吸入含糖皮质激素三联疗法对不同血嗜酸性 粒细胞百分比的中重度慢性阻塞性肺疾病 患者急性加重频率的效果研究  

The effect of inhaled glucocorticoid triple therapy on the frequency of acute exacerbations in patients with moderate to severe chronic obstructive pulmonary disease with different blood eosinophil percentage

作　　者：高帆[1] 王清秀 李瑞[1] 韩校鹏 刘英丽 刘剑波[1] GAO Fan;WANG Qingxiu;LI Rui;HAN Xiaopeng;LIU Yingli;LIU Jianbo(Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450000,P.R.China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症学科,河南郑州450000

出　　处：《中国呼吸与危重监护杂志》2021年第10期685-689,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190324)。

摘　　要：目的研究含糖皮质激素三联疗法对具有不同血嗜酸性粒细胞百分比(EOS%)的中重度慢性阻塞性肺疾病(简称慢阻肺)稳定期患者急性加重频率的影响。方法选取我院呼吸与危重症学科2020年1月至2020年3月以中重度慢阻肺为第一诊断入院的患者124例作为研究对象,根据血EOS%将患者分为A组(EOS%<2%)和B组(EOS%≥2%),再将A、B两组分别随机分为A1、A2和B1、B2四组亚组,A1、B1组患者用药为二联双长效支气管舒张剂,A2、B2患者用药为含糖皮质激素三联制剂。即A1组(EOS%<2%,二联疗法),A2组(EOS%<2%,三联疗法),B1组(EOS%≥2%,二联疗法),B2组(EOS%≥2%,三联疗法)。经系统治疗出院后随访1年,比较不同亚组间患者随访1年内发生急性加重的次数、住院第1天至随访结束患者第1秒用力呼气容积占预计值百分比(FEV1%pred)的变化及肺炎发生率之间的差异。结果在血EOS%≥2%的患者中,三联疗法比二联疗法患者用药期间急性加重频率减少了40%(平均每例患者每年0.875比1.471次,P=0.0278),而在血EOS%<2%的患者中减少了4%(1.080比1.125次,P=0.3527);在同样使用含糖皮质激素三联疗法时,血EOS%≥2%的患者比血EOS%<2%的患者急性加重频率减少了19%(0.875比1.080次,P=0.0462)。无论血EOS%≥2%或<2%,三联疗法与二联疗法患者治疗前后FEV1%pred变化差异均无统计学意义(P>0.05)。无论EOS%≥2%或<2%,三联疗法与二联疗法患者用药期间肺炎发生率差异均无统计学意义(P>0.05)。结论吸入含糖皮质激素三联疗法适用于高水平血EOS%的中重度慢阻肺患者。Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease(COPD)with different blood eosinophil percentage(EOS%).Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects,and the patients were divided into group A according to EOS%(EOS%<2%)and B group(EOS%≥2%).Then the A and B groups were randomly divided into four subgroups A1,A2 and B1,B2,and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation.The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids.Namely A1 group(EOS%<2%,dual therapy),A2 group(EOS%<2%,triple therapy),B1 group(EOS%≥2%,dual therapy),B2 group(EOS%≥2%,triple therapy).The patients were instructed to take medication regularly as in hospital after discharge.After discharge,patients were followed up by telephone every two weeks for a period of one year.The number of acute exacerbations,the change of forced expiratory volume in the first second as a percentage of the expected value(FEV1%pred)and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year.Results In the patients with EOS%≥2%,triple therapy reduced the number of acute attacks by 40%during treatment compared with dual therapy patients(average 0.875 vs.1.471 times per patient per year,P=0.0278).While in the patients with EOS%<2%,it was reduced by 4%(1.080 vs.1.125 times,P=0.3527).In the same use of glucocorticoid-containing triple preparations,the number of acute exacerbations in the patients with EOS%≥2%during medication was 19%less than that of the patients with EOS%<2%(an average of 0.875 to 1.080 times per patient per year,P=0.0462).Regardless of EOS%≥2%or<2%,there was no signific

关 键 词：慢性阻塞性肺疾病急性加重 吸入性糖皮质激素 嗜酸性粒细胞 

分 类 号：R563.9[医药卫生—呼吸系统]