糖皮质激素治疗外周血嗜酸粒细胞增多的慢性阻塞性肺疾病急性加重期患者的临床疗效

Clinical Effect of Glucocorticoids on Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients with Increased Eosinophilic Granulocytes

目的观察糖皮质激素治疗嗜酸粒细胞(EOS)增多的慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效。方法选取苏州市相城区中医医院2013年1月—2017年4月收治的AECOPD患者148例,其中外周血EOS比例正常者111例作为对照组(外周血EOS比例≤2%),外周血EOS比例升高者37例作为观察组(外周血EOS比例>2%)。两组患者均在常规治疗基础上给予注射用甲泼尼龙琥珀酸钠治疗,连续治疗7 d。比较两组患者治疗前后呼出气一氧化氮(FeNO)、外周血EOS比例、动脉血气分析指标、第1秒用力呼气容积占预计值百分比(FEV_1%pred)及慢性阻塞性肺疾病评估测试(CAT)评分,记录两组患者住院时间,观察两组患者治疗期间不良反应发生情况;FeNO与AECOPD患者外周血EOS比例的相关性分析采用Pearson相关性分析。结果观察组患者治疗前后FeNO及其差值、治疗前后外周血EOS比例及其差值高于对照组(P<0.05)。Pearson相关性分析结果显示,治疗前FeNO与AECOPD患者外周血EOS比例呈正相关(r=0.691,P<0.01);治疗后FeNO亦与AECOPD患者外周血EOS比例呈正相关(r=0.793,P<0.01)。两组患者治疗前后动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、FEV_1%pred及CAT评分比较,差异均无统计学意义(P>0.05)。观察组患者住院时间短于对照组(P<0.05)。治疗期间,观察组患者未出现明显不良反应;对照组患者出现轻度胃部不适1例,治疗结束后自行缓解。结论糖皮质激素可有效减轻EOS增多的AECOPD患者气道炎症,缩短患者住院时间;外周血EOS比例与气道炎症有关。

Objective To observe the clinical effect of glucocorticoids on acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） patients with increased eosinophilic granulocytes（ EOS）. Methods From January 2013 to April 2017,a total of 148 patients with AECOPD were selected in the Traditional Chinese Medicine Hospital of Xiangcheng District,Suzhou,thereinto 111 patients with normal peripheral blood EOS ratio were served as control group（ with peripheral blood EOS ratio equal or less than 2%）,37 patients with elevated peripheral blood EOS ratio were served as observation group（ with peripheral blood EOS ratio over 2%）. Patients of the two groups received methylprednisolone sodium succinate for injection,both groups continuously treated for 7 days. FeNO,peripheral blood EOS ratio,arterial blood-gas analysis results,FEV_1% pred and CAT score before and after treatment,hospital stays and incidence of adverse reactions during the treatment were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between FeNO and peripheral blood EOS ratio in patients with AECOPD. Results FeNO and its difference value before and after treatment,peripheral blood EOS ratio and its difference value before and after treatment of observation group were statistically significantly higher than those of control group（ P〈0. 05）. Pearson correlation analysis results showed that,FeNO was positively correlated with peripheral blood EOS ratio in patients with AECOPD before treatment（ r = 0. 691,P〈0. 01） and after treatment（ r = 0. 793,P〈0. 01）.No statistically significant differences of PaO_2,PaCO_2,FEV_1% pred or CAT score was found between the two groups（ P〈0. 05）. Hospital stays of observation group was statistically significantly shorter than that of control group（ P〈0. 05）. No one of observation group occurred any obvious adverse reactions during the treatment,while 1 cases of control group occurred mild stomach discomfort with spontaneous remission after the treatment. Conclusion Glucocorticoids on effectively relive the airway inflammation of AECOPD patients with increased EOS,shorten the hospital stays; peripheral blood EOS ratio is significantly correlated with the airway inflammation.