不同炎症细胞表型在频繁发作的慢阻肺急性加重期患者中的临床特征差异

Clinical characteristics of different inflammatory cell phenotypes in patients with frequent AECOPD

目的探讨不同炎症细胞表型在频繁发作的慢性阻塞性肺疾病急性加重期(AECOPD)患者中的临床特征差异,评估炎症表型在指导AECOPD患者治疗的作用。方法收集2019年1月至2019年12月在我科以AECOPD为主要诊断的患者临床资料,分为频繁加重组和非频繁加重组,使用多因素Logistic回归分析评估COPD频繁急性加重的危险因素,根据外周血细胞计数进一步将频繁加重组患者分为:EOS组、NE组、MIX组、AGR组,对每个亚组患者进行一般资料、临床特征及预后比较。结果共纳入410例AECOPD患者,其中频繁加重组181例,非频繁加重组229例。频繁加重组中EOS组36例,NE组86例,MIX组42例,AGR组17例。频繁加重组较非频繁加重组患者年龄更大,BMI、EOS、EOS%、PaO_(2)更低,WBC、NEUT、NEU%、CRP、NLR、PaCO_(2)更高,差异有统计学意义(P<0.05)。与EOS组患者比,NE组体温更高、心率更快、咳脓痰比例更高,住院时间更长,无创呼吸机使用率及死亡率更高,NEUT、NEU%、NLR、CRP更高,EOS、EOS%更低(均P<0.05);在治疗方面,NE组抗生素联合使用率更高,而EOS组则以吸入/静滴激素使用为主,且使用时间更短。结论在频繁加重的COPD中,中性粒细胞型的患者表现出更严重的临床特征,且死亡风险更高。

Objective To explore the clinical characteristics of different inflammatory cell phenotypes in patients with frequent acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to evaluate the role of inflammatory phenotypes in guiding the treatment of patients with AECOPD.Methods The clinical data of patients with AECOPD as the main diagnosis in our department from January 2019 to December 2019 were collected and divided into frequent plus recombination and non-frequent plus recombination.The risk factors of frequent acute exacerbation of COPD were evaluated by multivariate logistic regression analysis.According to the peripheral blood cell count,the patients with frequent plus recombination were further divided into the EOS group,NE group,MIX group,and AGR group.The patients in each subgroup were compared in general information,clinical characteristics,and prognosis.Results A total of 410 patients with AECOPD were included,including 181 cases of frequent recombination and 229 cases of non-frequent recombination.There were 36 cases in the EOS group,86 cases in the NE group,42 cases in the MIX group,and 17 cases in the AGR group.Patients with frequent recombination were older than non-frequent recombination,with lower BMI,EOS,EOS%,and PaO_(2),and higher WBC,NEUT,NEU%,CRP,NLR,and PaCO_(2),the difference was statistically significant(P<0.05).Compared with the EOS group,the NE group had a higher temperature,faster heart rate,a higher proportion of expectoration,longer hospital stay,the higher utilization rate of noninvasive ventilator and mortality,higher NEUT,NEU%,NLR and CRP,and lower EOS and EOS%(all P<0.05);In terms of treatment,the combined use rate of antibiotics was higher in NE group,while inhaled/intravenous hormone was mainly used in EOS group,and the use time was shorter.Conclusion In frequently exacerbating COPD,patients with neutrophil type show more severe clinical features and a higher risk of death.