FeNO联合嗜酸性粒细胞计数对COPD患者ICS治疗的应用价值研究

Study on FeNO Combined with Eosinophil Count to Treat COPD Patients with ICS

目的探讨呼出气一氧化氮(FeNO)联合嗜酸性粒细胞(EOS)计数对慢性阻塞性肺疾病(COPD)患者ICS治疗的应用价值研究。方法前瞻性选取2019年8月至2020年8月我院收治的40例COPD患者,根据EOS及FeNO结果分成四组(A组EOS和FeNO指标不高;B组EOS指标高;C组FeNO指标高;D组EOS和FeNO指标都高)。对入选患者给予ICS/LABA治疗6个月、12个月,记录患者血EOS计数、FeNO、痰EOS计数、FEV1、CAT评分。结果所有患者在年龄、吸烟、性别等比较,差异无统计学意义(P>0.05)。使用K-W检验比较分析四组患者治疗前后(1年)血/痰EOS水平变化情况,差异有统计学意义(P<0.05)。Friedman检验FeNO水平与血/痰EOS计数的关系,治疗前后差异有统计学义(M=0.000,P<0.05),且各组两两比较,差异有统计学意义(P<0.05)。试验前后,Spearman相关性分析COPD急性加重期与血/痰EOS计数、FENO三者关系,提示血EOS与COPD急性加重期呈正相关(r=0.165)。治疗前后,K-W检验评估各组CAT评分为0.037,差异无统计学意义,且两两对比各组治疗CAT评分无明显差别(调整后P均>0.05);治疗前后,K-W检验评估FEV1为0.008,差异有统计学意义(P<0.05)。治疗前后,经过两两对比,A组与B、D组之间患者FEV1变化指标有差别(调整后P=0.044,0.012),A组与C组FEV1变化指标无差别(调整后P=0.073);C组与B、D组之间患者FEV1变化指标无差别(调整后均P=1.000);D组与B组FEV1变化指标无差别(调整后P=1.000)。试验前后,Durbin Waston检验分析COPD急性加重期与血/痰EOS变化值、CAT评分变化值、FEV1变化值的相关性,提示Durbin Waston检验为2.326,观测值具有相互独立性,R^(2)=0.39,校正后R^(2)=-0.102,提示低影响强度。血/痰EOS变化值、CAT评分变化值、FEV1变化值与COPD急性加重期存在线性相关性,不存在多重共线性。结论 FeNO联合EOS计数一定程度上可以预测COPD患者急性加重的风险,指导慢阻肺ICS治疗。

Objective To explore the application values of FeNO combined with EOS count to treat COPD Patients with ICS. Methods From August 2019 to August 2020, 40 COPD patients admitted to our hospital were prospectively selected and divided into four groups according to EOS and FeNO results. Group A had low EOS and FeNO indicators, group B had higher EOS indicators, group C had higher FeNO indicators, and group D had higher EOS and FeNO indicators. Selected patients were treated with ICS/LABA for 6 months and 12 months. Blood EOS count, FeNO, sputum EOS count, FEV1 and CAT score were recorded. Results There were no significant differences in age, smoking and gender(P>0.05). K-W test was used to compare and analyze EOS changes in blood/sputum of four groups before and after treatment(1 year)with statistically significant differences(P<0.05). Friedman tested relationship between FeNO and blood/sputum eosinophil count with statistically significant difference before and after treatment(M=0.000, P<0.05), and pair-wise comparison among each group showed statistically significant difference(P<0.05). Spearman correlation analyzed relationships among acute exacerbation stage of COPD, blood/sputum EOS count and FENO that blood EOS was positive correlated with acute exacerbation of COPD(r=0.165). Before and after treatment, CAT score of each group evaluated by K-W test was 0.037 with no statistically significant difference(All P>0.05 after adjustment). K-W test evaluated FEV1 was 0.008 with statistically significant difference(P<0.05). FEV1 change was different between group A, B and D(adjusted P=0.044,0.012), and there were no differences between group A and group C(adjusted P=0.073). There were no difference in FEV1 change among group C, B and D(all adjusted P=1.000). There was no difference in FEV1 change between group D and B(adjusted P=1.000). Durbin Waston test was conducted to analyze changes of COPD acute exacerbation and blood/sputum EOS change, CAT and FEV1, suggesting that Durbin Waston test was 2.326, and observed values were independent of each other(R^(2)=0.39,R^(2)=-0.102 after correction)suggesting low influence intensity. There was a linear correlation among blood/sputum EOS, CAT, FEV1 and acute exacerbation of COPD without multicollinearity. Conclusion FeNO combined with EOS count predict risks of acute exacerbation in COPD patients to a certain extent and guide to treat ICS.