持续性血嗜酸性粒细胞增多症的患病率：与 COPD 患者结局的关系。
Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD.
机构信息
Pulmonary Dept, Hospital Universitario Ntra Sra de La Candelaria, Tenerife, Spain
Pulmonary and Critical Care Dept, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
Eur Respir J. 2017 Nov 22;50(5). doi: 10.1183/13993003.01162-2017. Print 2017 Nov.
The impact of blood eosinophilia in chronic obstructive pulmonary disease (COPD) remains controversial.To evaluate the prevalence and stability of a high level of blood eosinophils (≥300 cells·μL) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels <300 cells·μL A similar eosinophil blood pattern was observed in controls. Exacerbation rates did not differ in patients with and without eosinophilia. All-cause mortality was lower in patients with high eosinophils compared with those with values <300 cells·μL (15.8% 33.7%; p=0.026).In patients with COPD, blood eosinophils ≥300 cells·μL persisting over 2 years was not a risk factor for COPD exacerbations. High eosinophil count was associated with better survival.
血液嗜酸性粒细胞增多对慢性阻塞性肺疾病（COPD）的影响仍存在争议。为了评估高水平血液嗜酸性粒细胞（≥300 细胞·μL）的患病率和稳定性及其与结局的关系，我们在 CHAIN 队列的 424 例 COPD 患者（预计 1 秒用力呼气量（FEV）60%）和 67 例无 COPD 的吸烟者中以及在 BODE 队列的 308 例 COPD 患者（FEV 60%）中分别在基线和 2 年内测定了血液嗜酸性粒细胞。我们使用 Cox 风险分析将嗜酸性粒细胞水平与加重和生存相关联。在 COPD 患者中，CHAIN 队列中有 15.8%，BODE 队列中有 12.3%的患者在所有 3 次就诊时血液嗜酸性粒细胞持续升高。相当一部分（43.8%）患者的计数在截止值上下波动，而其余患者的嗜酸性粒细胞水平持续<300 细胞·μL。在对照组中也观察到了类似的嗜酸性粒细胞血液模式。嗜酸性粒细胞患者与非嗜酸性粒细胞患者的加重率没有差异。与嗜酸性粒细胞水平<300 细胞·μL 的患者相比，高嗜酸性粒细胞患者的全因死亡率较低（15.8% 比 33.7%；p=0.026）。在 COPD 患者中，2 年以上持续存在血液嗜酸性粒细胞≥300 细胞·μL 不是 COPD 加重的危险因素。高嗜酸性粒细胞计数与更好的生存相关。
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