嗜酸性粒细胞型和中性粒细胞型慢性阻塞性肺疾病急性加重住院患者临床特征及预后比较  

Comparison of clinical characteristics and prognosis of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD

作　　者：张颖 姜明明[1] 孙宝华[1] ZHANG Ying;JIANG Mingming;SUN Baohua(Department of Respiratory and Critical Care Medicine,Cangzhou Central Hospital,Cangzhou,Hebei 061000,P.R.China)

机构地区：[1]沧州市中心医院呼吸与危重症医学科,河北沧州061000

出　　处：《中国呼吸与危重监护杂志》2021年第4期241-246,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：河北省医学科学研究课题(20200335)。

摘　　要：目的探讨嗜酸性粒细胞型和中性粒细胞型慢性阻塞性肺疾病(简称慢阻肺)急性加重住院患者临床特点及病死率的差异。方法回顾性分析2015年1月至2016年12月在沧州市中心医院呼吸与危重症医学科以慢阻肺急性加重作为第一诊断的510例住院患者的临床资料,并随访至2020年1月1日。根据外周血细胞计数将患者分为嗜酸性粒细胞急性加重组(外周血嗜酸性粒细胞百分比>2%)、中性粒细胞急性加重组(中性粒细胞百分比>65%或白细细胞计数>11×10^(9)/L)和寡细胞组急性加重组(不满足上述两种情况)。进行三组临床特征的比较,并对影响患者全因病死率的危险因素进行Cox回归分析。结果共纳入510例慢阻肺急性加重住院患者,其中嗜酸性粒细胞急性加重组180例,中性粒细胞急性加重组273例,寡细胞急性加重组57例。与中性粒细胞急性加重组相比,嗜酸性粒细胞急性加重组发病时间短,心力衰竭比例低,机械通气、抗生素联合使用、静脉糖皮质激素应用比例低,住院时间短,住院病死率低(均P<0.05)。共有485例患者完成随访,中位随访41个月。以嗜酸性粒细胞急性加重组作为参照组,中性粒细胞急性加重患者长期死亡风险更高(HR=1.691,95%CI1.205~2.373,P=0.002)。结论同嗜酸性粒细胞型慢阻肺急性加重患者相比,中性粒细胞型慢阻肺急性加重患者有更为严重的临床特征,且死亡风险更高。Objective To explore the clinical characteristics and long term mortality of patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease(COPD) exacerbations requiring hospital admission. Methods A retrospective review of the clinical data and long-term follow up was performed for 510 patients with first diagnosis of acute exacerbation of COPD(AECOPD) requiring hospital admission between January 2015 and December 2016. The follow-up was completed in January 1, 2020. These patients were divided into three groups according to routine blood test:an eosinophilic exacerbation group, with peripheral blood eosinophils >2%;a neutrophilic exacerbation group, with peripheral blood neutrophils >65% or leukocytes >11×10^(9)/L;a paucigranulocytic exacerbation group, any case did not belong to the above two groups. The differences of clinical characteristics were compared among three groups. Cox regression model was used for analysis of independent risk factors of all-cause mortality of AECOPD patients. Results A total of 510 AECOPD patients were enrolled(180 eosinophilic, 273 neutrophilic and 57 paucigranulocytic, respectively).Compared with the neutrophilic exacerbation group, the eosinophilic exacerbation group had shorter time since onset of symptoms, the lower proportion of comorbid heart failure, the lower proportion of mechanical ventilation, dual antibiotics and systematic corticosteroid treatment, the shorter length of hospitalization and lower hospital mortality(all P<0.05). The average follow-up duration was 41 months for 485 AECOPD patients who completed long term follow-up.Compared with the eosinophilic exacerbation group, the neutrophilic exacerbation group was associated with a higher long-term mortality of AECOPD(HR=1.691, 95%CI 1.205-2.373, P=0.002). Conclusion COPD patients with neutrophilic exacerbations have more serious clinical features and higher mortality than those with eosinophilic exacerbations.

关 键 词：慢性阻塞性肺疾病 嗜酸性粒细胞 中性粒细胞 预后 

分 类 号：R563.9[医药卫生—呼吸系统]