不同血清总IgE水平慢性阻塞性肺疾病呼吸衰竭患者的临床特征及抗曲霉治疗  

Clinical features and value of anti-aspergillus therapy in chronic obstructive pulmonary disease patients with respiratory failure and high serum total IgE levels

作　　者：施远 王维 许永江 张茹明 沈建英 孙武铭 SHI Yuan;WANG Wei;XU Yongjiang;ZHANG Ruming;SHEN Jianying;SUN Wuming(Department of Respiratory Medicine,Shaoxing Central Hospital,Shaoxing 312030,China)

机构地区：[1]绍兴市中心医院呼吸内科,312030

出　　处：《浙江医学》2024年第20期2197-2199,共3页Zhejiang Medical Journal

基　　金：浙江省医学会基金项目(2022ZYC-A213)。

摘　　要：目的比较不同血清总IgE水平慢性阻塞性肺疾病(COPD)急性加重合并Ⅱ型呼吸衰竭患者的临床特征,探讨抗曲霉治疗的临床意义。方法回顾性选取2022年6月至2023年6月在绍兴市中心医院呼吸内科住院治疗的COPD急性加重合并Ⅱ型呼吸衰竭的患者119例。根据入院时血清总IgE水平分为总IgE增高(≥100 U/mL)组61例,总IgE未增高(IgE<100 U/mL)组58例。患者均于入院时进行痰培养。比较两组患者的临床特征、抗曲霉治疗情况和600 d病死率。结果两组患者性别、年龄、痰培养念珠菌阳性率、无创呼吸机使用率、有创呼吸机使用率、吸烟情况、G试验阳性率、1年生存率比较差异均无统计学意义(均P>0.05)。与总IgE未增高组患者比较,总IgE增高组患者嗜酸性粒细胞计数、痰培养曲霉阳性率、抗曲霉药物使用率均较高,首次住院时间较长,年住院次数较多,糖皮质激素全身使用时间较长,600 d病死率较高,差异均有统计学意义(均P<0.05)。结论总IgE水平增高的COPD呼吸衰竭患者若常规治疗效果欠佳,或者长时间使用糖皮质激素未能撤减,虽然痰培养曲霉不一定阳性,但早期经验性使用抗曲霉药物可能有效。Objective To investigate the clinical characteristics and value of anti-aspergillus therapy in acute exacerbation chronic obstructive pulmonary disease(AECOPD)patients with high serum total IgE levels and typeⅡrespiratory failure.Methods Medical records of 119 AECOPD patients with typeⅡrespiratory failure admitted in Shaoxing Central Hospital between June 2022 and June 2023 were retrospectively analyzed.According to the serum total IgE level at admission,there were 61 cases with increased total IgE(≥100 U/mL,group A)and 58 cases without increased total IgE(IgE<100 U/mL,group B).All patients had spatum culture and received anti-aspergillus therapy.The clinical characteristics,treatment efficacy and 600d mortality rate were compared between two groups.Results There is no significant differences in gender,age,smoking status,positive candida sputum culture,G-test positivity,non-invasive ventilator and invasive ventilator use,and 1-year survival rate between two groups(all P>0.05).The eosinophil count,the positive aspergillus rate of sputum culture,the use of anti-aspergillus drugs,the length of first hospitalization,the annual hospitalization frequency,the systemic use of glucocorticoids and the 600 d-mortality rate in group A were significantly higher than those in group B(all P<0.05).Conclusion For COPD patients with respiratory failure and elevated total IgE who had inefficient multiple antibiotic regimens or long-term glucocorticoids use,early use of anti-aspergillus agents may effective,even no evidence shows positive aspergillus spatum culture.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 曲霉 总IGE 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]