布地奈德/福莫特罗与糖皮质激素治疗EOS增多表型和非EOS增多表型AECOPD的短期疗效比较

Short term efficacy difference of budesonide/formoterol in treatment of EOS hypertrophic phenotype and non-EOS hypertrophic phenotype AECOPD

目的观察布地奈德/福莫特罗与糖皮质激素(GC)治疗嗜酸性粒细胞(EOS)增多表型和非EOS增多表型慢性阻塞性肺疾病急性加重期(AECOPD)的短期疗效比较。方法选取2020年6月—2023年6月中国人民解放军新疆军区总医院呼吸内科诊治的AECOPD患者168例,根据EOS比例分为EOS增多表型组(EOS>2%,n=42)、非EOS增多表型组(EOS≤2%,n=126);EOS增多表型组随机分为Ⅰ亚组(n=21)、Ⅱ亚组(n=21),非EOS增多表型组随机分为Ⅲ亚组(n=63)、Ⅳ亚组(n=63)。Ⅰ、Ⅲ亚组给予布地奈德/福莫特罗吸入治疗,Ⅱ、Ⅳ亚组口服或静脉滴注GC治疗。比较入院时、治疗5 d后静脉血EOS计数、血气分析指标[氧合指数(PaO_(2)/FiO_(2))、动脉血二氧化碳分压(PaCO_(2))]、慢性阻塞性肺疾病评估测试量表(CAT)评分及住院时间。结果治疗5 d后,Ⅰ亚组、Ⅱ亚组静脉血EOS计数低于入院时,且Ⅱ亚组静脉血EOS计数低于Ⅰ亚组(t/P=2.641/0.012),Ⅲ、Ⅳ亚组静脉血EOS计数比较差异无统计学意义(P>0.05);治疗5 d后,Ⅱ亚组PaO_(2)/FiO_(2)高于Ⅰ亚组,PaCO_(2)、CAT评分低于Ⅰ亚组(t/P=4.331/<0.001,3.351/0.002,2.884/0.006),而Ⅲ亚组、Ⅳ亚组PaO_(2)/FiO_(2)、PaCO_(2)、CAT评分差异无统计学意义(P>0.05);治疗5 d后,Ⅰ亚组PaO_(2)/FiO_(2)高于Ⅲ亚组,PaCO_(2)、CAT评分低于Ⅲ亚组(t/P=8.856/<0.001,6.588/<0.001,1.964/0.049),Ⅱ亚组PaO_(2)/FiO_(2)高于Ⅳ亚组,PaCO_(2)、CAT评分低于Ⅳ亚组(t/P=12.456/<0.001,10.350/<0.001,5.356/<0.001);Ⅱ亚组住院时间短于Ⅰ亚组(t/P=2.718/0.010),Ⅰ亚组住院时间短于Ⅲ亚组(t/P=4.394/0.010),Ⅱ亚组住院时间短于Ⅳ亚组(t/P=6.700/<0.001)。结论EOS增多表型AECOPD患者,GC全身给药短期疗效均优于布地奈德/福莫特罗雾化吸入,而非EOS增多表型AECOPD患者,雾化吸入疗法和GC全身给药短期疗效相似,雾化吸入疗法可替代GC全身给药。

Objective To observe the short term efficacy of budesonide/formoterol and glucocorticoid(GC)in the treatment of eosinophilic(EOS)hyperplasia and non-EOS hyperplasia acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinical data of 168 patients with AECOPD treated and treated by the respiratory Department of the General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army from June 2020 to June 2023 were analyzed.According to the EOS ratio,they were divided into the EOS increased phenotype group(EOS>2%,n=42)and the non-EOS increased phenotype group(EOS≤2%,n=126).The EOS proliferation phenogroup was randomly divided into subgroup Ⅰ(n=21)and subgroup Ⅱ(n=21),and the non-EOS proliferation phenogroup was randomly divided into subgroupⅢ(n=63)and subgroup IV(n=63).Subgroups I andⅢwere given budesonide/formoterol inhalation therapy,and subgroups Ⅱ and Ⅳ were given oral or intravenous glucocorticoid(GC)therapy.Venous blood EOS count,blood gas analysis index[PaO_(2)/FiO_(2),arterial partial pressure of carbon dioxide(PaCO_(2))],Chronic obstructive pulmonary disease Evaluation Test Scale(CAT)score and length of stay were compared at admission and 5 days after treatment.Results After 5 days of treatment,the EOS count in venous blood of subgroup Ⅰ and subgroup Ⅱ was lower than that at admission,and the EOS count in venous blood of subgroup Ⅱ was lower than that in subgroup Ⅰ(t/P=2.641/0.012).After 5 days of treatment,the PaO_(2)/FiO_(2)of subgroup Ⅱ was higher than that of subgroup I,and the PaCO_(2)and CAT scores were lower than those of subgroup Ⅰ(t/P=4.331/<0.001,3.351/0.002,2.884/0.006).There was no significant difference in PaO_(2)/FiO_(2),PaCO_(2)and CAT scores between subgroupⅢand subgroup Ⅳ(P>0.05).After 5 days of treatment,the PaO_(2)/FiO_(2)combination in subgroup Ⅰ was higher than that in subgroupⅢ(t/P=8.856/<0.001,6.588/<0.001,1.964/0.049),the PaCO_(2)and CAT scores were lower than those in subgroupⅢ,the PaO_(2)/FiO_(2)scores in subgroup II were higher than those in subgroup IV,and the PaCO_(2)and CAT scores were lower than those in subgroup Ⅳ(t/P=12.456/<0.001,10.350/<0.001,5.356/<0.001);The length of hospitalization in subgroup Ⅱ was shorter than that in subgroup Ⅰ(t/P=2.718/0.010).The length of stay in subgroup Ⅰ was shorter than that in subgroupⅢ(t/P=4.394/0.010),and the length of stay in subgroup Ⅱ was shorter than that in subgroup Ⅳ(t/P=6.700/<0.001).Conclusion In patients with EOS increased phenotype AECOPD,the short-term efficacy of GC systemic administration is better than budesonide/formoterol aerosol inhalation,while in non-EOS increased phenotype AECOPD patients,the short term efficacy of aerosol inhalation therapy is similar to GC systemic administration,and aerosol inhalation therapy can replace GC systemic administration.