外周血嗜酸粒细胞对慢性阻塞性肺疾病急性加重患者恢复期再入院的预测价值研究  

Predictive value of peripheral blood eosinophils on readmission in patients during recovery period with acute exacerbation of chronic obstructive pulmonary disease

作　　者：冯小艺 李沁雪 梁斌苗[1] 欧雪梅[1] Feng Xiaoyi;Li Qinxue;Liang Binmiao;Ou Xuemei(Department of Respiratory and Critical Care Medicine,Sichuan University West China Hospital,Chengdu 610041,China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,成都610041

出　　处：《国际呼吸杂志》2022年第24期1895-1901,共7页International Journal of Respiration

基　　金：四川省科技厅重点研发项目(2018SZ0109)。

摘　　要：目的研究血嗜酸粒细胞对慢性阻塞性肺疾病急性加重(AECOPD)患者恢复期再入院的预测价值。方法本研究为病例对照研究。采用非随机抽样法,纳入2015年2月至2021年3月在四川大学华西医院因"AECOPD"住院的患者496例,根据90 d内是否再入院分为再入院组(112例)及未再入院组(384例),比较2组的临床特征。利用二元logistic回归分析AECOPD患者恢复期再入院的独立危险因素。利用受试者工作特征曲线下面积比较不同生物学标志物之间的预测价值。结果与未再入院患者相比,再入院患者年龄更大[74(13)岁比73(14)岁],出院时血嗜酸粒细胞比例(EOS%)[0.40%(1.80%)比1.00%(2.80%)]更低,中性粒细胞/淋巴细胞比值(NLR)[7.80(10.15)比5.89(8.48)]、白细胞计数[8.46(5.80)×109/L比7.96(5.54)×109/L]及B型钠尿肽[516.50(2231.00)ng/L比404.00(1118.00)ng/L]水平更高,住院时长[15(10)d比13(7)d]及带机率[52%(46.4%)比121%(31.5%)]更高[U值分别为18724.50、17731.50、16484.50、19369.00、16287.00、16584.00,χ^(2)=9.33,P值均<0.05]。二元logistic回归分析显示,年龄(OR=1.35,95%CI:1.09~1.70)、NLR(OR=1.89,95%CI:1.23~2.93)是AECOPD患者3个月内再入院的危险因素,而血EOS%(OR=0.57,95%CI:0.35~0.90)是AECOPD患者3个月内再入院的保护因素。血EOS%越低,出院后3个月内再发急性加重、因加重而再入院及死亡的风险均增高。血EOS%在AECOPD患者3个月内再入院风险的预测价值(曲线下面积为0.778,敏感度为85.0%,特异度为71.4%)优于NLR及C反应蛋白。EOS%<2%组患者NLR、降钙素原、C反应蛋白及白细胞介素6水平均更高,住院时间更长,带机率及使用激素的比例更高,更易合并肺炎、呼吸衰竭、真菌感染及多重耐药菌感染(P值均<0.05)。EOS%与NLR、白细胞介素6呈负相关(r值分别为-0.192、-0.111,P值均<0.05)。结论AECOPD患者血EOS%与90 d内再发急性加重及再入院风险呈负相关,这与稳定期有所不同。血嗜酸粒细胞是一种Objective To analyze the predictive value of blood eosinophils on readmission of patients during recovery period with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods This was a case-control study.A non-random sampling method was used.A total of 496 patients hospitalized for AECOPD in West China Hospital of Sichuan University from February 2015 to March 2021 were enrolled.According to whether the patients were readmitted within 90 days after discharge,112 patients were assigned to readmission group and 384 patients to non-readmission group.The clinical characteristics of the two groups were compared.The independent risk factors for readmission of AECOPD during convalescence were analyzed by binary logistic regression.The predictive value of different biomarkers was compared using the area under the receiver operating characteristic curve.Results Compared with non-readmitted patients,readmitted patients were older(74[13]y vs 73[14]y),had lower percentage of blood eosinophils(0.40%[1.8%]vs 1.00%[2.80%]),higher levels of NLR(7.80[10.15]vs 5.89[8.48]),white blood cell count(8.46[5.80]×109/L vs 7.96[5.54]×109/L),and B-type natriuretic peptide(516.50[2231.00]ng/L vs 404.00[1118.00]ng/L),longer hospital stay(15[10]d vs 13[7]d),and higher probability of ventilator use(52[46.4%]vs 121[31.5%])(U=18724.50,17731.50,16484.50,19369.00,16287.00,16584.00,χ^(2)=9.33,all P<0.05).Binary logistic regression analysis showd that age(OR=1.35,95%CI:1.09-1.70)and NLR(OR=1.89,95%CI:1.23-2.93)were the risk factors of readmission within three months in patients with AECOPD,while blood eosinophils(OR=0.57,95%CI:0.35-0.90)were the protective factors of readmission within three months.Lower blood eosinophils were related to a significantly increased risk of recurrent acute exacerbation,readmission,and death due to exacerbation within three months after discharge.The predictive value of blood eosinophils at three-month readmission in AECOPD patients was superior to NLR and CRP(the area under the curve is 0.778,the

关 键 词：肺疾病 慢性阻塞性 急性加重 血嗜酸粒细胞 再入院 炎症指标 C反应蛋白 病情 结局 

分 类 号：R563.9[医药卫生—呼吸系统]