| 徐翠丽,张晓丰,李秀.血嗜酸性粒细胞在稳定期慢性阻塞性肺疾病吸入药物选择中的作用[J].安徽医药,2020,24(7):1338-1342. |
| 血嗜酸性粒细胞在稳定期慢性阻塞性肺疾病吸入药物选择中的作用 |
| Role of blood eosinophils in inhaled drug selection for stable chronic obstructive pulmonary disease |
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| DOI：10.3969/j.issn.1009?6469.2020.07.017 |
| 中文关键词: 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 |
| 英文关键词: Pulmonary disease,chronic obstructive Eosinophil Glucocorticoids Forced expiratory volume Vital capacity Nitric oxide Tiotropium bromide |
| 基金项目:安徽省科技攻关计划项目( 1301042220) |
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| 中文摘要: |
| 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/LA? BA)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±1.3，0)、(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。 |
| 英文摘要: |
| Objective To investigate the effect of serous eosinophils(EOS)in the management of stable chronic obstructive pulmo? nary disease(COPD).Methods A 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 num? ber of acute exacerbations in the previous year were collected and analyzed.According to the proportion of serous EOS% and thetype 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.Results There 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 treat? ment(P＜0.05).There were no significant differences in FEV1/FVC% among the four groups before and after treatment(P＞0.05).Af? ter 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 be? tween 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＜0.05There 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 exacerba?tions in each group was significantly different from that before treatment(P＜0.05).EOS% was positively correlated with FeNO be?fore treatment(rs＝0.823，P＜0.05).Conclusion Inhaled 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. |
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