稳定期 COPD 中嗜酸性粒细胞恶化与嗜酸性粒细胞水平的关系。
The association between eosinophilic exacerbation and eosinophilic levels in stable COPD.
机构信息
Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
出版信息
BMC Pulm Med. 2021 Mar 2;21(1):74. doi: 10.1186/s12890-021-01443-4.
BACKGROUND
Blood eosinophil count may predict treatment response in patients with chronic obstructive pulmonary disease (COPD) during acute exacerbations (AE). However, the ability and thresholds of blood eosinophil counts in stable status to predict eosinophilic AECOPD have not been completely investigated.
METHODS
This was a retrospective multicenter study performed January 2010 to December 2014. COPD subjects hospitalized with exacerbations, were included. Blood samples were obtained at the time of AE and stable disease at outpatient clinic before or after admission. We identified a blood eosinophil count cut-off point at stable COPD, either taken as a percentage or as absolute value, for identification of eosinophilic exacerbation.
RESULTS
There was significant positive correlation of eosinophil counts between stable COPD and AECOPD. The best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation based on blood eosinophil count ≥ 2% was 300 cells/µL (area under the ROC curve [AUC] 0.614, P = 0.001, 39% sensitivity, 83.8% specificity). When the eosinophilic COPD exacerbation was based on blood eosinophil count ≥ 300 cells/µL, the best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation was also 300 cells/uL (AUC 0.634, P = 0.046, 45.8% sensitivity, 80.9% specificity).
CONCLUSIONS
We demonstrated association between blood eosinophil counts at stable COPD and those with AECOPD. The thresholds of blood counts at stable COPD to predict eosinophilic exacerbations was 300 cells/µL. Further and prospective studies in other populations should validate our results.
背景
嗜酸性粒细胞计数可能预测慢性阻塞性肺疾病（COPD）患者在急性加重期（AE）期间的治疗反应。然而，在稳定状态下，嗜酸性粒细胞计数的能力和阈值是否能够预测嗜酸性 AECOPD 尚未得到充分研究。
方法
这是一项回顾性多中心研究，于 2010 年 1 月至 2014 年 12 月进行。纳入因加重而住院的 COPD 患者。在 AE 时和入院前或后门诊的稳定期采集血液样本。我们确定了稳定 COPD 时的嗜酸性粒细胞计数截断点，无论是以百分比还是绝对值表示，用于识别嗜酸性加重。
结果
稳定 COPD 和 AECOPD 之间的嗜酸性粒细胞计数存在显著正相关。基于嗜酸性粒细胞计数≥2%，稳定状态下嗜酸性粒细胞计数预测嗜酸性 COPD 加重的最佳截断值为 300 个细胞/µL（ROC 曲线下面积 [AUC] 为 0.614，P=0.001，敏感性为 39%，特异性为 83.8%）。当基于嗜酸性粒细胞计数≥300 个细胞/µL 预测嗜酸性 COPD 加重时，稳定状态下嗜酸性粒细胞计数预测嗜酸性 COPD 加重的最佳截断值也是 300 个细胞/µL（AUC 为 0.634，P=0.046，敏感性为 45.8%，特异性为 80.9%）。
结论
我们证明了稳定 COPD 时的嗜酸性粒细胞计数与 AECOPD 时的嗜酸性粒细胞计数之间存在关联。预测嗜酸性加重的稳定期嗜酸性粒细胞计数的阈值为 300 个细胞/µL。应在其他人群中进行进一步和前瞻性研究来验证我们的结果。
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