嗜酸性粒细胞增高慢性阻塞性肺疾病急性加重住院患者临床特征分析  

Clinical features of the patients with eosinophilic acute exacerbation of chronic obstructive pulmonary disease

作　　者：朱涛[1] 杜发旺 王勤[2] 熊伟 王汉超 陈亮[3] Zhu Tao;Du Fawang;Wang Qin;Xiong Wei;Wang Hanchao;Chen Liang(Department of Respiratory and Critical Care Medicine,Suining Central Hospital,Suining 629000,China;Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 410000,China;Department of Internal Medicine,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院呼吸与危重症医学科,遂宁629000 [2]重庆医科大学附属第二医院呼吸与危重症医学科,重庆410000 [3]遂宁市中心医院内科,遂宁629000

出　　处：《国际呼吸杂志》2024年第6期661-668,共8页International Journal of Respiration

基　　金：国家自然科学基金青年项目(8180011074);四川省自然科学基金(面上项目)(23NSFSC0667);四川省卫生健康委员会科技项目(临床研究专项)(23LCYJ008)。

摘　　要：目的探讨嗜酸性粒细胞增高慢性阻塞性肺疾病急性加重(EOS-AECOPD)住院患者的临床特征,并构建列线图模型。方法本研究为横断面研究。采用非随机抽样法,收集遂宁市中心医院2022年7月至2023年7月的慢性阻塞性肺疾病急性加重(AECOPD)住院患者495例。经纳入和排除标准筛选后,共有304例患者符合本次研究的条件。以血嗜酸性粒细胞(EOS)0.3×10^(9)/L作为截断值分为2组,EOS-AECOPD组98例,非嗜酸性粒细胞增高慢性阻塞性肺疾病急性加重(NEOS-AECOPD)组206例。收集2组患者人口学指标、基础疾病情况、临床症状、肺功能指标、血气指标、血常规、肝肾功能及胸部CT结果等。先进行单因素分析和共线性分析,然后纳入差异变量构建logistic回归模型,最后采用Nomogram及相关曲线可视化和验证logistic回归模型结果。结果EOS-AECOPD组男24例,女74例,年龄(71.23±9.08)岁;NEOS-AECOPD组男48例,女158例,年龄(71.55±9.51)岁。EOS-AECOPD组原发性高血压发病率[44.9%(44/98)比34.5%(71/206),χ^(2)=3.07,P=0.080]、血淋巴细胞计数[1.42(1.12,1.97)×10^(9)/L比1.25(0.96,1.62)×10^(9)/L,Z=2.87,P=0.004]高于NEOS-AECOPD组,血中性粒细胞计数[(5.40±2.21)×10^(9)/L比(6.13±3.78)×10^(9)/L,t=1.77,P=0.078]、血中性粒细胞比例[71.48%(63.28%,77.29%)比77.50%(69.10%,85.10%),Z=5.21,P<0.001]、血尿素氮[(6.04±1.75)mmol/L比(6.59±2.43)mmol/L,t=2.00,P=0.047]、谷草转氨酶[(21.41±10.20)U/L比(28.38±11.26)U/L,t=2.00,P=0.047]、直接胆红素[(4.08±1.87)μmol/L比(4.82±2.73)μmol/L,t=2.41,P=0.016]和总胆红素水平[(10.02±4.09)μmol/L比(11.28±5.33)μmol/L,t=2.06,P=0.040]低于NEOS-AECOPD组。以方差膨胀因子>10作为高共线性截断值,进行共线性分析后,剔除血中性粒细胞计数和总胆红素,将剩余的6个变量纳入logistic回归模型。结果显示原发性高血压、血中性粒细胞比例和谷草转氨酶水平是EOS-AECOPD患者的独立危险因素(均P<0.05)。效应曲线�ObjectiveTo explore the clinical features and develop a nomogram model for patients with increased blood eosinophils(EOS)and acute exacerbation of chronic obstructive pulmonary disease(AECOPD).MethodsIn this cross-sectional study,using non-random sampling method,495 patients with AECOPD in Suining Central Hospital were screened from July 2022 to July 2023.Based on inclusion and exclusion criteria,304 patients were recruited in this study.EOS 0.3×10^(9)/L was used as cut-off value.98 patients with blood EOS≥0.3×10^(9)/L(eosinophilic AECOPD[EOS-AECOPD])and 206 patients with blood EOS<0.3×10^(9)/L(non-eosinophilic AECOPD[NEOS-AECOPD])were enrolled.Demographic information,underlying diseases,clinical symptoms,lung function,arterial blood gas(ABG),blood routine,liver and renal functions,and chest CT results were collected.Firstly,univariate analysis and collinearity analysis were performed.Secondly,logistics regression model was established by incorporating differential variables.Finally,nomogram and its-associated curves were used to visualize and verify the results of logistics regression model.ResultsThere were 24 males and 74 females in EOS-AECOPD group,aged(71.23±9.08)years old.There were 48 males and 158 females in NEOS-AECOPD group,aged(71.55±9.51)years old.Compared to those in NEOS-AECOPD group,the EOS-AECOPD group showed higher values in the following variables:the incidence of essential hypertension(44.9%[44/98]vs 34.5%[71/206],χ^(2)=3.07,P=0.080),blood lymphocytes count(1.42[1.12,1.97]×10^(9)/L vs 1.25[0.96,1.62]×10^(9)/L,Z=2.87,P=0.004);lower in blood neutrophils count([5.40±2.21]×10^(9)/L vs[6.13±3.78]×10^(9)/L,t=1.77,P=0.078),blood neutrophils percentage(71.48%[63.28%,77.29%]vs 77.50%[69.10%,85.10%],Z=5.21,P<0.001),blood urea nitrogen([6.04±1.75]mmol/L vs[6.59±2.43]mmol/L,t=2.00,P=0.047),aspartate aminotransferase([21.41±10.20]U/L vs[28.38±11.26]U/L,t=2.00,P=0.047),direct bilirubin([4.08±1.87]μmol/L vs[4.82±2.73]μmol/L,t=2.41,P=0.016),and total bilirubin([10.02±4.09]μmol/L vs[11.2

关 键 词：肺疾病 慢性阻塞性 血嗜酸性粒细胞 原发性高血压 血中性粒细胞比例 谷草转氨酶 

分 类 号：R563.9[医药卫生—呼吸系统]