慢性阻塞性肺疾病患者血嗜酸粒细胞分布及临床特征分析

Distribution and clinical characteristics of eosinophils in patients with chronic obstructive pulmonary disease

目的分析呼吸科门诊慢性阻塞性肺疾病患者血嗜酸性粒细胞分布情况,研究高嗜酸性粒细胞慢阻肺患者临床特征。方法本研究中收集2018年7月1日至2020年7月1日我院呼吸科门诊稳定期慢阻肺患者226例,其中女性患者53例,男性患者173例,年龄56~74岁,中位数66岁,根据血EOS计数以0.1×10^(9)/L为临界值,分析高血EOS计数慢阻肺患者呼吸道症状、肺功能、过去一年急性加重情况等临床特征。结果高EOS慢阻肺组男性患者78例(84.8%),明显高于低EOS慢阻肺组(95例,70.9%),差异具有统计学意义(χ^(2)=5.86,P=0.015),高EOS组过去1年急性加重次数(0.6±0.3)次,因急性加重导致住院次数(0.3±0.1)次,低EOS组过去1年急性加重次数(0.3±0.2)次,因急性加重导致住院次数(0.1±0.1)次,高EOS组均高于低EOS组,差异有统计学意义(均P<0.05)。高EOS组慢阻肺患者GOLD 3级及GOLD 4级占比更高,中性粒细胞百分比较低,均具有统计学差异(P<0.05)。将P<0.05的因素如性别、中性粒细胞百分比、过去1年急性加重次数及GOLD分级进行多因素分析,高EOS慢阻肺组与较高GOLD分级(OR=3.775,95%CI:1.891~8.294,P=0.002)、中性粒细胞百分比较低(OR=0.891,95%CI:0.771~0.981,P=0.019)、过去1年频繁急性加重(OR=1.655,95%CI:1.231~3.871,P=0.001)存在相关性,与性别无关联(OR=1.765,P=0.098)。结论高EOS慢阻肺与较低中性粒细胞百分比、较重气流受限、频繁急性加重相关。

Objective To analyze the distribution of blood eosinophils of patients with chronic obstructive pulmonary disease in outpatient department of respiratory department and to study the clinical characteristics of patients with hypereosinophilic COPD.Methods In this study,226 patients with stable COPD were collected from the respiratory department of our hospital from July 1,2018 to July 1,2020.There were 53 female patients and 173 male patients,aging from 56 to 74 years old,with a median age of 66 years old.According to the blood EOS count with a critical value of 0.1×10^(9)/L,the clinical characteristics of patients with high blood EOS count such as respiratory symptoms,lung function and acute exacerbation in the past year were analyzed.Results There were 78 male patients(84.8%)in the high-EOS COPD group,which was significantly higher than that in the low-EOS COPD group(95 cases,70.9%),and the difference was statistically significant(χ^(2)=5.86,P=0.015).The number of acute exacerbation in the high EOS group in the past 1 year was 0.6±0.3,and the number of hospitalization due to acute exacerbation was 0.3±0.1.The number of acute exacerbation in the high EOS group in the past 1 year was 0.3±0.2,and the number of hospitalization due to acute exacerbation was 0.1±0.1,which were higher than those in the low EOS group(all P<0.05).The proportion of GOLD3 and GOLD4 in COPD patients in the high EOS group was higher,and the percentage of neutrophil was lower,with statistical differences(P<0.05).Factors with P<0.05,such as gender,neutrophil percentage,number of acute exacerbation in the past year and GOLD grade were studied by multi-factor logical analysis.The high EOS COPD group was associated with higher GOLD grade(OR=3.775,95%CI:1.891~8.294,P=0.002),lower neutrophil percentage ratio(OR=0.891,95%CI:0.771-0.981,P=0.019),and frequent acute exacerbation in the past 1 year(OR=1.655,95%CI:1.231-3.871,P=0.001),regardless of sex(OR=1.765,P=0.098).Conclusion About 40%of COPD patients have≥100 blood EOS/μL,which is associated with a lower percentage of neutrophils,heavier airflow restriction,and more frequent acute exacerbation.