血嗜酸性粒细胞水平影响慢性阻塞性肺疾病急性加重患者使用全身糖皮质激素的药物利用评价

Evaluation on drug use of systemic glucocorticoid affected by the level of eosinophils in peripheral blood of the patients with acute exacerbation of chronic obstructive pulmonary disease

目的:分析不同外周血嗜酸性粒细胞水平的慢性阻塞性肺疾病急性加重(AECOPD)患者全身糖皮质激素的应用情况,以指导临床合理用药。方法:采用回顾性研究方法,以慢性阻塞性肺疾病全球创议(GOLD)最新发布的AECOPD管理推荐为评价标准,根据外周血嗜酸性粒细胞百分比水平(EOS)分成两组,EOS≥2. 0%为EOS观察组,EOS <2. 0%为EOS对照组,采用SPSS 19. 0统计分析软件进行数据处理,比较两组的全身糖皮质激素的使用比例及住院天数的差异,以及两组治疗前后第1秒用力呼气容积(FEV1)的差异。结果:纳入本研究的AECOPD患者共550人次,其中EOS≥2. 0%的患者有193人次,占35. 10%,EOS <2. 0%的患者有357人次,占64. 90%。使用全身糖皮质激素有164人次,占29. 82%,使用吸入糖皮质激素有386人次,占70. 18%。使用全身性糖皮质激素的164人次中EOS观察组有45人次,占27. 44%; EOS对照组119人次,占72. 56%。EOS观察组的平均住院天数更短,与EOS对照组比较,两组间差异有显著性,P=0. 04。EOS观察组在使用全身糖皮质激素后FEV1有改善,与治疗前比较差异有显著性,P=0. 04。结论:以最新AECOPD管理推荐为评价标准,在治疗AECOPD时,全身糖皮质激素存在使用过度和使用不足的现象;临床药师在指导临床用药和进行药物利用评价时,尽量采用国际上专业内认同的最新推荐意见,与临床医生共同推动合理用药。

AIM:To analyze the application situation of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)diagnosed with different eosinophil levels in peripheral blood in order to guide clinical rational drug use.METHODS:A retrospective research method was adopted;the latest published AECOPD management recommendations issued by the Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD)were taken as evaluation criterion.According to the percentage of eosinophils(EOS)in peripheral blood,all patients were divided into two groups:patients with EOS≥2.0%as EOS observation group and patients with EOS<2.0%as EOS control group.SPSS 19.0 statistical analysis software was used for data processing;the differences in the proportion of systemic glucocorticoids used and the length of hospital stay between the two groups were compared,so was the difference of forced expiratory volume in 1s(FEV1)between the two groups before and after treatment.RESULTS:A total of 550 AECOPD patients were included in the study,of which there were 193 patients with EOS≥2.0%,accounting for 35.10%,and there were 357 patients with EOS<2.0%,accounting for 64.90%,there were 164 patients who used systemic glucocorticoids,accounting for 29.82%,there were 386 patients who used inhaled glucocorticoids,accounting for 70.18%.There were 45 patients out of the 164 patients who used systemic glucocorticoids in the EOS observation group,accounting for 27.44%;there were 119 patients who used systemic glucocorticoids in the EOS control group,accounting for 72.56%.Compared with the EOS control group,the average length of hospital stay in the EOS observation group was shorter;so the difference between the two groups was significant(P=0.04).FEV1 in EOS observation group was improved after using systemic glucocorticoid,and there was significant difference between before and after treatment(P=0.04).CONCLUSION:According to the latest AECOPD management recommendations as an evaluation criterion,systemic glucocorticoids are overused and underused in the treatment of AECOPD;clinical pharmacists should refer to the latest recommendations recognized by international professional pharmacists when guiding clinical drug use and conducting drug utilization evaluation in order to promote rational use of drugs together with clinicians.