不同血嗜酸性粒细胞水平的男性COPD患者使用ICS+LABA临床特征观察

Observation the effect of blood eosinophils and inhaled corticosteroid/long-acting beta-2 agonist in clinical characteristics of COPD

目的观察不同血嗜酸性粒细胞水平的男性COPD患者,使用ICS+LABA与否对急性发作次数、住院次数、肺炎累患次数、FEV1、mMRC等的影响。方法随机选择142例男性稳定期COPD患者,以血EOS≥2%及是否使用ICS+LBAB将其分为A组(EOS≥2%,使用ICS+LBAB治疗)、B组(EOS≥2%,使用除ICS+LBAB以外的治疗方案)、C组(EOS<2%,使用ICS+LBAB治疗)、D组(EOS<2%,使用除ICS+LBAB以外的治疗方案);随访1年,记录并比较四组治疗前后mMRC评分、FEV1%Pred、FEV1,1年内急性加重次数、住院治疗次数、肺炎累患次数。结果随访1年,完成本研究共112例,以GOLD 2~3级COPD患者为主,各组间年龄、BMI无统计学差异(P>0.05)。随访1年后,A组FEV1下降较B组少(P=0.002),B、D组FEV1下降差异无统计学意义(P>0.05);B组急性加重率高于A、C、D组(P<0.05);余各组间无统计学意义(P>0.05);住院率B组较D组高(P=0.01),余各组间无统计学差异(P>0.05);肺炎累患率各组间比较无统计学差异(P>0.05)。治疗前各组mMRC评分有统计学差异(P=0.026),治疗后mMRC评分各组间无统计学差异(P>0.05)。结论对血EOS≥2%的COPD患者,使用含ICS+LABA方案治疗可延缓FEV1下降,降低年急性加重率及住院率,未见肺炎累患率增加,药物干预在缓解患者自主呼吸困难程度方面起到一定作用。

Objective To observe the effect of blood eosinophils(EOS)and inhaled corticosteroid/long-acting beta-2 agonist efficacy in acute episodes,hospitalizations,pneumonia,and force expiratory volume in 1 second(FEV1)and modified British medical research council(mMRC)in COPD.Methods 142 male stable COPD patients were randomly selected.They were divided into A group(EOS≥2%,treatment with an inhaled corticosteroid(ICS)/long-actingβ2 agonist(LABA)),B group(EOS≥2%,and treatment without ICS+LBAB),C group(EOS<2%,treatment with an ICS+LBAB),D group(EOS<2%,treatment without ICS+LBAB).Follow up for 1 year,record and compare the four groups before and after treatment mMRC score,FEV1%Pred,FEV1,the number of acute aggravation,hospitalizations,Number of cases of pneumonia.Results After 1 year follow-up,112 cases were completed,mainly GOLD2~3 COPD patients,and there were no statistical significantly differences between the groups in age and BMI(P>0.05).But the decline of FEV1 in Group A was significantly slower than B(P=0.002),there were no statistical significantly differences in Groups B and D(P>0.05).Compared with groups one by one,the annual acute aggravation rate of Group B was highest than other Groups(P<0.05).There were no statistical significantly differences between the remaining groups comparison(P>0.05).Hospitalization rate of group B was higher than group D(P=0.01),and there were no statistical significantly differences between the remaining groups(P>0.05).There were no statistical significantly differences in the annual rate of pneumonia(P>0.05).There were statistical significantly differences among the groups in mMRC score-before(P=0.026),mMRC score-after and there were no statistical significantly differences between the groups(P>0.05).Conclusion For patients with blood EOS≥2%COPD,using of ICS+LABA treatment can delay the decline of FEV1,reduce the annual acute aggravation rate and hospitalization rate,and do not increase the rate of pneumonia recurrence,drug intervention in patients with spontaneous breathing difficulty degree plays a role.