不同炎症表型AECOPD及ACO患者临床特征和糖皮质激素治疗反应比较

Comparison of Clinical Characteristics and Response to Glucocorticoid Therapy in Patients with Different Inflammatory Phenotypes of AECOPD and ACO

背景急性加重是慢性气道疾病患者肺功能显著下降的重要原因,严重影响患者的健康和生活质量,增加医疗经济负担。早期识别慢性阻塞性肺疾病急性加重期(AECOPD)的不同炎症表型和哮喘-慢阻肺重叠(ACO)并及时给予精准治疗在减少急性加重的发生、控制疾病进展、改善生存质量方面显得颇为重要。目的比较不同炎症表型AECOPD及ACO患者的临床特征及其对糖皮质激素治疗的反应,为进一步指导糖皮质激素的应用提供参考。方法收集2018年1月至2020年12月在河北医科大学第二医院呼吸与危重症医学科住院的AECOPD和ACO患者的临床资料,以外周血嗜酸粒细胞(EOS)百分比2%为临界值分组,EOS%≥2%为EOS组,EOS%<2%为非EOS组,ACO患者作为ACO组,分析3组患者的临床特征、对糖皮质激素治疗的反应情况。结果EOS组的超敏C反应蛋白(hs-CRP)、外周血中性粒细胞绝对值(NE绝对值)、中性粒细胞/淋巴细胞比值(NLR)、纤维蛋白原/血清白蛋白(FAR)、肺部及全身激素的使用率、激素应用总量低于非EOS组,激素疗程、住院时间短于非EOS组,白蛋白(ALB)水平高于非EOS组(P<0.05);EOS组的体质指数(BMI)、FEV1%pred、肺功能重度程度、NE绝对值、NLR、肺部及全身激素的使用率、激素应用总量低于ACO组,激素疗程短于ACO组,年龄、男性患病率、吸烟率、EOS%≥2%比例高于ACO组,住院时间长于ACO组(P<0.05)。结论EOS可能作为评价AECOPD病情严重程度并指导糖皮质激素治疗的一项重要指标。EOS%≥2%的AECOPD患者急性加重诱因考虑多由非感染因素引起,治疗上应用抗生素应该更加慎重。ACO和EOS%≥2%的AECOPD患者临床特征存在差异,把握两者独特的临床特点,对慢性气道疾病的早期识别和精准的治疗决策具有积极意义。

Background Acute exacerbation is an important cause for the significant decline of lung function in patients with chronic airway disease,which seriously affects the health and quality of life of patients,and significantly increases the medical and economic burden of the disease.Early identification of different inflammatory phenotypes in acute exacerbations of chronic obstructive pulmonary disease(AECOPD)and asthma-COPD overlap(ACO)and timely and precise treatment are important in reducing the occurrence of exacerbations,controlling disease progression,and improving quality of life.Objective To compare the clinical characteristics of AECOPD with different inflammatory phenotypes and ACO patients and their response to glucocorticoid therapy,and to provide a reference for further guiding the application of glucocorticoids.Methods The basic clinical data of AECOPD and ACO patients hospitalized in respiratory and critical care Medicine Department of the Second Hospital of Hebei Medical University from January 2018 to December 2020 were collected.The basic clinical data were collected,and the peripheral blood eosinophils(EOS)percentage(2%)was used as the critical value,EOS%≥2%was defined as EOS group,EOS%<2%was defined as non-EOS group,and ACO patients were defined as ACO group.The clinical characteristics and response to glucocorticoids of the three groups were analyzed.Results High-sensitivity C-reactive protein(hs-CRP),absolute value of peripheral blood neutrophils(NE),neutrophil/lymphocyte ratio(NLR),fibrinogen/serum albumin(FAR),lung and the use rate of systemic hormones,total hormone application,hormone treatment course,and hospitalization time of AECOPD patients in the EOS group were lower than those in the non-EOS group(P<0.05).ALB of AECOPD patients in EOS group was higher than that in non-EOS group(P<0.05).Body mass index(BMI),FEV1%pred,severity of pulmonary function,absolute value of NE,NLR,utilization rate of pulmonary and systemic hormones,total hormone application,and hormone treatment course of AECOPD patients in the EOS group were lower than those in ACO group(P<0.05).The age,hospitalization time,male prevalence rate,smoking rate,and EOS%≥2%of AECOPD patients in EOS group were higher than those in ACO group(P<0.05).Conclusion EOS may be used as an important indicator to evaluate the severity of AECOPD and guide glucocorticoid therapy.The causes of acute exacerbations of COPD patients in the EOS group were mostly considered to be caused by non-infectious factors,and the treatment of antibiotics may be more prudent.AECOPD patients in EOS group have different clinical characteristics,and it is of positive significance to grasp their unique clinical characteristics for the early identification of chronic airway disease and accurate treatment decision.