诱导痰嗜酸性粒细胞对AECOPD患者糖皮质激素治疗的指导意义

The guiding significance of induced sputum eosinophils for glucocorticoid therapy in patients with AECOPD

目的本研究旨在观察慢性阻塞性肺疾病急性加重期(AECOPD)患者诱导痰嗜酸性粒细胞(EOS)水平与糖皮质激素治疗反应性的关系,并探讨诱导痰EOS水平与外周血EOS比例之间的相关性。方法纳入2021年9月至2022年5月于南京医科大学连云港临床医学院呼吸与危重症学科因AECOPD住院的患者为研究对象,记录患者一般资料、临床资料及随访数据。根据诱导痰EOS比例分为A1组(EOS≥3%)、A2组(EOS<3%);根据外周血EOS比例分为B1组(EOS≥2%)、B2组(EOS<2%)。分析诱导痰与外周血EOS比例有无相关性以及诱导痰EOS比例对AECOPD患者糖皮质激素治疗的指导意义。结果共有71例患者入组。治疗前各组患者的一般情况差异均无统计学意义(P>0.05)。A1组治疗7天后△FEV_(1)为(112.50±14.70)mL,A2组△FEV_(1)为(74.70±9.02)mL,差异有统计学意义(P<0.05);A1组住院时长为(11.79±1.03)天,A2组为(22.29±2.49)天,差异有统计学意义(P<0.05);A1组全身糖皮质激素总量为(452.32±160.00)mg,A2组为(872.02±454.04)mg,差异有统计学意义(P<0.001)。B1和B2组的临床资料差异均无统计学意义(P>0.05)。A1组住院时长为(11.79±1.03)天,B1组为(18.76±3.02)天,差异有统计学意义(P<0.05);A1组全身糖皮质激素总量为(452.32±160.00)mg,B1组为(641.18±277.31)mg,差异有统计学意义(P<0.05)。诱导痰EOS比例与外周血EOS比例相关性有统计学差异(r=0.4687,P<0.001)。结论在AECOPD患者中,诱导痰EOS与外周血EOS相关性较弱,诱导痰EOS比例对AECOPD患者糖皮质激素的使用更有指导意义。

Objective The aim of this study was to examine the relationship between induced sputum eosin￣ophil levels and responsiveness to glucocorticoid therapy in patients with acute exacerbation of chronic obstructive pul￣monary disease(AECOPD),and to investigate the correlation between induced sputum eosinophil(EOS)levels and peripheral blood eosinophil ratios.Methods Patients who were hospitalized for AECOPD in the Department of Re￣spiratory and Critical Care at Lianyungang Clinical College of Nanjing Medical University from September 2021 to May 2022 were enrolled in the study,and their general information,clinical data,and follow￣up data were recorded.The induction sputum EOS ratio was divided into group A1(EOS≥3%)and group A2(EOS<3%),and the blood EOS ratio was divided into group B1(EOS≥2%)and group B2(EOS<2%).To analyze whether there is any correla￣tion between induced sputum and blood EOS ratio and the guiding significance of induced sputum EOS ratio on glu￣cocorticoid treatment in AECOPD patients.Results A total of 71 patients were enrolled.Before treatment,there was no significant difference in the general condition among all groups(P>0.05).The△FEV_(1)after 7 days of treat￣ment was(11250±1470)mL in group A1 and(74.70±9.02)mL in group A2,with statistically significant differences(P<0.05),The length of stay was(11.79±1.03)days in group A1 and(22.29±2.49)days in group A2,with a statistically significant difference(P<0.05),the total amount of systemic glucocorticoids was(452.32±160.00)mg in group A1 and(872.02±454.04)mg in group A2,with a statistically significant difference(P<0.001).No statistically significant differences were found between the clinical data of both groups B1 and B2(P>0.05).The length of stay was(11.79±1.03)days in group A1 and(18.76±3.02)days in group B1,with statistically significant differences(P<0.05),the total amount of systemic glucocorticoids was(452.32±160.00)mg in group A1 and(641.18±277.31)mg in group B1,with statistically significant differences(P<0.05).The correlation between the ratio of induced sputum EOS and blood EOS was statistically different(r=0.4687,P<0.001).Conclusion In patients with AECOPD,induced sputum EOS is weakly correlated with pe￣ripheral blood EOS and the ratio of induced sputum EOS is more instructive for the use of glucocorticoid in patients with AECOPD.