引用本文:祝雅静,刘 娟,秦 艳,王丽君.不同炎症表型慢性阻塞性肺疾病急性加重患者的临床特征及预后分析[J].中国临床新医学,2024,17(3):289-295.
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不同炎症表型慢性阻塞性肺疾病急性加重患者的临床特征及预后分析
祝雅静,刘 娟,秦 艳,王丽君
江苏省苏北人民医院呼吸内科呼吸综合功能室,扬州 225002
摘要:
[摘要] 目的 分析不同炎症表型慢性阻塞性肺疾病急性加重(AECOPD)患者的临床特征及预后。方法 回顾性分析2021年1月至2022年4月苏北人民医院呼吸内科收治的255例AECOPD患者的临床资料。根据患者入院首次外周血细胞计数结果,将其分为嗜酸粒细胞(EOS)组(87例)、中性粒细胞组(92例)、混合粒细胞组(30例)和粒细胞缺乏组(46例)。比较四组患者的临床特征及出院后1年内急性加重再入院率。结果 四组患者白细胞计数(WBC)、EOS百分比(EOS%)、EOS、中性粒细胞百分比(NE%)、中性粒细胞(NE)、淋巴细胞百分比(LY%)、淋巴细胞(LY)、中性粒细胞计数/淋巴细胞计数比值(NLR)、C反应蛋白(CRP)、降钙素原(PCT)、白蛋白(ALB)水平比较,差异有统计学意义(P<0.05)。中性粒细胞组WBC、NE%、NE、NLR、CRP、PCT水平高于EOS组,EOS%、EOS、LY%、LY、ALB水平低于EOS组;混合粒细胞组WBC、NE%、NE、NLR水平高于EOS组,LY%、LY、ALB水平低于EOS组,EOS%、EOS水平高于中性粒细胞组;粒细胞缺乏组WBC、NE%、NE、NLR、PCT水平低于中性粒细胞组与混合粒细胞组,LY%、LY水平高于中性粒细胞组与混合粒细胞组,EOS%、EOS水平低于EOS组与混合粒细胞组,CRP水平低于中性粒细胞组,差异有统计学意义(P<0.05)。四组患者肺功能指标比较差异有统计学意义(P<0.05)。中性粒细胞组第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)水平低于EOS组;粒细胞缺乏组FEV1%pred、FEV1/FVC水平高于中性粒细胞组,FEV1/FVC水平高于混合粒细胞组,差异有统计学意义(P<0.05)。四组患者住院天数、静脉激素及抗生素使用率比较差异有统计学意义(P<0.05)。中性粒细胞组住院天数大于EOS组,静脉激素使用率高于EOS组,抗生素使用率高于EOS组和粒细胞缺乏组,差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线显示,急性加重再入院率由高到低依次为中性粒细胞组(61.06%)、混合粒细胞组(54.78%)、粒细胞缺乏组(45.23%)和EOS组(42.89%),log-rank检验显示四组差异有统计学意义(χ2=10.816,P=0.013)。结论 基于外周血细胞计数的四种不同炎症表型的AECOPD患者在炎症指标水平、营养状况、肺功能、住院天数、治疗效果及预后等方面存在明显差异。中性粒细胞型AECOPD相比于EOS型AECOPD表现出更严重的临床特征,且出院后1年内急性加重再入院率更高。
关键词:  慢性阻塞性肺疾病  炎症表型  外周血细胞计数  临床特征  预后
DOI:10.3969/j.issn.1674-3806.2024.03.09
分类号:R 256.1
基金项目:
Analysis on clinical features and prognosis of the acute exacerbation of chronic obstructive pulmonary disease patients with different inflammatory phenotypes
ZHU Yajing, LIU Juan, QIN Yan, WANG Lijun
Respiratory Comprehensive Function Room, Department of Respiratory Medicine, Northern Jiangsu People′s Hospital, Yangzhou 225002, China
Abstract:
[Abstract] Objective To analyze the clinical features and prognosis of the acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients with different inflammatory phenotypes. Methods The clinical data of 255 patients with AECOPD who were admitted to the Department of Respiratory Medicine of Northern Jiangsu People′s Hospital from January 2021 to April 2022 were retrospectively analyzed. The patients were divided into eosinophil(EOS) group(87 cases), neutrophil group(92 cases), mixed granulocyte group(30 cases) and agranulocytosis group(46 cases) according to their initial peripheral blood cell count results at admission. The clinical features and the readmission rates of the patients admitted to hospital for AECOPD within one year after discharge were compared among the four groups. Results There were statistically significant differences in white blood cell count(WBC), EOS percentage(EOS%), EOS, neutrophil(NE) percentage(NE%), NE, lymphocyte(LY) percentage(LY%), LY, neutrophil count to lymphocyte count ratio(NLR), C-reactive protein(CRP), procalcitonin(PCT) and albumin(ALB) levels among the patients in the four groups(P<0.05). The neutrophil group had higher WBC, NE%, NE, NLR, CRP and PCT levels, and lower EOS%, EOS, LY%, LY and ALB levels compared with the EOS group. The mixed granulocyte group had higher WBC, NE%, NE and NLR levels, and lower LY%, LY and ALB levels than the EOS group, and the mixed granulocyte group had higher EOS% and EOS levels than the neutrophil group. Compared with the neutrophil group and the mixed granulocyte group, the agranulocytosis group had lower WBC, NE%, NE, NLR and PCT levels, and higher LY% and LY levels. EOS% and EOS levels in the agranulocytosis group were lower than those in the EOS group and the mixed granulocyte group, while CRP level in the agranulocytosis group was lower than that in the neutrophil group. The differences were statistically significant(P<0.05). There were statistically significant differences in the pulmonary function indexes among the patients in the four groups(P<0.05). The neutrophil group had lower forced expiratory volume in one second as a percentage of the predicted value(FEV1%pred) and forced expiratory volume in one second(FEV1)/forced vital capacity(FVC) levels than the EOS group. FEV1%pred and FEV1/FVC levels in the agranulocytosis group were higher than those in the neutrophil group, while FEV1/FVC level in the agranulocytosis group was higher than that in the mixed granulocyte group. The differences were statistically significant(P<0.05). There were statistically significant differences in the hospitalized days, utilization rates of intravenous corticosteroids and antibiotics among the patients in the four groups(P<0.05). The neutrophil group had more hospitalized days and higher utilization rate of intravenous corticosteroids than the EOS group, and the neutrophil group had higher utilization rate of antibiotics than the EOS group and the agranulocytosis group. The differences were statistically significant(P<0.05). Kaplan-Meier survival curves showed that the readmission rates of the patients admitted to hospital for AECOPD were ranked from high to low in the neutrophil group(61.06%), the mixed granulocyte group(54.78%), the agranulocytosis group(45.23%) and the EOS group(42.89%), and the log-rank test showed statistically significant differences among the 4 groups(χ2=10.816, P=0.013). Conclusion There are significant differences in inflammatory indicators, nutritional status, pulmonary function, hospitalized days, therapeutic effect and prognosis among the AECOPD patients with four different inflammatory phenotypes based on peripheral blood cell count. The AECOPD patients with neutrophilic type show more severe clinical features and have a higher rate of readmission to hospital for AECOPD within one year after discharge than those with eosinophilic type.
Key words:  Chronic obstructive pulmonary disease(COPD)  Inflammatory phenotype  Peripheral blood cell count  Clinical feature  Prognosis