血嗜酸粒细胞对慢性阻塞性肺疾病急性加重期激素治疗反应性和再入院的预测价值

Blood eosinophils: a biomarker of response to glucocorticoids and increased readmissions in severe hospitalized exacerbations of COPD

目的分析不同水平血嗜酸粒细胞(EOS)慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床特点,探讨血EOS对AECOPD激素治疗反应性和再入院的预测价值。方法纳入2017年1月1日至12月31日在中南大学湘雅二医院呼吸与危重症学科住院的120例AECOPD患者,以入院血常规中EOS百分比(EOS%)分为两组,EOS%≥2%为EOS组(56例),EOS%<2%为非EOS组(64例)。对比分析两组患者临床特点、糖皮质激素治疗反应性以及再发重度急性加重风险。结果EOS组与非EOS组比较,白细胞、中性粒细胞百分比(N%)、中性粒细胞与淋巴细胞比值(NLR),C-反应蛋白(CRP)较低,使用抗生素疗程更短[分别为8(6~10)d和9(7~11)d,P=0.033];应用糖皮质激素治疗患者EOS组较非EOS组症状改善更明显(δCAT≥2分别为86.8%和68.2%,P=0.046),住院时间更短[分别为9(7~11)和10(9~13),P=0.042];EOS组患者中糖皮质激素治疗患者较未使用患者症状改善更明显(δCAT≥2分别为86.8%和61.1%,P=0.040)。出院后1年随访结果显示,EOS组重度急性加重发生风险更高[校正OR值为2.67(1.10~6.46),P=0.030;HR为1.57(1.02~2.40),P=0.040]。结论慢性阻塞性肺疾病急性加重期血嗜酸粒细胞水平对预测糖皮质激素治疗反应性和再发重度急性加重风险具有一定的参考价值。

Objective To compare the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by different levels of blood eosinophil (EOS) count and to investigate the predictive value of the response to glucocorticoid treatment and the readmission rate in the patients with higher blood eosinophils. Methods A total of 120 patients with AECOPD were admitted to the Department of Pulmonary and Critical Care Medicine in The Second Xiangya Hospital of Central South University from January 01, 2017 to December 31, 2017. Patients were divided into two groups according to their admission blood eosinophil fractions. Patients with EOS%≥2% were in the EOS group (n=56), while patients with EOS%<2% were in the Non-EOS group (n=64). The clinical characteristics, hospitalization treatments especially the glucocorticoid treatment response were compared, and the risk of severe acute exacerbation of the two groups including the 12-month COPD-related readmission, and time to first COPD-related readmission were also compared. Results Compared with the Non-EOS group, the EOS group had lower values of white blood cell (WBC), neutrophil fraction (N%), blood neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). The EOS group also required shorter course of antibiotic treatment [8 (6-10) and 9 (7-11), P=0.033]. In glucocorticoid-treated patients (n=82), the EOS group had significantly alleviated symptoms than the Non-EOS group (patients withδCAT≥2 were 86.8% and 68.2%, respectively, P=0.046), and the duration of hospitalization of the EOS group was shorter [9 (7-11) and 10 (9 to 13), P=0.042]. Patients with glucocorticoid treatment in the EOS group had significantly alleviated symptoms than those without glucocorticoid treatment (patients with δCAT ≥ 2 were 86.8% and 61.1%, respectively, P=0.040). The follow-up one year after discharge showed a higher risk of severe acute exacerbation in the EOS group [Adjust OR 2.67 (1.10-6.46), P=0.030;HR: 1.57 (1.02-2.40), P=0.040]. Conclusion The blood eosinophil levels were useful in predicting the AECOPD patients′ response to glucocorticoid treatment and the risk of severe acute exacerbations.