周阳,张东伟,韩玉,刘倩,宓家炜,于思菁,朱洁晨,朱述阳
ZHOU Yang,ZHANG Dongwei,HAN Yu,LIU Qian,MI Jiawei,YU Sijing,ZHU Jiechen,ZHU Shuyang

• 1:徐州医科大学附属医院呼吸与危重症医学科
• 2:柳州市人民医院呼吸与危重症医学科

摘要(Abstract)：

目的 观察吸入用糖皮质激素（ICS）对外周血嗜酸性粒细胞增多慢性阻塞性肺疾病急性加重（AECOPD）患者肺功能的影响。方法 267例慢性阻塞性肺疾病患者，按照入院时外周血EOS分为嗜酸组（EOS≥100个/μL）和非嗜酸组（EOS <100个/μL），根据患者出院时维持药物中是否含有ICS分为含ICS组和不含ICS组，嗜酸组患者又分为含ICS和不含ICS组；记录患者性别、年龄、体质量指数（BMI）、吸烟、糖尿病、高血压、入院前1年急性加重风险以及维持治疗方案，采用Pearson分析EOS水平与肺功能相关性。结果 嗜酸组与非嗜酸组、含ICS组与不含ICS组患者性别、年龄、BMI、吸烟、糖尿病、高血压、入院前1年急性加重风险以及维持治疗方案等方面比较，差异无统计学意义（P> 0.05）；而CRP、EOS、FEV1、FEV1/FVC、PEF以及出院后1年内中重度加重等方面比较，差异具有统计学意义（P<0.05）;Pearson相关性分析结果显示，EOS水平与FEV1、FEV1/FVC以及PEF呈负相关（r=-0.562、-0.644、-0.778,P<0.001）。结论 EOS≥100个/μL的慢性阻塞性肺疾病患者加用ICS维持治疗可降低急性加重风险，改善患者肺功能。
Objective To observe the effect of inhaled corticosteroids( ICS) on the pulmonary function of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) patients with increasing peripheral blood eosinophil(EOS).Methods Two hundred and sixty-seven patients with chronic obstructive pulmonary disease were divided into EOS group(EOS≥100/μL) and non-EOS group(EOS < 100/μL) according to peripheral blood EOS; patients with ICS were divided into ICScontaining group and ICS-free group, and the EOS group was divided into ICS-containing and ICS-free subgroups; patients' gender, age, body mass index(BMI), smoking, diabetes, hypertension, the risk of the acute exacerbation and the maintenance treatment plan 1 year before admission were recorded.Pearson was adopted to analyze the correlation between EOS level and lung function.Results There were no significant differences in gender, age, BMI, smoking, diabetes, hypertension, the risk of acute exacerbation, and the maintenance treatment plan 1 year before admission between the eosinophilic group and the non-eosinophilic group, and between the ICS group and the ICS-free group(P> 0. 05); there were statistically significant differences in CRP, EOS, FEV1, FEV1/FVC, PEF,and moderate to severe exacerbation within 1 year after discharge(P< 0. 05); Pearson correlation analysis showed that there was negative correlation between EOS levels with FEV1, FEV1/FVC and PEF(r=-0. 562,-0. 644,-0. 778;P< 0. 001).Conclusion The addition of ICS to maintenance therapy for patients with chronic obstructive pulmonary disease with EOS ≥100/μL can reduce the risk of acute exacerbation and improve the lung function of patients.

关键词(KeyWords)： 慢性阻塞性肺疾病;嗜酸性粒细胞;急性加重;吸入用糖皮质激素
chronic obstructive pulmonary disease(COPD);eosinophil(EOS);acute exacerbation;inhaled corticosteroids(ICS)

Abstract:

Keywords:

基金项目(Foundation): 广西壮族自治区卫生健康委员会（Z20190032）

作者(Author): 周阳,张东伟,韩玉,刘倩,宓家炜,于思菁,朱洁晨,朱述阳
ZHOU Yang,ZHANG Dongwei,HAN Yu,LIU Qian,MI Jiawei,YU Sijing,ZHU Jiechen,ZHU Shuyang

DOI: 10.19367/j.cnki.2096-8388.2022.06.015

参考文献(References)：

• [1] LI X, CAO X, GUO M, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017:systematic analysis for the Global Burden of Disease Study 2017[J]. BMJ,2020, 368(1):m234.
• [2] HALPIN D M G, CELLI B R, CRINER G J, et al. The gold summit on chronic obstructive pulmonary disease in low-and middle-income countries[J]. Int J Tuberc Lung Dis, 2019, 23(11):1131-1141.
• [3] SILVERMAN E K. Exacerbations in chronic obstructive pulmonary disease:do they contribute to disease progression?[J]. Proc Am Thorac Soc, 2007, 4(8):586-590.
• [4] SINGH D, KOLSUM U, BRIGHTLING C E, et al. Eosinophilic inflammation in COPD:prevalence and clinical characteristics[J]. Eur Respir J, 2014, 44(6):1697-1700.
• [5] GARUDADRI S, WOODRUFF P G. Targeting chronic obstructive pulmonary disease phenotypes, endotypes,and biomarkers[J]. Ann Am Thorac Soc, 2018, 15(Suppl 4):234-238.
• [6] BAFADHEL M, MCKENNA S, TERRY S, et al. Acute exacerbations of chronic obstructive pulmonary disease:identification of biologic clusters and their biomarkers[J].Am J Respir Crit Care Med, 2011, 184(6):662-671.
• [7] Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of copd[EB/OL].[2017-11-16]. https：//goldcopd.org/gold-reports.
• [8] VAN DEN BERGE M, KERSTJENS H A. Blood eosinophils as a continuous variable in the treatment of COPD:impact on the guidelines[J]. Lancet Respir Med, 2019,7(9):722-723.
• [9] PIGNATTI P, VISCA D, CHERUBINO F, et al. Do blood eosinophils strictly reflect airway inflammation in COPD Comparison with asthmatic patients[J]. Respir Res, 2019, 20(1):145.
• [10] PARK H Y, LEE H, KOH W J, et al. Association of blood eosinophils and plasma periostin with FEV1 response after 3-month inhaled corticosteroid and long-acting beta2-agonist treatment in stable COPD patients[J].Int J Chron Obstruct Pulmon Dis, 2016, 11(1):23-30.
• [11]ELTBOLI O, MISTRY V, BARKER B, et al. Relationship between blood and bronchial submucosal eosinophilia and reticular basement membrane thickening in chronic obstructive pulmonary disease[J]. Respirology, 2015,20(4):667-670.
• [12]BAFADHEL M, MCKENNA S, TERRY S, et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease:a randomized placebo-controlled trial[J]. Am J Respir Crit Care Med, 2012, 186(1):48-55.
• [13] PASCOE S, LOCANTORE N, DRANSFIELD M T, et al. Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease:a secondary analysis of data from two parallel randomised controlled trials[J]. Lancet Respir Med, 2015, 3(6):435-442.
• [14]FERGUSON G T, RABE K F, MARTINEZ F J, et al.Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease(KRONOS):a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial[J]. Lancet Respir Med, 2018, 6(10):747-758.
• [15]BAFADHEL M, DAVIES L, CALVERLEY P M, et al.Blood eosinophil guided prednisolone therapy for exacerbations of COPD:a further analysis[J]. Eur Respir J,2014, 44(3):789-791.
• [16]COUILLARD S, LARIVéE P, COURTEAU J, et al. Eosinophils in COPD exacerbations are associated with increased readmissions[J]. Chest, 2017, 151(2):366-373.
• [17] HASEGAWA K, CAMARGO C A, JR. Prevalence of blood eosinophilia in hospitalized patients with acute exacerbation of COPD[J]. Respirology, 2016, 21(4):761-764.
• [18] SAHA S, BRIGHTLING C E. Eosinophilic airway inflammation in COPD[J]. Int J Chron Obstruct Pulmon Dis, 2006, 1(1):39-47.
• [19]BELANGER M, COUILLARD S, COURTEAU J, et al.Eosinophil counts in first COPD hospitalizations:a comparison of health service utilization[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13(1):3045-3054.
• [20] DISANTOSTEFANO R L, HINDS D, LE H V, et al.Relationship between blood eosinophils and clinical characteristics in a cross-sectional study of a US populationbased COPD cohort[J]. Respir Med, 2016, 112(1):88-96.
• [21]BAFADHEL M, PETERSON S, DE BLAS M A, et al.Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease:a post-hoc analysis of three randomised trials[J].Lancet Respir Med, 2018, 6(2):117-126.
• [22]OSHAGBEMI O, BURDEN A, BRAEKEN D, et al. Stability of blood eosinophils in COPD and controls and the impact of gender, age, smoking and baseline counts[J].Am J Respir Crit Care Med, 2017, 195(1):1402-1404.
• [23]JACOBSEN E A, HELMERS R A, LEE J J, et al. The expanding role(s)of eosinophils in health and disease[J]. Blood, 2012, 120(19):3882-3890.
• [24]GEORGE L,BRIGHTLING L E, et al. Eosinophilic airway inflammation:role in asthma and chronic obstructive pulmonary disease[J]. Ther Adv Chronic Dis, 2016, 7(1):34-51.
• [25]MOQBEL R, LEVI-SCHAFFER F, KAY A B. Cytokine generation by eosinophils[J]. J Allergy Clin Immunol,1994, 94(6):1183-1188.
• [26] DAVOINE F, LACY P. Eosinophil cytokines, chemokines, and growth factors:emerging roles in immunity[J]. Front Immunol, 2014, 5(1):570.
• [27]SI-FANG W U, ZHOU L Q, FENG W U. Correlation of ICAM-1 and EOS levels with the severity of symptoms and lung function in patients with bronchial asthma[J].Journal of Clinical Pulmonary Medicine,2019, 24(5):34-37.

文章评论(Comment)：