诊断时血嗜酸性粒细胞计数与慢性阻塞性肺疾病年度加重频率和严重程度的关联:一项前瞻性纵向分析

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM Canadian respiratory journal Pub Date : 2023-01-01 DOI:10.1155/2023/8678702
Arda Kiani, Fatemehsadat Rahimi, Siamak Afaghi, Maryam Paat, Mohammad Varharam, Mehdi Kazempour Dizaji, Maryam Dastoorpoor, Atefeh Abedini
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引用次数: 0

摘要

关于血嗜酸性粒细胞计数与COPD恶化的关系存在争议。我们的目的是确定慢性阻塞性肺病诊断时外周血嗜酸性粒细胞是否会影响慢性阻塞性肺病年度急性加重(AECOPD)的频率和严重程度。方法:本前瞻性研究对伊朗某肺科中心973例新诊断的COPD患者进行了为期1年的随访。采用Cox比例模型、多项式回归和受体算子特征曲线评价嗜酸性粒细胞水平对AECOPD的影响。采用线性回归模型评估嗜酸性粒细胞计数与AECOPDs的持续关联。结果:与900细胞/微升和600细胞/微升的慢性阻塞性肺病患者相比,嗜酸性粒细胞>200细胞/微升的患者是较高的吸烟者,肺动脉高压患病率较高,预测发生一种以上AECOPD的敏感性分别为71.1%和64.3%。新诊断AECOPD患者的约登指数以800个细胞/微升嗜酸性粒细胞计数切断值最高,敏感性为80.2%,特异性为76.6%。使用线性模型,血清嗜酸性粒细胞增加180细胞/微升与进一步恶化相关。评估性别、BMI、吸烟包年、FEV1/FVC、CAT评分、GOLD评分、肺动脉高压、年度流感、肺炎球菌疫苗接种、白细胞计数、嗜酸性粒细胞,仅嗜酸性粒细胞(危险比(HR) = 1.44;95%置信区间= 1.33-2.15;p值= 0.03)和GOLD评分(HR = 1.19;95% ci = 1.30-1.52;p值= 0.03)为AECOPD >3次/年的独立危险因素。嗜酸性粒细胞组和非嗜酸性粒细胞组的ICU入院要求、有创通气和AECOPDs死亡率相似。结论:慢性阻塞性肺疾病诊断时嗜酸性粒细胞增多是慢性阻塞性肺疾病复发的一个因素。为了降低AECOPDs的风险和疾病负担,临床医生可以考虑对嗜酸性慢性阻塞性肺病患者使用较低阈值的吸入器皮质类固醇和室内氧气,无论其临床状态如何。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Association of Upon-Diagnosis Blood Eosinophilic Count with Frequency and Severity of Annual Exacerbation in Chronic Obstructive Pulmonary Disease: A Prospective Longitudinal Analysis.

Introduction: There is a controversy regarding the relationship between blood eosinophil count and COPD exacerbation. We aimed to determine whether peripheral eosinophils upon COPD diagnosis could affect the frequency and severity of annual acute exacerbation of COPD (AECOPD).

Methods: This prospective study was conducted on 973 newly diagnosed COPD patients who were under 1-year follow-up in a pulmonology center in Iran. The Cox proportional model, polynomial regression, and receiver operator characteristic curves were conducted to evaluate the impact of the eosinophil levels on AECOPD. A linear regression model was conducted to evaluate the continuous association of eosinophilic count with AECOPDs.

Results: Patients with eosinophil >200 cells/microliter were higher pack-year smokers with more pulmonary hypertension prevalence compared to COPD patients with <200 cells/microliter. There was a positive correlation between the eosinophilic count and the frequency of AECOPDs. Eosinophil >900 cells/microliter and eosinophil >600 cells/microliter had a sensitivity of 71.1% and 64.3%, respectively, in predicting the occurrence of more than one AECOPD. Eosinophilic count cutoff of 800 cells/microliter had the highest Youden index with sensitivity and specificity of 80.2% and 76.6%, respectively, for incident AECOPD in newly diagnosed patients. Using a linear model, increasing 180 cells/microliter in serum eosinophils was associated with further exacerbation. Evaluating gender, BMI, smoking pack-year, FEV1/FVC, CAT score, GOLD score, pulmonary hypertension, annual influenza, pneumococcal vaccinations, leukocytosis, and blood eosinophils, only blood eosinophils (hazard ratio (HR) = 1.44; 95% confidence interval = 1.33-2.15; p value = 0.03) and GOLD score (HR = 1.19; 95% CI = 1.30-1.52; p value = 0.03) were found as independent risk factors of AECOPD >3 episodes/year. Requirement for ICU admission, invasive ventilation, and mortality rate due to AECOPDs was similar between eosinophilic and noneosinophilic groups.

Conclusion: Eosinophilia upon COPD diagnosis is a factor of recurrent AECOPDs. To reduce the risk of AECOPDs and the burden of disease, clinicians may consider inhaler corticosteroids and domiciliary oxygen with a lower threshold for eosinophilic-COPD patients regardless of their clinical status.

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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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