嗜酸性粒细胞百分比评估AECOPD患者静脉使用糖皮质激素疗效的临床价值

Clinical value of eosinophil percentage in evaluating the efficacy of intravenous glucocorticoid in patients with AECOPD

目的探讨嗜酸性粒细胞百分比评估慢性阻塞性肺疾病急性加重期(AECOPD)患者静脉使用糖皮质激素疗效的临床价值。方法AECOPD患者100例分为A组(嗜酸性粒细胞百分比<2%,62例)和B组(嗜酸性粒细胞百分比≥2%,38例)。依据治疗方法,两组又分为A1、A2和B1、B2四个亚组。A2组和B2组采用常规扩张支气管对症治疗5d;A1组和B1组加用静脉滴注甲泼尼龙40mg/d治疗5d。比较亚组治疗前后炎症指标、COPD自我评估测试(CAT)评分、肺功能指标和血气分析指标。比较住院时间和3个月内再住院率,并观察A1组和B1组静脉使用糖皮质激素相关不良反应发生情况。结果A1、A2组和B1、B2组治疗后炎症指标、CAT评分、肺功能指标和血气分析指标均得到改善(P<0.05),且B1组治疗后上述指标改善优于B2组(P<0.05)。A1组3个月内再住院率低于A2组(P<0.05)。与B2组比较,B1组住院时间缩短,且3个月内再住院率降低(P<0.05)。A1组与B1组静脉使用糖皮质激素相关不良反应发生率相仿(P>0.05)。结论嗜酸性粒细胞百分比可作为指导AECOPD患者静脉使用糖皮质激素治疗的导向性标志物,嗜酸性粒细胞百分比≥2%的患者对静脉使用糖皮质激素治疗的反应更灵敏,临床转归更好。

Objective To explore the clinical value of eosinophil percentage in evaluating the efficacy of intravenous glucocorticoid in the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred patients with AECOPD were divided into group A(eosinophil percentage<2%,62cases)and group B(eosinophil percentage≥2%,38 cases).According to different treatments,groups of A and B were subdivided into groups of A1,A2 and B1,B2.Groups of A2and B2were treated with routine bronchodilation symptomatic treatment for 5days,and groups of A1and B1were treated with additional intravenous methylprednisolone 40mg/d for 5days.The inflammatory indicators,COPD assessment test(CAT)scores,indicators of pulmonary function and blood gas analysis were compared before and after treatment between the subgroups.The hospital stay and rate of re-hospitalization within 3months were compared between the subgroups,and the incidence of adverse reactions related to intravenous glucocorticoid was observed as well.Results Compared to before treatment,the inflammation indicators,CAT scores,indicators of pulmonary function and blood gas analysis of groups of A1,A2,B1and B2 were improved after treatment(P<0.05),which were improved better in group B1than those in group B2 after treatment(P<0.05).The rate of re-hospitalization within 3months in group A1was lower than that in group A2(P<0.05).Compared with group B2,hospital stay in group B1was shorter and rate of re-hospitalization within 3 months was lower(P<0.05).The incidence of adverse reactions related to intravenous glucocorticoid in group A1 was similar to that in group B1(P>0.05).Conclusion The eosinophil percentage can be used as a marker to guide the treatment of intravenous glucocorticoid in AECOPD patients.The AECOPD patients with eosinophil percentage≥2%have more sensitive response to intravenous glucocorticoid and better clinical outcomes.