Pulmonary Dept, Hospital Universitario Ntra Sra de La Candelaria, Tenerife, Spain
Pulmonary and Critical Care Dept, Brigham and Women's Hospital, Boston, MA, USA.
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。
