痰嗜酸性粒细胞评估糖皮质激素治疗AECOPD的疗效价值  

Value of sputum eosinophils to evaluate the effect of glucocorticoid treatment in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：王莹莹[1] 郝兴亮[2] 冯涛[2] 崔丽华[2] 王世寿[2] 苗伟伟[2] 

机构地区：[1]胜利油田中心医院药学部,山东东营257034 [2]胜利油田中心医院呼吸内科,山东东营257034

出　　处：《临床药物治疗杂志》2017年第7期22-25,共4页Clinical Medication Journal

摘　　要：目的 :探讨痰嗜酸粒细胞增高与慢性阻塞性肺疾病急性加重期患者(AECOPD)糖皮质激素疗效的关系。方法:选取198例AECOPD患者作为此次研究的观察对象,分为痰嗜酸性粒细胞阳性激素治疗组(A组)、痰嗜酸性粒细胞阳性非激素治疗组(B组)、痰嗜酸性粒细胞阴性激素治疗组(C组)、痰嗜酸性粒细胞阴性非激素治疗组(D组)。4组患者分别在治疗前及治疗后7 d、14 d测FEV1、FEV1占预计值百分比(FEV1pre%)及呼吸困难量表(MMRC)评分,统计6个月内首次发生COPD急性发作时间和COPD急性加重发生率。结果:A组治疗后痰检嗜酸性粒细胞计数逐渐降低,且病人MMRC评分逐渐降低;A组较B组痰嗜酸性粒细胞降低更明显,MMRC评分及肺功能改善A组均优于B组(P<0.05);同为应用糖皮质激素治疗A组较C组MMRC评分及肺功能改善有差别(P<0.05);A组6个月内首次发生急性加重间隔时间为(110.23±36.23)d,6月内发生急性加重发生率33.6%,与其余各组比较均差异均有统计学意义(P<0.05)。结论:嗜酸粒细胞阳性AECOPD患者糖皮质激素治疗后能及早缓解临床症状和改善肺功能,预示痰检嗜酸粒细胞阳性是临床AECOPD患者使用糖皮质激素治疗的较好指标。Objective： To investigate the relationship between sputum eosinophil increase and effectiveness of glucocorticoid therapy in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods： A total of 198 admitted patients with AECOPD were selected for this study, and sputum or induced sputum examination was carried out for all the patients. The patients were divided into four groups： sputum eosinophil positive group with glucocorticoid therapy（group A）, sputum eosinophil positive group without glucocorticoid therapy（group B）, sputum eosinophil negative group with glucocorticoid therapy（group C）, and sputum eosinophil negative group without glucocorticoid therapy（group D）. The data of forced expiratory volume in one second（FEV1）, FEV1pre%, and MMRC score were collected before, at the 7th and 14 th day after treatment. The first onset time of acute exacerbation and acute exacerbation rate of COPD within 6 months were recorded. Results： The sputum eosinophils and MMRC score decreased gradually in group A; compared with group B, the sputum eosinophils decreased significantly, the MMRC score and pulmonary function of patients in group A improved significantly（P〈0.05）; compared with group C, the MMRC score and pulmonary function of patients in group A improved significantly（P〈0.05）; the first onset time of acute exacerbation in group A was（110.23±36.23） d and the acute exacerbation rate of COPD was 33.6% within 6 months, which was significantly better than the other groups（P〈0.05）. Conclusion： After glucocorticoid treatment, the clinical symptoms and pulmonary function of sputum eosinophil positive patients with AECOPD improved early, which indicated that sputum eosinophil positivity is an ideal clinical index for efficacy evaluation of glucocorticoid therapy in patients with AECOPD.

关 键 词：痰嗜酸性粒细胞 慢性阻塞性肺疾病急性加重 糖皮质激素 肺功能 

分 类 号：R969.3[医药卫生—药理学]