血小板增多与 COPD 发病的相关性：SPIROMICS 和 COPDGene 队列研究。
Association of thrombocytosis with COPD morbidity: the SPIROMICS and COPDGene cohorts.
机构信息
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St. 5th Floor, Baltimore, MD, 21287, USA.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
出版信息
Respir Res. 2018 Jan 26;19(1):20. doi: 10.1186/s12931-018-0717-z.
BACKGROUND
Thrombocytosis has been associated with COPD prevalence and increased all-cause mortality in patients with acute exacerbation of COPD (AECOPD); but whether it is associated with morbidity in stable COPD is unknown. This study aims to determine the association of thrombocytosis with COPD morbidity including reported AECOPD, respiratory symptoms and exercise capacity.
METHODS
Participants with COPD were included from two multi-center observational studies (SPIROMICS and COPDGene). Cross-sectional associations of thrombocytosis (platelet count ≥350 × 10/L) with AECOPD during prior year (none vs. any), exertional dyspnea (modified Medical Research Council (mMRC) score ≥ 2), COPD Assessment Test (CAT) score ≥ 10, six-minute-walk distance (6MWD), and St. George Respiratory questionnaire (SGRQ) were modeled using multivariable logistic or linear regression. A pooled effect estimate for thrombocytosis was produced using meta-analysis of data from both studies.
RESULTS
Thrombocytosis was present in 124/1820 (6.8%) SPIROMICS participants and 111/2185 (5.1%) COPDGene participants. In meta-analysis thrombocytosis was associated with any AECOPD (adjusted odds ratio [aOR] 1.5; 95% confidence interval [95% CI]: 1.1-2.0), severe AECOPD (aOR 1.5; 95% CI: 1.1-2.2), dyspnea (mMRC ≥ 2 aOR 1.4; 95% CI: 1.0-1.9), respiratory symptoms (CAT ≥ 10 aOR 1.6; 95% CI: 1.1-2.4), and higher SGRQ score (β 2.7; 95% CI: 0.5, 5). Thrombocytosis was also associated with classification into Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D (aOR 1.7 95% CI: 1.2-2.4).
CONCLUSIONS
Thrombocytosis was associated with higher likelihood of prior exacerbation and worse symptoms. Platelet count, a commonly measured clinical assay, may be a biomarker for moderate-severe COPD symptoms, guide disease classification and intensity of treatment. Future longitudinal studies investigating the role of platelets in COPD progression may be warranted.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01969344 (SPIROMICS) and NCT00608764 (COPDGene).
背景
血小板增多症与 COPD 患病率以及 COPD 急性加重（AECOPD）患者的全因死亡率增加有关；但它是否与稳定期 COPD 的发病率有关尚不清楚。本研究旨在确定血小板增多症与 COPD 发病率的关系，包括报告的 AECOPD、呼吸症状和运动能力。
方法
本研究纳入了两项多中心观察性研究（SPIROMICS 和 COPDGene）中的 COPD 患者。使用多变量逻辑或线性回归模型，对血小板增多症（血小板计数≥350×10/L）与前一年的 AECOPD（无 vs. 有）、运动性呼吸困难（改良医学研究理事会（mMRC）评分≥2）、COPD 评估测试（CAT）评分≥10、6 分钟步行距离（6MWD）和圣乔治呼吸问卷（SGRQ）之间的横断面相关性进行建模。使用来自两项研究的数据进行荟萃分析，得出血小板增多症的汇总效应估计值。
结果
在 1820 名 SPIROMICS 参与者中有 124 名（6.8%）和 2185 名 COPDGene 参与者中有 111 名（5.1%）存在血小板增多症。荟萃分析显示，血小板增多症与任何 AECOPD（校正比值比[aOR]1.5；95%置信区间[95%CI]：1.1-2.0）、严重 AECOPD（aOR 1.5；95%CI：1.1-2.2）、呼吸困难（mMRC≥2，aOR 1.4；95%CI：1.0-1.9）、呼吸症状（CAT≥10，aOR 1.6；95%CI：1.1-2.4）和更高的 SGRQ 评分（β 2.7；95%CI：0.5, 5）相关。血小板增多症也与全球慢性阻塞性肺疾病倡议（GOLD）D 组的分类相关（aOR 1.7；95%CI：1.2-2.4）。
结论
血小板增多症与更高的既往加重和更严重的症状相关。血小板计数，一种常用的临床检测，可能是中重度 COPD 症状的生物标志物，可指导疾病分类和治疗强度。未来的研究可能需要调查血小板在 COPD 进展中的作用。
试验注册
ClinicalTrials.gov：NCT01969344（SPIROMICS）和 NCT00608764（COPDGene）。
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