不同外周血嗜酸性粒细胞水平的中、重度AECOPD患者的临床疗效观察

Clinical efficacy of moderate and severe AECOPD patients with different levels of peripheral blood eosinophils

目的:观察不同外周血嗜酸性粒细胞水平(EOS)对中、重度慢性阻塞性肺疾病急性加重期(AECOPD)患者临床治疗及预后的影响。方法:将本院住院就诊的131例AECOPD患者,根据不同的EOS%水平将患者分为A组58例(EOS<2%)和B组73例(EOS≥2%);比较两组患者住院期间的炎症指标、肺功能、血气分析、住院天数、无创呼吸机使用率、ICU入院率等指标。结果:B组患者血白细胞计数(WBC)、中性粒细胞(NEUT)、淋巴细胞(LY)、血清淀粉样蛋白(SAA)、降钙素原(PCT)、呼出气一氧化氮(FeNO)、二氧化碳分压(PaCO_(2))水平、Ⅱ型呼吸衰竭和肺心病的发生率、使用无创呼吸机比率和ICU入院率低于A组(均P<0.05);而两组患者肺功能、使用有创呼吸机人数、一年内病死率以及PaO2水平均无明显差异(均P>0.05)。结论:外周血EOS<2%的中、重度AECOPD患者预后较差,外周血EOS水平有助于AECOPD患者的病情评估、治疗、预后等方面具有一定的参考价值。

Objective:To observe the effects of different levels of eosinophils(EOS)in peripheral blood on the clinical treatment,prognosis of patients with moderate and severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD)at acute exacerbation stage.Methods:131 AECOPD patients in our hospital were divided into group A(58 patients with EOS<2%)and group B(73 patients with EOS≥2%)according to different EOS%levels.Inflammation index,pulmonary function,blood gas analysis,hospitalization length,the rate of noninvasive ventilator use,ICU admission rate and other indicators were compared between the two groups.Results:The levels of white blood cell count(WBC),neutrophils(neutrophils),lymphocytes(LY),serum amyloid protein A(SAA),procalcitonin(PCT),Fractional exhaled nitric oxide(FeNO),partial pressure of carbon dioxide(Pa-CO_(2))the incidence of typeⅡrespiratory failure and cor pulmonale,the rate of noninvasive ventilator use and the admission rate to ICU of the patients in group B were lower than those in group A(all P<0.05)while there were no significant differences between the two groups in terms of pulmonary function,number of patients using invasive ventilators,mortality within one year and PaO2 level(all P>0.05).Conclusion:The prognosis of AECOPD patients with peripheral blood EOS<2%is poor.The level of peripheral blood EOS has certain reference value for the evaluation,treatment,prognosis of AECOPD patients.