SPIROMICS COPD 队列中绝对血嗜酸性粒细胞计数低的临床意义。
Clinical Implications of Low Absolute Blood Eosinophil Count in the SPIROMICS COPD Cohort.
机构信息
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN.
University of North Carolina, Chapel Hill, NC.
出版信息
Chest. 2023 Mar;163(3):515-528. doi: 10.1016/j.chest.2022.10.029. Epub 2022 Nov 4.
BACKGROUND
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) considers blood eosinophil counts < 100 cells/μL (BEC) in people with COPD to predict poor inhaled corticosteroid (ICS) responsiveness. However, the BEC phenotype is inadequately characterized, especially in advanced COPD.
RESEARCH QUESTION
Are there differences between GOLD group D patients with high BEC and those with low BEC regarding baseline characteristics and longitudinal outcomes?
STUDY DESIGN AND METHODS
We used multivariable mixed models and logistic regression to contrast clinical characteristics and outcomes of BEC vs BEC > 100 (BEC) in all subjects with COPD (n = 1,414) and GOLD group D subjects (n = 185) not receiving ICS.
RESULTS
We identified n = 485 with BEC (n = 61 GOLD group D) and n = 929 people with BEC (n = 124 GOLD group D). BEC status was stable at 6 weeks and approximately 52 weeks (intraclass correlations of 0.78 and 0.71, respectively). Compared with BEC, BEC comprised more women, with greater current smoking, and less frequent childhood asthma. Among all analyzed participants, the two BEC-defined subsets showed similar rates of lung function decline (mean slope, BEC vs BEC, -50 vs -39 mL/y; P = .140), exacerbations (0.40 vs 0.36/y; P = .098), subsequent ICS initiation (2.5% vs 4.4%; P = .071), and mortality (7.8% vs 8.4%; P = .715). However, in GOLD group D, people with BEC showed higher exacerbation rates within 365 days of enrollment (0.62 vs 0.33/y; P = .002) and total follow-up (1.16 vs 0.83/y; P = .014). They also had greater lung function decline (mean slope of -68 mL/y vs -23 mL/y; P = .036) and had greater emphysema at baseline (voxels < 950 Hounsfield units at total lung capacity of 7.46% vs 4.61%; P = .029).
INTERPRETATION
In non-ICS-treated GOLD group D COPD, people with BEC had more baseline emphysema, prospective exacerbations, and lung function decline. Our analysis has identified a particularly vulnerable subpopulation of people with COPD, suggesting the need for studies focused specifically on their therapeutic treatment.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT01969344; URL: www.
CLINICALTRIALS
gov.
背景
全球慢性阻塞性肺疾病倡议（GOLD）认为，COPD 患者血液嗜酸性粒细胞计数 <100 个/μL（BEC）可预测吸入皮质类固醇（ICS）反应不佳。然而，BEC 表型的特征描述不足，尤其是在晚期 COPD 中。
研究问题
在未接受 ICS 治疗的所有 COPD 患者（n=1414）和 GOLD 组 D 患者（n=185）中，BEC 较高和较低的 GOLD 组 D 患者在基线特征和纵向结局方面是否存在差异？
研究设计和方法
我们使用多变量混合模型和逻辑回归来对比 BEC 与 BEC > 100（BEC）在所有 COPD 患者（n=1414）和未接受 ICS 治疗的 GOLD 组 D 患者（n=185）中的临床特征和结局。
结果
我们确定了 n=485 例 BEC（n=61 例 GOLD 组 D）和 n=929 例 BEC（n=124 例 GOLD 组 D）。BEC 状态在 6 周和大约 52 周时保持稳定（组内相关系数分别为 0.78 和 0.71）。与 BEC 相比，BEC 组中更多的女性，当前吸烟的频率更高，而儿童时期哮喘的频率更低。在所有分析的参与者中，两个 BEC 定义的亚组显示出相似的肺功能下降率（平均斜率，BEC 与 BEC，-50 与-39mL/y；P=0.140），急性加重（0.40 与 0.36/y；P=0.098），随后开始使用 ICS（2.5%与 4.4%；P=0.071）和死亡率（7.8%与 8.4%；P=0.715）。然而，在 GOLD 组 D 中，BEC 患者在入组后 365 天内急性加重发生率更高（0.62 与 0.33/y；P=0.002）和总随访期（1.16 与 0.83/y；P=0.014）。他们的肺功能下降也更明显（平均斜率为-68mL/y 与-23mL/y；P=0.036），并且基线时肺气肿更严重（全肺容量为 7.46%时<950 个 Hounsfield 单位的体积比为 4.61%；P=0.029）。
解释
在未接受 ICS 治疗的 GOLD 组 D COPD 患者中，BEC 患者的基线肺气肿更严重，未来急性加重的风险更高，肺功能下降更明显。我们的分析确定了 COPD 患者中一个特别脆弱的亚群，这表明需要专门针对他们的治疗进行研究。
临床试验注册
ClinicalTrials.gov；编号：NCT01969344；网址：www.clinicaltrials.gov。
临床试验
ClinicalTrials.gov。
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