慢性阻塞性肺疾病急性加重患者血嗜酸粒细胞增高的发生情况及临床特征

Prevalence and clinical characteristics of blood eosinophilia in patients with acute exacerbation of chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病（简称慢阻肺）急性加重患者外周血嗜酸粒细胞（EOS）增高的发生情况及临床特征。方法回顾性分析2014年7月至2016年6月成都大学附属医院呼吸内科慢阻肺急性加重住院患者的临床资料，按照外周血EOS增高定义为EOS≥2%及EOS≥3%两种标准将患者分为增高组与非增高组，比较两组人口统计学、临床症状、检验及检查结果、住院时间及住院费用的差异。结果共纳入患者559例，按EOS比例2%和3%两种标准，EOS增高组分别为241例（43.1%）和152例（27.2%）。无论按哪种标准，EOS增高组与非增高组在年龄、性别、病程差异均无统计学意义（均P〉0.05），慢性阻塞性肺疾病全球倡议（GOLD）肺功能分级、肺功能指标、改良英国医学研究会呼吸困难量表（mMRC）评分、抗生素用药率、糖皮质激素使用率、住院日均费用差异均无统计学意义（均P〉0.05）。按照2%标准，EOS增高组白细胞总数、中性粒细胞计数、单核细胞计数、hs－CRP均显著低于非增高组[（5.9±2.0）×10^9比（8.2±4.0）×10^9个/L、（3.9±1.6）×10^9比（6.5±3.8）×10^9个/L、（0.446±0.169）×10^9比（0.501±0.276）×10^9个/L、（25.8±35.9）比（46.2±55.6）mg/L]（均P〈0.01），嗜碱性细胞计数、淋巴细胞计数均显著高于非增高组[（0.043±0.025）×10^9比（0.029±0.021）×10^9个/L、（1.3±0.6）×10^9比（1.1±0.6）×10^9个/L]（均P〈0.01），住院时间、住院总费用均显著短于或低于非增高组[（10.6±5.0）比（11.6±5.8）d、（11 851±7 491）比（14 254±10 751）元人民币]（均P〈0.05）。按照3%标准，EOS增高组白细胞总数、中性粒细胞计数、单核细胞计数、hs－CRP均显著低于非增高组（均P〈0.05），嗜碱性细胞计数显著高于非增高组（均P〈0.01），淋巴细胞计数、住院时间、住院总费用两组差异均无统计学意义（均P〉0.05）。结论慢阻肺急性加重患者EOS增高发生比例相对较高，EOS增高患者具有更高的嗜碱性粒细胞比例增高发生率。

ObjectiveTo investigate the prevalence and clinical characteristics of peripheral blood eosinophilia （EOS） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.MethodsFrom July 2014 to June 2016, AECOPD patients in the Department of Respiratory Medicine of Affiliated Hospital of Chengdu University, were retrospectively stratified into two groups according to two standards of eosinophilic exacerbations （the peripheral blood eosinophil count ≥2% or ≥3% on admission）. Demography, clinical symptoms, laboratory results, length of stay, total hospitalization expenses, and defined daily expenses were compared between groups.ResultsA total of 559 cases with AECOPD were finally recorded, the prevalence of eosinophilia was 43.1% （241 cases by EOS≥2%） and 27.2% （152 cases by EOS≥3%）, respectively. According to either standard, there were no significant differences in sexes, age, course of disease （P〉0.05）, and there were no significant differences in global initiative for chronic obstructive lung disease （GOLD） grades, parameters of pulmonary function, modified british medical research council （mMRC） scores, rate of antibiotic use, systemic glucocorticoids administration, and average daily expenses （P〉0.05）. According to 2% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients [（5.9±2.0）×10^9/L vs （8.2±4.0）×10^9/L, （3.9±1.6）×10^9/L vs （6.5±3.8）×10^9/L, （0.446±0.169）×10^9/L vs （0.501±0.276）×10^9/L, （25.8±35.9） vs （46.2±55.6） mg/L, all P〈0.01]; basophils, lymphocytes were higher than non-eosinophilic patients [（0.043±0.025）×10^9/L vs （0.029±0.021） ×10^9/L, （1.3±0.6） ×10^9/L vs （1.1±0.6） ×10^9/L, both P〈0.01]; length of stay, total hospital expense were shorter （or lower） than non-eosinophilic patients [（10.6±5.0） vs （11.6±5.8） d, （11 851±7 491） vs （14 254±10 751） RMB, both P〈0.05]. According to 3% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients （all P〈0.05）, and basophil were higher than non-eosinophilic patients （P〈0.01）, but no significant differences were observed in lymphocytes, length of stay and total hospital expense （all P〉0.05）.ConclusionEosinophilia is of relative high prevalence in AECOPD patients, and basophil in eosinophilic patients is higher than non-eosinophilic patients.