变应原特异性IgE阳性慢性阻塞性肺疾病临床特征分析  

Clinical characteristics of patients with chronic obstructive pulmonary disease and positive specific IgE

作　　者：陈庆琳 姚秀娟[1] 刘晓芳[1] 李然[1] 王玉红[1] 张希春[1] Chen Qinglin;Yao Xiujuan;Liu Xiaofang;Li Ran;Wang Yuhong;Zhang Xichun(Department of Respiratory and Critical Care Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,北京100730

出　　处：《中华健康管理学杂志》2024年第5期339-346,共8页Chinese Journal of Health Management

基　　金：北京市自然科学基金资助项目(7212018)。

摘　　要：目的探讨血清变应原特异性IgE(SIgE)阳性慢性阻塞性肺疾病(慢阻肺)临床特征。方法本研究为回顾性队列研究,纳入存在过敏特征并完成血清SIgE检测的稳定期慢阻肺患者105例,均于2022年9月至2023年10月就诊于首都医科大学附属北京同仁医院呼吸与危重症医学科门诊,SIgE检测有≥1项阳性结果者归入SIgE阳性组(32例),SIgE均阴性者归入SIgE阴性组(73例)。比较两组患者实验室检查、肺功能、慢阻肺症状评分、过去1年中重度急性加重事件发生率及药物治疗的差异。分析慢阻肺患者SIgE阳性的危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)分析诊断慢阻肺SIgE阳性的最佳预测值。结果与SIgE阴性组相比,SIgE阳性组合并鼻炎、鼻窦炎、鼻窦炎伴鼻息肉、湿疹及有药物或食物过敏史的占比更高,已戒烟占比更高,IgE高于正常界值的占比、IgE水平、外周血嗜酸性粒细胞百分比(EOS%)、EOS计数及呼出气一氧化氮(FeNO)水平均更高(均P<0.05);慢阻肺全球创议(GOLD)肺功能分级重度及以上占比更高,第一秒用力呼气容积(FEV1)占预计值百分比(%预计值)、用力呼出25%和25%~75%肺活量时的呼气流量(MEF25%和MEF75/25%)较低,FEV1与用力肺活量(FVC)的比值(FEV1/FVC)更高(均P<0.05);SIgE阳性组改良版英国医学研究委员会呼吸困难问卷(mMRC)评分及慢阻肺评估测试(CAT)评分更高、过去1年中重度急性加重事件发生率更高(均P<0.05);使用吸入性短效β2受体激动剂(SABA)或吸入用短效抗胆碱能药物(SAMA)、吸入性糖皮质激素(ICS)、茶碱及口服激素治疗占比更高(均P<0.05)。EOS%(OR=1.252,95%CI:1.039~1.508)是慢阻肺SIgE阳性的危险因素(P<0.05),已戒烟(OR=0.385,95%CI:0.197~0.751)是其保护因素(P<0.05)。EOS%>2.5%诊断SIgE阳性的ROC曲线AUC值为0.647(95%CI:0.543~0.752),灵敏度和特异度分别为52.8%和73.1%。结论SIgE阳性慢阻肺临床症状重,急性加重风险高,治疗存在�Objective To investigate the clinical features of patients with chronic obstructive pulmonary disease(COPD)and serum-positive specific IgE(SIgE).Methods This study was a retrospective cohort study.A total of 105 stable COPD patients with allergic features and completed serum SIgE testing were included,and all of them were from Capital Medical University,Beijing Tong Ren Hospital from September 2022 to October 2023.Those with at least one positive result of SIgE testing were classified as positive SIgE COPD group,and those with negative SIgE were classified as negative SIgE COPD group.There were 32 cases(30.5%)in the positive SIgE COPD group and 73 cases(69.5%)in the negative SIgE COPD group.Differences in laboratory tests,pulmonary function,chronic obstructive pulmonary symptom scores,incidence of severe acute exacerbation events in the past year,and drug therapy were compared between the two groups.The risk factors for positive SIgE COPD were analyzed,and the best predictive value for the diagnosis of positive SIgE COPD was analyzed using the area under the curve(AUC)of receiver operating characteristic(ROC).Results Compared with the negative SIgE COPD group,the percentage of positive SIgE COPD group with rhinitis,sinusitis,sinusitis with nasal polyps,eczema,and a history of drug or food allergy were higher(all P<0.05)and the percentage of those who had quit smoking were higher(P<0.05);the percentage of IgE above normal thresholds,the level of IgE,the percentage of peripheral blood eosinophil(EOS%),the count of EOS,and fractional exhaled nitric oxide(FeNO)were higher(all P<0.05),and the percentage of those who had severe and above severe Global Strategy for the Diagnosis,Management,and Prevention of COPD(GOLD)pulmonary function classification were higher,while the percentage of forced expiratory volume in one second(FEV1%predicted),25%maximal expiratory flow(MEF25%)and MEF75/25%were lower,and FEV1/FVC was higher(all P<0.05).The positive SIgE COPD group had higher modified British medical research council(mMRC)sc

关 键 词：肺疾病 慢性阻塞性 变应原 免疫球蛋白E 抗体特异性 疾病特征 

分 类 号：R563.9[医药卫生—呼吸系统]