Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain.
Int J Chron Obstruct Pulmon Dis. 2020 Mar 31;15:681-690. doi: 10.2147/COPD.S240720. eCollection 2020.
Chronic obstructive pulmonary disease (COPD) is associated with increased lung and systemic inflammation. We aimed to identify associations between easy-to-obtain blood biomarkers and the frequency and severity of exacerbations.
Cross-sectional, multicentre study performed in four centres in Spain, Italy, Bulgaria, and Slovenia. Blood samples were obtained for blood cell count, C-reactive protein (CRP), alpha-1 antitrypsin (AAT) and fibrinogen analysis. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and eosinophil/basophil ratio (EBR) were calculated. Firstly, patients were divided into clinical phenotypes according to the Spanish guidelines of COPD, and secondly, patients were classified into 2 groups: non-exacerbators (≤1 ambulatory exacerbation in the previous year) and exacerbators (≥2 ambulatory exacerbations or 1 hospitalisation in the previous year). A multivariate stepwise logistic regression model was performed to identify laboratory parameters associated with exacerbators.
A total of 355 patients with a mean age 66 years (SD=8.9) were included, and 64% were male. The mean FEV1% (forced expiratory volume in the first second) was 55% (SD=20%), and the mean COPD Assessment Test (CAT) score was 15.6 (SD=7.9). One hundred ninety-six (55.2%) patients were classified in the non-exacerbator group, and 159 (44.8%) were exacerbators. Patients in the exacerbators group presented lower haemoglobin levels (p=0.019) and ERB (p= 0.023) but higher CRP levels (p=0.001). In the multivariate analysis, females, higher levels of CRP, lower FEV1% and low EBR were independently related to exacerbators.
Female sex, having a more severe impairment of lung function, higher CRP levels and a lower EBR are associated with an exacerbator phenotype in COPD.
慢性阻塞性肺疾病（COPD）与肺部和全身炎症的增加有关。我们旨在确定易于获得的血液生物标志物与加重的频率和严重程度之间的关联。
在西班牙、意大利、保加利亚和斯洛文尼亚的四个中心进行了横断面、多中心研究。采集血样进行血细胞计数、C 反应蛋白（CRP）、α-1 抗胰蛋白酶（AAT）和纤维蛋白原分析。计算中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）和嗜酸性粒细胞/嗜碱性粒细胞比值（EBR）。首先，根据西班牙 COPD 指南将患者分为临床表型，其次，将患者分为 2 组：非加重组（前一年≤1 次门诊加重）和加重组（前一年≥2 次门诊加重或 1 次住院）。进行多变量逐步逻辑回归模型以确定与加重者相关的实验室参数。
共纳入 355 名平均年龄 66 岁（SD=8.9）的患者，其中 64%为男性。平均 FEV1%（第一秒用力呼气量）为 55%（SD=20%），平均 COPD 评估测试（CAT）评分为 15.6（SD=7.9）。196 名（55.2%）患者被归类为非加重组，159 名（44.8%）为加重组。加重组患者的血红蛋白水平较低（p=0.019）和 EBR 较低（p=0.023），但 CRP 水平较高（p=0.001）。多变量分析表明，女性、较高的 CRP 水平、较低的 FEV1%和较低的 EBR 与加重者独立相关。
女性、更严重的肺功能损害、更高的 CRP 水平和较低的 EBR 与 COPD 加重者表型相关。
