Wu Hong-Xia, Zhuo Kai-Quan, Cheng De-Yun
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery, Suining Municipal Hospital of TCM, Suining, China.
Front Med (Lausanne). 2019 Dec 10;6:282. doi: 10.3389/fmed.2019.00282. eCollection 2019.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with different clinical and pathophysiological characteristics. Cumulative evidence shows that eosinophil levels may be connected to the therapeutic effects and phenotype of COPD. However, the prevalence of eosinophilic inflammation in COPD and the baseline characteristics of eosinophilic COPD remain unknown. Our study investigated the prevalence of COPD with eosinophil levels of >2% and the characteristics of eosinophilic COPD. We searched the Cochrane Central Library, Medline, Embase, and the Web of Science for trials of eosinophil and COPD published from database inception to May 1, 2019. In total, 40,112 COPD patients that were involved in 19 trials were included in the final analysis. The prevalence of eosinophilic COPD ranged from 18.84 to 66.88%, with an average prevalence of 54.95% across all studies. We found that men, ex-smokers, individuals with a history of ischemic heart disease, and individuals with a higher body mass index (BMI) were at higher risk of eosinophilic COPD (OR 1.36, 95% CI 1.26-1.46, < 0.00001; OR 1.23, 1.12-1.34, < 0.0001; OR 1.31, 1.14-1.50, = 0.001; MD 0.70, 0.27-1.12, = 0.001). There was, however, a lower proportion of GOLD stage I patients among those with eosinophilic COPD (OR 0.84, 0.73-0.96, = 0.01). No significant differences were found in terms of age, current smoker status, pack-years smoked, percent of predicted forced expiratory volume in 1 s, hypertension, diabetes, or other GOLD stages between the two groups ( > 0.05). Our analysis suggests that eosinophilic inflammation is prevalent in COPD. Eosinophilic COPD was more likely to occur in men, ex-smokers, those with a higher BMI, and those with a high risk of some comorbidity; however, a lower proportion of patients with eosinophilic COPD experienced mild airflow limitations.
慢性阻塞性肺疾病（COPD）是一种具有不同临床和病理生理特征的异质性疾病。越来越多的证据表明，嗜酸性粒细胞水平可能与COPD的治疗效果和表型相关。然而，COPD中嗜酸性粒细胞炎症的患病率以及嗜酸性粒细胞性COPD的基线特征仍不清楚。我们的研究调查了嗜酸性粒细胞水平>2%的COPD的患病率以及嗜酸性粒细胞性COPD的特征。我们检索了Cochrane中心图书馆、Medline、Embase和科学网，以查找从数据库建立到2019年5月1日发表的关于嗜酸性粒细胞与COPD的试验。最终分析共纳入了19项试验中的40112例COPD患者。嗜酸性粒细胞性COPD的患病率在18.84%至66.88%之间，所有研究的平均患病率为54.95%。我们发现，男性、既往吸烟者、有缺血性心脏病史的个体以及体重指数（BMI）较高的个体患嗜酸性粒细胞性COPD的风险更高（比值比1.36，95%置信区间1.26 - 1.46，P < 0.00001；比值比1.23，1.12 - 1.34，P < 0.0001；比值比1.31，1.14 - 1.50，P = 0.001；平均差0.70，0.27 - 1.12，P = 0.001）。然而，嗜酸性粒细胞性COPD患者中GOLD I级患者的比例较低（比值比0.84，0.73 - 0.96，P = 0.01）。两组在年龄、当前吸烟状态、吸烟包年数、预计1秒用力呼气量百分比、高血压、糖尿病或其他GOLD分级方面未发现显著差异（P > 0.05）。我们的分析表明，嗜酸性粒细胞炎症在COPD中普遍存在。嗜酸性粒细胞性COPD更可能发生在男性、既往吸烟者、BMI较高者以及有某些合并症高风险的人群中；然而，嗜酸性粒细胞性COPD患者中气流受限较轻的比例较低。
