外周血嗜酸性粒细胞与慢性阻塞性肺疾病急性发作风险的关系

Relationship between blood eosinophils and risk of acute exacerbation of COPD

目的 探讨外周循环血嗜酸性粒细胞与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病人未来急性加重风险的关系。方法 纳入2015年1月至2019年1月在广州市花都区人民医院各科就诊的COPD病人共499例,收集病人临床数据,进行回顾性分析。病人分为对照组和急性发作组,急性发作组进一步根据病人出院后1年内,有无急性加重发作事件发生分为频发组与非频发组,收集病人年龄、性别、体质量指数(BMI)、是否使用吸入用激素治疗(inhaled corticosteroids,ICS)、静脉血嗜酸性粒细胞计数以及比例、肺功能结果中的第一秒用力呼气容积占预计值比值(FEV1%预计值)(频发组及非频发组均需收集病人急性事件出院后首次出现急性加重时的外周静脉血嗜酸性粒细胞计数及比例)。结果 在499例病人中,急性加重病人有307例(61.52%),在这307例病人中,有186例(60.59%)病人在急性事件出院后1年内出现≥1次的急性加重。急性加重组与对照组、频发组与非频发组在嗜酸性粒细胞计数、嗜酸性粒细胞计数≥200个/微升、嗜酸性粒细胞计数≥300个/微升、嗜酸性粒细胞比例、嗜酸性粒细胞比例≥2%、嗜酸性粒细胞比例≥4%、是否使用ICS治疗均差异无统计学意义(均P>0.05);频发组与非频发组病人出院后出现首次急性加重时,其嗜酸性粒细胞计数、嗜酸性粒细胞计数≥200个/微升、嗜酸性粒细胞计数≥300个/微升、嗜酸性粒细胞比例、嗜酸性粒细胞比例≥2%、嗜酸性粒细胞比例≥4%也均差异无统计学意义(均P>0.05);但对照组与急性加重组、频发组与非频发组FEV1%预计值[分别为67.25(62.90,72.70)比48.10(32.30,60.50)、35.60(28.42,48.10)比62.3(54.70,69.15)]结果差异有统计学意义(均P<0.05)。结论 外周血嗜酸性粒细胞不能预测慢性阻塞性肺疾病病人在未来的急性发作风险,而病人基础肺功能情况与病人未来急性加重风险相关。

Objective To investigate the relationship between eosinophils in peripheral blood and the risk of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD).MethodA total of 499 patients with Chronic Obstructive Pulmonary Disease (COPD) who were treated in Huadu District People’s Hospital from January 2015 to January 2019 were selected.The clinical data of the patients were collected and analyzed retrospectively.Patients were assigned into control group and acute exacerbation group.According to the occurrence of acute exacerbation events within one year after patient discharge,the acute exacerbation group was further divided into frequent roup and non-frequent group.The age,gender,body mass index (BMI) and inhaling corticosteroids therapy (ICS),peripheral blood eosinophil count and proportion,forced expiratory volume in the first second of pulmonary function results (FEV1 to predicted FEV1 Ratio) were collected (both frequent and non-frequent group were needed to collect the absolute count and proportion of peripheral blood eosinophils in the first acute exacerbation after discharge from hospital).Results Among the 499 patients,307(61.52%) had acute exacerbation.Among these 307 patients,186 (60.59%) had acute exacerbation more than once in one year after the occurrence of acute exacerbation.In control group and acute exacerbation group,in the frequent group and non-frequent group,the eosinophil count,eosinophil count≥200/μL,eosinophil count≥300/μL,eosinophil proportion,proportion of eosinophils≥2%,proportion of eosinophils≥4%and ICS treatment show no significant difference (all P>0.05).When the first acute exacerbation occurs in patients in the frequent group and the non-frequent group after discharge from hospital,the eosinophil count,eosinophil count≥200/μL,eosinophil count≥300/μL,proportion of eosinophil,proportion of eosinophils≥2%,proportion of eosinophils≥4%all showed no significant difference.(all P>0.05).However,there was significant difference in the forced expiratory volume in the first second to its predicted values ratio between the control group and the acute exacerbation group,the frequent group and the non-frequent group[67.25(62.90,72.70) vs.48.10 (32.30,60.50),35.60 (28.42,48.10) vs.62.3 (54.70,69.15)],respectively (P<0.05).Conclusion Eosinophils in peripheral blood can not predict the risk of future acute exacerbation in patients with COPD,and the basic pulmonary function of patients is related to the risk of future acute exacerbation.