Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan.
Clinical Research Center, Saga University Hospital, Saga, Japan.
BMC Pulm Med. 2020 Dec 7;20(1):318. doi: 10.1186/s12890-020-01362-w.
Exacerbations are critical events in chronic pulmonary obstructive disease (COPD). The frequency of COPD exacerbations is associated with the prognosis, including mortality, but no useful biomarker has been established.
The present retrospective study investigated 481 COPD patients. Clinical features in the stable period were compared between patients who experienced severe exacerbation (n = 88, 18.3%) and those who never experienced severe exacerbation (n = 393, 81.7%). In the patients who experienced exacerbations, clinical features were also compared between frequent exacerbators (exacerbation rate ≥ 2 times/year, n = 27, 30.7%) and infrequent exacerbators (1 time/year, n = 61, 69.3%).
Compared to COPD patients who never experienced exacerbations, body mass index (BMI), serum albumin, and pulmonary functions were significantly lower, and the cardiovascular disease comorbidity rate, COPD assessment test score, modified Medical Research Council dyspnea scale, and use of long-term oxygen therapy, long-acting β adrenergic agonist therapy, inhaled corticosteroid therapy, and macrolide therapy were significantly higher in COPD patients with exacerbations (all p < 0.01). In patients who experienced exacerbations, frequent exacerbators had significantly lower % forced expiratory volume in 1.0 s and a higher risk of critical exacerbations, percentage of blood eosinophils, history of mechanical ventilation use, and use of long-term oxygen therapy and of macrolide therapy than infrequent exacerbators (all p < 0.01). On multivariate analysis, the percentage of blood eosinophils was the parameter most correlated with exacerbation frequency (β value [95% confidence interval] 1.45 [1.12-1.88], p < 0.01).
Blood eosinophil in the stable period is the factor most correlated with the frequency of severe exacerbations.
The patients in this study was registered retrospectively.
加重是慢性阻塞性肺疾病（COPD）的关键事件。COPD 加重的频率与预后相关，包括死亡率，但尚未建立有用的生物标志物。
本回顾性研究调查了 481 例 COPD 患者。比较了经历严重加重（n=88，18.3%）和从未经历严重加重（n=393，81.7%）的稳定期患者的临床特征。在经历加重的患者中，还比较了频繁加重者（加重率≥2 次/年，n=27，30.7%）和非频繁加重者（1 次/年，n=61，69.3%）的临床特征。
与从未经历过加重的 COPD 患者相比，经历过加重的患者的体重指数（BMI）、血清白蛋白和肺功能明显较低，心血管疾病合并症发生率、COPD 评估测试评分、改良的医学研究理事会呼吸困难量表以及长期氧疗、长效β肾上腺素能激动剂治疗、吸入皮质类固醇治疗和大环内酯类治疗的使用率明显较高（均 P<0.01）。在经历过加重的患者中，频繁加重者的 1.0 秒用力呼气量百分比明显较低，发生严重加重的风险较高，血嗜酸性粒细胞百分比较高，有机械通气使用史，长期氧疗和大环内酯类治疗的使用率较高（均 P<0.01）。多变量分析显示，血嗜酸性粒细胞百分比是与加重频率最相关的参数（β值[95%置信区间]1.45[1.12-1.88]，P<0.01）。
稳定期的血嗜酸性粒细胞是与严重加重频率最相关的因素。
本研究中的患者是回顾性注册的。
