基于外周血嗜酸粒细胞及中性粒细胞比较不同表型AECOPD临床特征及恶化风险

Comparison of clinical characteristics and exacerbation risk of different phenotypes of AECOPD based on peripheral blood eosinophils and neutrophils

目的基于外周血嗜酸粒细胞及中性粒细胞的粒细胞分型,评估不同表型慢性阻塞性肺疾病急性加重(AECOPD)临床特征及恶化风险对个体化治疗和预后改善具有重要意义。方法本研究为队列研究。采用非随机对照法,收集2019年10月至2021年6月就诊于重庆医科大学附属第二医院呼吸与危重症医学科的AECOPD患者448例,根据入院时第一次抽取的外周血细胞计数结果,将患者分为嗜酸粒细胞组(n=158)、中性粒细胞组(n=174)、混合粒细胞组(n=46)和乏粒细胞组(n=70),比较4组患者住院期间临床特征,以出院后再发需要住院治疗的急性加重作为随访结局,对所有患者随访1年时间,绘制Kaplan-Meier生存曲线,并进一步对恶化危险因素进行Cox回归分析。结果住院期间呼吸衰竭发生率差异有统计学意义(P=0.043);静脉激素及高级抗生素使用率均以中性粒细胞组最高,嗜酸粒细胞组较低(48.3%比31.0%,33.3%比7.0%,P<0.05)。Kaplan-Meier生存曲线显示中性粒细胞组再发急性加重率最高,其次为混合粒细胞组,嗜酸粒细胞组及乏粒细胞组再发急性加重率较低(P=0.003)。以嗜酸粒细胞组作为对照组,中性粒细胞组再发急性加重风险较高(HR=1.95,95%CI:1.13~3.37,P=0.017),其他恶化因素包括年龄(HR=1.04,95%CI:1.01~1.07,P=0.005)、第1秒用力呼气容积占预计值百分比(HR=0.98,95%CI:0.96~0.99,P=0.002)以及吸入性糖皮质激素(HR=1.61,95%CI:1.01~2.57,P=0.046)。结论基于外周血嗜酸粒细胞及中性粒细胞的粒细胞分型,中性粒细胞型AECOPD相比于嗜酸粒细胞型AECOPD住院期间病情严重,且再发急性加重风险高。

Objective To evaluate the clinical characteristics and exacerbation risk of different phenotypes of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)based on granulocyte classification of peripheral blood eosinophils and neutrophils.It is of great significance to personalized treatment and prognosis improvement.Methods This was a cohort study.Using a non-random control method,a total of 448 patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,from October 2019 to June 2021 were selected.According to the peripheral blood cell level at admission,the patients were divided into eosinophil group(n=158),neutrophil group(n=174),mixed granulocyte group(n=46),and hypogranulocyte group(n=70).The clinical characteristics during the hospital stay was compared,recurrent exacerbation requiring hospitalization within one year was used as follow-up outcome,all patients were followed up for 1 year,Kaplan-Meier survival curve was plotted,and Cox regression analysis was performed to evaluate the risk factors.Results During hospitalization,the incidence of respiratory failure was statistically significant(P=0.043).The usage of intravenous glucocorticoids and advanced antibiotics was the highest in the neutrophil group and lower in the eosinophil group(48.3%vs 31.0%,33.3%vs 7.0%,P<0.05).The Kaplan-Meier survival curves showed that the rate of recurrent acute exacerbation was the highest in the neutrophil group,followed by the mixed granulocyte group,and lower in the eosinophil group and hypogranulocyte group(P=0.003).With the eosinophil group as the control group,the risk of recurrent acute exacerbation was higher in the neutrophil group(HR=1.95,95%CI:1.13-3.37,P=0.017).Other exacerbation factors included age(HR=1.04,95%CI:1.01-1.07,P=0.005),FEV1%pred(HR=0.98,95%CI:0.96-0.99,P=0.002)and ICS(HR=1.61,95%CI:1.01-2.57,P=0.046).Conclusions Based on granulocyte classification of peripheral blood eosinophils and neutrophils,neutrophil AECOPD is more severe than eosinophil AECOPD during hospitalization and has a higher risk of recurrent acute exacerbation.