析

Analysis of the relationship between eosinophil levels and the prognosis of AECOPD

目的探讨慢性阻塞性肺疾病(慢阻肺)急性加重期血嗜酸性粒细胞水平与预后的关系。方法回顾分析2013年3月至2015年3月在我科住院的慢阻肺急性加重期患者。入院时均进行相关资料登记,出院后对其随访1年。对病人的基本情况、血常规中嗜酸性粒细胞百分比、中性粒细胞/淋巴细胞比值、CRP水平、D-二聚体水平、住院时间(天)、再住院与否、是否死亡进行资料统计。根据嗜酸性粒细胞水平进行分组:组1(嗜酸性粒细胞组),嗜酸性粒细胞百分比>2%;组2(非嗜酸性粒细胞组),嗜酸性粒细胞百分比≤2%。出院后患者生存情况采用K-M生存分析评估。结果共有1200位慢阻肺急性加重期患者最终入组。35%的患者嗜酸性粒细胞升高。嗜酸性粒细胞组(组1)D-二聚体水平、CRP水平、中性粒细胞/淋巴细胞比值(NLR)、住院时间均较非嗜酸性粒细胞组(组2)低,有统计学差异(P<0.05)。随访1年后两组患者再住院率分别为40.7%、63.7%,有统计学差异(P<0.05)。根据K-M生存分析发现两组随访1年病死率无明显差异(P>0.05)。结论慢阻肺急性加重期患者非嗜酸性粒细胞组再住院率高、住院时间延长,D-二聚体、CRP、NLR值较高,随访1年两组病死率无明显差异。外周血嗜酸性粒细胞水平能够指导临床判断预后。

Objective To probe the relationship between blood eosinophil level and the prognosis of AECO- PD. Methods A retrospective observational cohort study was carried out in our department from March 2013 to March 2015. All hospitalized AECOPD patients were enrolled in our department. The related information was regis- tered at their initial hospitalization and followed-up for one year after discharge. Base data were collected from the hospital database. Subject＇s characteristics, hemogram parameters, C-reactive protein levels, neutrophil to lympho- cyte ratio （NLR）, D-dimer level on admission, duration of hospital stay, readmission, and mortality were recorded. They were divided into two groups according to peripheral blood eosinophil （PBE） level： the group 1 with eosinophil percentage 〉 2% and the group 2 （non-eosinophil group, ≤ 2% ）. Their survival situation after hospital discharge was evaluated by Kaplan-Meier survival analysis. Results A total of 1200 patients hospitalized with AECOPD were included, and the PBE elevated proportion was 35%. The levels of D-dimer, C-reactive protein, and neutrophil to lymphocyte ratio （NLR） on admission, and the duration of hospital stay were significantly lower in the groupl than in the group 2 （All P 〈0. 05）. The readmission rate was 40. 7% and 63.7% respectively in the group 1 and the group 2 （ P 〈 0. 05 ）. According to Kaplan-Meier survival analysis, the mortality after discharge was not distinctly different in the two groups. Conclusion the AECOPD patients in the non-eosinophil group have higher readmission rate, lon- ger duration of hospital stay, and high value of CRP, NLR and D-dimer, and the mortality shows no significant differ- ence during the first year of follow-up between the two groups, which means PBE can guide the clinical prognosis.