监测 COPD 患者：2 年随访中的系统性和支气管嗜酸性粒细胞炎症。
Monitoring COPD patients: systemic and bronchial eosinophilic inflammation in a 2-year follow-up.
机构信息
Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Via S.Maugeri 10, Pavia, 27100, Italy.
Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
出版信息
BMC Pulm Med. 2024 May 19;24(1):247. doi: 10.1186/s12890-024-03062-1.
BACKGROUND
High blood eosinophils seem to predict exacerbations and response to inhaled corticosteroids (ICS) treatment in patients with chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate for 2 years, blood and sputum eosinophils in COPD patients treated with bronchodilators only at recruitment.
METHODS
COPD patients in stable condition treated with bronchodilators only underwent monitoring of lung function, blood and sputum eosinophils, exacerbations and comorbidities every 6 months for 2 years. ICS was added during follow-up when symptoms worsened.
RESULTS
63 COPD patients were enrolled: 53 were followed for 1 year, 41 for 2 years, 10 dropped-out. After 2 years, ICS was added in 12/41 patients (29%) without any statistically significant difference at time points considered. Blood and sputum eosinophils did not change during follow-up. Only FEV/FVC at T0 was predictive of ICS addition during the 2 year-follow-up (OR:0.91; 95% CI: 0.83-0.99, p = 0.03). ICS addition did not impact on delta (T24-T0) FEV, blood and sputum eosinophils and exacerbations. After 2 years, patients who received ICS had higher blood eosinophils than those in bronchodilator therapy (p = 0.042). Patients with history of ischemic heart disease increased blood eosinophils after 2 years [p = 0.03 for both percentage and counts].
CONCLUSIONS
Blood and sputum eosinophils remained stable during the 2 year follow-up and were not associated with worsened symptoms or exacerbations. Almost 30% of mild/moderate COPD patients in bronchodilator therapy at enrollment, received ICS for worsened symptoms in a 2 year-follow-up and only FEV/FVC at T0 seems to predict this addition. History of ischemic heart disease seems to be associated with a progressive increase of blood eosinophils.
背景
高血嗜酸性粒细胞似乎可以预测慢性阻塞性肺疾病（COPD）患者的恶化和对吸入性皮质类固醇（ICS）治疗的反应。我们的研究目的是前瞻性地评估在招募时仅接受支气管扩张剂治疗的 COPD 患者的血液和痰中的嗜酸性粒细胞，为期 2 年。
方法
仅接受支气管扩张剂治疗的稳定期 COPD 患者，每 6 个月监测肺功能、血液和痰中的嗜酸性粒细胞、恶化情况和合并症，为期 2 年。在随访过程中，如果症状恶化，则添加 ICS。
结果
共纳入 63 例 COPD 患者：53 例随访 1 年，41 例随访 2 年，10 例脱落。2 年后，在 41 例患者中，有 12 例（29%）添加了 ICS，但在考虑的时间点上没有统计学上的显著差异。在随访期间，血液和痰中的嗜酸性粒细胞没有变化。只有 T0 时的 FEV/FVC 是预测 2 年随访期间添加 ICS 的因素（OR：0.91；95%CI：0.83-0.99，p=0.03）。ICS 的添加并未影响 delta（T24-T0）FEV、血液和痰中的嗜酸性粒细胞和恶化。2 年后，接受 ICS 治疗的患者的血液嗜酸性粒细胞高于接受支气管扩张剂治疗的患者（p=0.042）。有缺血性心脏病病史的患者在 2 年后血液嗜酸性粒细胞增加[百分比和计数均为 p=0.03]。
结论
在 2 年的随访期间，血液和痰中的嗜酸性粒细胞保持稳定，与症状恶化或恶化无关。在招募时接受支气管扩张剂治疗的轻度/中度 COPD 患者中，近 30%在 2 年随访中因症状恶化而接受了 ICS 治疗，只有 T0 时的 FEV/FVC 似乎可以预测这种添加。缺血性心脏病史似乎与血液嗜酸性粒细胞的逐渐增加有关。
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