血嗜酸性粒细胞作为生物标志物在慢性阻塞性肺疾病中的研究进展  

Research progress of blood eosinophils as the biomarker in chronic obstructive pulmonary disease

作　　者：王红梅[1] 刘耘充 郑丹蕾 陈亚红[1] WANG Hong-mei;LIU Yun-chong;ZHENG Dan-lei;CHEN Ya-hong(Department of Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院呼吸与危重症医学科,北京100191

出　　处：《中华全科医学》2020年第5期815-820,共6页Chinese Journal of General Practice

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”专项课题(2016YFC1304301)。

摘　　要：慢性阻塞性肺疾病全球倡议(global initiative for chronic obstructive lung disease,GOLD)2017首次推荐将血嗜酸性粒细胞(eosinophil,EOS)作为慢性阻塞性肺疾病(简称慢阻肺)生物学标志物,GOLD 2020再次强调血EOS对于指导急性加重高风险的慢阻肺稳定期患者吸入糖皮质激素(ICS)的治疗大有裨益。血EOS指导临床决策强调个性化评估、精准治疗,对于推动慢阻肺治疗由"风险管理型"向"靶向型"发展具有巨大潜力。但其临床应用的有效性和安全性仍存在争议:①血EOS能否真实反映慢阻肺患者气道EOS炎症程度、疾病严重程度和急性加重风险;②血EOS升高患者加用ICS对于预防急性加重的疗效是否确切;③血EOS升高患者加用ICS的疗效与ICS本身带来的肺炎等副作用的效益-风险比仍需权衡;④血EOS用以预测急性加重风险和ICS疗效的阈值仍未得到统一;⑤血EOS相关的靶向治疗疗效参差不齐。近年来,血EOS逐渐成为慢阻肺患者治疗领域的热点和争议的焦点,相关领域研究层出不穷,本文针对血EOS自身稳定性、对慢阻肺气道炎症反应、疾病严重程度、急性加重风险预测的有效性、指导ICS临床应用的价值、靶向治疗等方面的研究进展和争议进行综述,以期对血EOS临床应用的有效性和安全性有更深入的理解。Blood eosinophil(EOS)is recommended as a biomarker of chronic obstructive pulmonary disease(COPD)in GOLD 2017 for the first time.GOLD 2020 emphasizes that blood EOS is of great benefits in guiding the use of inhaled corticosteroids(ICS)in patients with stable COPD who are suffering from the high risk of acute exacerbations.Blood EOS highlights personalized assessment and precise treatment when making clinical decisions,which has great potential to promote the treatment of COPD from"risk management"to"targeted".However,there are still many controversies in the efficacy and safety when it comes to clinical application.Firstly,whether blood EOS can truly reflect the severity of airway EOS inflammation and disease and the risk of acute exacerbations in COPD patients.Secondly,whether the curative effect of adding ICS in patients with elevated EOS for preventing exacerbations is accurate.Thirdly,the benefit-risk ratio of the curative effect and the side effect such as pneumonia of ICS should be taken into consider in patients with elevated EOS.Fourthly,the threshold used to predict the risk of acute exacerbations and the curative effect of ICS isn’t yet unified.Finally,the curative effect of targeted treatment therapy associated with blood EOS is uneven.Recently,blood EOS gradually becomes a hotspot and a focus of controversies in the field of treatment for COPD patients,with related researches emerging in an endless stream.This review focuses on EOS,including the progress and controversy about the stability,the efficacy to forecast the airway inflammation,disease severity and the risk of the acute exacerbations,the value in guiding the clinical application of ICS and targeted therapy,in order to have a deeper understanding in the efficacy and safety of EOS.

关 键 词：嗜酸性粒细胞 慢性阻塞性肺疾病 生物标志物 吸入糖皮质激素 慢阻肺急性加重 

分 类 号：R563[医药卫生—呼吸系统] R44[医药卫生—内科学]