外周血嗜酸粒细胞对慢性阻塞性肺疾病急性加重患者病情及治疗效果的影响

Effect of blood eosinophil count on the severity and treatment of AECOPD patients

目的探讨外周血嗜酸性粒细胞是否与慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)病情及治疗效果相关。方法回顾性分析住院治疗的572例成年AECOPD患者。将患者分为观察组84例(外周血嗜酸粒细胞绝对计数≥300细胞数/ul)和对照组487例(外周血嗜酸粒细胞绝对计数<300细胞数/ul),比较患者的基本资料、体重指数(BMI)、白细胞、中性粒细胞、C反应蛋白(CRP)、FEV1%(1s用力呼气容积)、FEV1/FVC(FEV1/用力肺活量FVC的比值)以及激素、吸入性糖皮质激素(ICS)使用情况。结果两组患者年龄、性别、BMI及吸烟情况比较,差异均无统计学意义(均P>0.05)。两组患者CRP指标相似,但观察组白细胞计数[(7.99±0.27)×10~9/L比(7.20±0.12)×10~9/L,P=0.013],嗜酸性粒细胞[(0.53±0.05)×10~9/L比(0.17±0.01)×10~9/L,P <0.001],嗜酸性粒细胞比例[(7.99±1.29)比(2.72±0.25),P<0.001]均较对照组显著升高,差异均有统计学意义。由于部分AECOPD患者不能耐受检查,观察组有49例(58.3%),对照组有286例(58.7%)进行了肺功能检查,两组患者进行肺功能检查的比例基本一致。观察组FEV1/FVC水平较对照组显著降低[(45.92±1.55)比(52.96±0.92),P=0.002],而FEV1%指标两组比较,差异无统计学意义(P>0.05)。观察组和对照组治疗过程中相关指标的对比发现,两组患者使用静脉激素和ICS的比例比较,差异均无统计学意义(均P>0.05)。观察组ICS用量[(45.54±4.53)mg比(45.54±4.53)mg,P=0.028]、住院时间[(13.48±0.83)d比(11.90±0.20)d,P=0.009]、住院费用[(16843±1635)元比(14435±285)元,P=0.012]均显著高于对照组,差异均有统计学意义。两组患者死亡率和呼吸机使用率比较,差异均无统计学意义(均P>0.05)。结论嗜酸粒细胞绝对计数≥300细胞数/ul的AECOPD患者具有肺功能较差、治疗效果不理想等特点,应针对此类AECOPD病例制定相应的治疗计划。

Objective To investigate the absolute counts of eosinophils in peripheral blood of patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)and to analysis whether the elevation of eosinophil is associated with AECOPD disease severity and treatment.Methods We retrospectively analyzed 572 adult AECOPD patients hospitalized.Patients were divided into blood eosinophil≥300 cell/uL group and control group.The general condition,BMI,white blood cells,neutrophil,CRP,FEV1%,FEV1/FVC index,systemic hormone,ICS use,hospitalization time and cost were compared.Results AECOPD patients with blood eosinophil≥300 cell/uL accounted for approximately 14.9%of all patients.There was no significant difference between the two groups in terms of general condition,neutrophil,CRP,FEV1%,but the FEV1/FVC level of observation group was significantly lower than the control group.During the course of treatment,there was no significant difference in the use of systemic hormones,the proportion of invasive ventilator-assisted ventilation,and mortality between the two groups.But the observation group had larger ICS usage,longer hospital stay,and higher total hospitalization costs.Conclusion AECOPD patients with blood eosinophil≥300 cell/uL have the characteristics of poor lung function and unsatisfactory therapeutic effect.The corresponding treatment plan should be developed for such cases.