肺泡一氧化氮和外周血嗜酸性粒细胞与AECOPD患者临床特征的关系及其评估近期预后的价值

The relationship between alveolar NO and peripheral blood eosinophils and clinical characteristics of patients with acute exacerbation of COPD and their short-term prognostic value

目的探讨肺泡一氧化氮(CaNO)和外周血嗜酸性粒细胞(EOS)与慢性阻塞性肺疾病急性加重期(AECOPD)患者临床特征的关系及其评估近期预后的价值。方法回顾性分析1285例AECOPD患者的临床资料。根据患者入院时的外周血EOS水平将其分为A组(EOS%≥2%,n=528)和B组(EOS%<2%,n=757),并根据入院时的CaNO水平分为C组(CaNO>5 ppb,n=562)和D组(CaNO≤5 ppb,n=723)。比较A、B组以及C、D组之间的临床特征、1年内急性加重发生率和病死率。分析入院时CaNO和外周血EOS水平与患者临床特征、1年内急性加重发生率和病死率的关系。绘制受试者操作特性曲线(ROC)分析入院时CaNO和外周血EOS水平单独和联合预测AECOPD患者1年内急性加重和病死的效能。结果A组的第1 s用力呼气的容积占预计值的百分比(FEV1%pred)和氧分压(PaO_(2))均高于B组,住院时间短于B组,二氧化碳分压(PaCO_(2))、机械通气率、抗生素联合应用率、肺部及全身激素的使用率、激素应用总量、1年内急性加重发生率和病死率均低于B组(P<0.05)。C组的FEV1%pred和PaO_(2)均低于D组,住院时间长于D组,PaCO_(2)、机械通气率、抗生素联合应用率、肺部及全身激素的使用率、激素应用总量、1年内急性加重发生率和病死率均高于D组(P<0.05)。AECOPD患者入院时CaNO和外周血EOS水平均可影响其FEV1%pred、PaO_(2)、PaO_(2)、机械通气率、抗生素联合应用率、住院时间、1年内急性加重发生率和病死率(P<0.05)。ROC曲线分析结果显示,入院时CaNO和外周血EOS水平联合预测AECOPD患者1年内急性加重和病死的敏感度和准确性均较高。结论EOS%≥2%患者和CaNO≤5 ppb患者的病情和近期预后情况更佳。CaNO和外周血EOS水平与AECOPD患者临床特征的关系及其近期预后均密切相关,可作为其病情和近期预后评估参考指标。

Objective To investigate the relationship between alveolar nitric oxide(CaNO)and peripheral blood eosinophils(EOS)with the clinical characteristics and short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods The clinical data of 1285 patients with acute exacerbation of COPD were retrospectively analyzed.According to the level of peripheral blood EOS at admission,they were divided into group A(EOS%≥2%,n=528)and group B(EOS%<2%,n=757),and were divided into group C(CaNO>5ppb,n=562)and group D(CaNO≤5ppb,n=723)according to the level of CaNO at admission.The clinical characteristics,1-year acute exacerbation incidence and mortality rate between groups A and B,as well as between groups C and D were compared.The relationship between the levels of CaNO and peripheral blood EOS at admission with the clinical characteristics of the patients,the incidence of acute exacerbation within one year,and the mortality within one year were analyzed.Receiver operating characteristic(ROC)curves were drawn to analyze the efficacy of CaNO and peripheral blood EOS levels alone and in combination to predict acute exacerbation and mortality within one year in patients with acute exacerbation of COPD.Results The volume of forceful expiration in the first second as a percentage of the predicted value(FEV1%pred)and the partial pressure of oxygen(PaO_(2))were higher and the length of hospital stay was shorter in group A than in group B.The partial pressure of carbon dioxide(PaCO_(2)),the rate of mechanical ventilation,the rate of antibiotic coadministration,the rate of pulmonary and systemic hormone use,the total amount of hormone application,the incidence of acute exacerbations within one year,and the rate of death were all lower than in group B(P<0.05).The FEV1%pred and PaO_(2) of group C were lower than those of group D,the hospitalization time of group C was longer than that of group D,the PaCO_(2),rate of mechanical ventilation,rate of combined antibiotics,rate of pulmonary and systemic hormones,total amount of hormones used,the occurrence of acute exacerbation within 1 year and the rate and fatality rate within one year of group C were higher than those of group D(P<0.05).The levels of CaNO and peripheral blood EOS at admission in patients with acute exacerbation of COPD could affect their FEV1%pred,PaO_(2),PaO_(2),mechanical ventilation rate,combined antibiotic rate,hospital stay time,the incidence of acute exacerbation and fatality rate within one year(P<0.05).The results of ROC curve analysis showed that the combination of CaNO and peripheral blood EOS levels at admission had high sensitivity and accuracy in predicting acute exacerbation and death within 1 year in patients with acute exacerbation of COPD.Conclusion The illness severity and short-term prognosis of patients with EOS%≥2%and CaNO≤5ppb are better.The levels of CaNO and peripheral blood EOS are correlated with the clinical characteristics of patients with acute exacerbation of COPD and their short-term prognosis,which can be used as reference indicators for the evaluation of their illness severity and short-term prognosis.