摘要
目的探讨血嗜酸性粒细胞(EOS)对稳定期慢性阻塞性肺疾病(COPD)吸入药物选择中的指导作用。方法选取于2017年12月1日至2018年5月31日就诊于合肥市第一人民医院门诊的182例稳定期COPD病人,记录其第一秒用力呼气容积/用力肺活量(FEV1/FVC%),血嗜酸性粒细胞百分比(EOS%),呼出气一氧化氮(FeNO),填写COPD病人自我评估测试(CAT)问卷及上一年急性加重次数。根据血EOS%是否≥2%及吸入药物种类将病人分为A1组(EOS≥2%、规律吸入布地奈德福莫特罗粉吸入剂(ICS/LABA))、A2组(EOS≥2%、规律吸入噻托溴铵粉吸入剂(LAMA)、B1组(EOS<2%、规律吸入ICS/LABA)及B2组(EOS<2%、规律吸入LAMA)。随访1年后重新测定FEV1/FVC%、CAT及随访1年期间的急性加重次数。结果治疗前CAT:四组差异无统计学意义(P>0.05);治疗后A1、A2、B1、B2组CAT分别为(11.69±2.28)、(13.47±2.67)、(13.14±2.09)、(12.54±1.44)分,A2、B1组分别与A1组比较,差异有统计学意义(P<0.05),A2组、B1组分别与B2组比较,差异无统计学意义(P>0.05),每组治疗后与治疗前CAT比较均差异有统计学意义(P<0.05);治疗前FEV1/FVC%:四组差异无统计学意义(P>0.05);治疗后FEV1/FVC%:四组差异无统计学意义(P>0.05),每组治疗后与治疗前FEV1/FVC%比较均差异无统计学意义(P>0.05);A1、A2、B1、B2组治疗前急性加重次数分别为(3.06±1.30)、(3.25±1.39)、2(1,2)、2(1,2)次:A1组与A2组、B1组与B2组比较差异无统计学意义(P>0.05),A1组与B1组、A2组与B2组差异有统计学意义(P<0.05);A1、A2、B1、B2组治疗后急性加重次数分别为1(1,2)、(2.03±0.95)、1(1,1)、1(1,1)次:A1组、B2组分别于与A2组比较,差异有统计学意义(P<0.05),A1、B2组分别与B1组比较,差异无统计学意义(P>0.05);每组治疗后与治疗前急性加重次数比较均差异有统计学意义(P<0.05);治疗前EOS%与FeNO呈正相关(rs=0.823,P<0.05)。结论吸入ICS/LABA对EOS升高的COPD病人疗效较好,EOS可用于预测COPD病人急性加重风险,指导COPD的治疗。
Objective To investigate the effect of serous eosinophils(EOS)in the management of stable chronic obstructive pulmonary disease(COPD).MethodsA total of 182 patients with stable COPD treated in the outpatient of the First People’s Hospital of Hefei between December 1,2017 to May 31,2018 were recruited.The patients’forcedexpiratoryvolumeinthe firstsecond/forcedvital capacity(FEV1/FVC),percentageofeosinophils(EOS%),exhaled nitric oxide(FeNO),self-assessmentofCOPD(CAT)and the number of acute exacerbations in the previous year were collected and analyzed.According to the proportion of serous EOS%and the type of inhaled drug,all enrolled patients were divided into the following groups:A1(EOS≥2%,inhaled budesonideformoterolpowder(ICS/LABA)),A2(EOS≥2%,inhaled tiotropium bromide powder(LAMA)),B1(EOS<2%,inhaled ICS/LABA)and B2(EOS<2%,inhaled LAMA).The data of FEV1/FVC%,CAT and the number of acute exacerbations were re-measured during one-year follow up.ResultsThere was no significant difference in CAT among the four groups before treatment(P>0.05).The CAT after treatment of group A1,A2,B1 and B2 was(11.69±2.28)points,(13.47±2.67)points,(13.14±2.09)points and(12.54±1.44)points,respectively.There was significant difference between group A1 and group A2(P<0.05),and no significant difference between group B1 and group B2(P>0.05).There was significant difference between group A1 and group B1(P<0.05).There was no significant difference between group A2 and group B2(P>0.05).After treatment,the CAT of each group was statistically different from that before treatment(P<0.05).There were no significant differences in FEV1/FVC%among the four groups before and after treatment(P>0.05).After treatment,the FEV1/FVC%of each group was not statistically different from that before treatment(P>0.05).The number of acute exacerbations of group A1,A2,B1 and B2 before treatment was(3.06±1.30),(3.25±1.39),2(1,2),2(1,2)times,respectively.There was no significant difference between A1 group and A2 group(P>0.05),and no significant difference between B1 group and B2 group(P>0.05).There was significant difference between A1 group and B1 group(P<0.05).There was significant difference between A2 group and B2 group(P<0.05).The number of acute exacerbations of group A1,A2,B1 and B2 after treatment was1(1,2),(2.03±0.95),1(1,1)and 1(1,1)times,respectively.There was significant difference between A1 group and A2 group(P<0.05).There was no significant difference between B1 group and B2 group(P>0.05).There was no significant difference between A1 group and B1 group(P>0.05).There was significant difference between A2 group and B2 group(P<0.05).The number of acute exacerbations in each group was significantly different from that before treatment(P<0.05).EOS%was positively correlated with FeNO before treatment(rs=0.823,P<0.05).ConclusionInhaled ICS/LABA is more effective in COPD patients with elevated EOS.EOS can be used to predict the risk of acute exacerbation in patients with COPD and to guide the treatment of COPD.
作者
徐翠丽
张晓丰
李秀
XU Cuili;ZHANG Xiaofeng;LI Xiu(Department of Respiratory Medicine,the Third Affiliated Hospital of Anhui Medical University(Hefei First People’s Hospital),Hefei,Anhui 230061,China)
出处
《安徽医药》
CAS
2020年第7期1338-1342,共5页
Anhui Medical and Pharmaceutical Journal
基金
安徽省科技攻关计划项目(1301042220)。
关键词
肺疾病
慢性阻塞性
嗜酸性粒细胞
糖皮质激素类
用力呼气量
肺活量
一氧化氮
噻托溴铵
Pulmonary disease,chronic obstructive
Eosinophil
Glucocorticoids
Forced expiratory volume
Vital capacity
Nitric oxide
Tiotropium bromide
