血、痰嗜酸性粒细胞联合计数评价慢性阻塞性肺疾病患者的临床预后

IF 3.4 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-10-20 DOI:10.1136/bmjresp-2025-003161

Jieqi Peng, Xiaohui Wu, Xiang Wen, Zhishan Deng, Fan Wu, Qi Wan, Gaoying Tang, Kunning Zhou, Lifei Lu, Cuiqiong Dai, Shengtang Chen, Changli Yang, Yongqing Huang, Shuqing Yu, Pixin Ran, Yumin Zhou

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引用次数: 0

摘要

背景：高血或痰嗜酸性粒细胞计数与慢性阻塞性肺疾病（COPD）的不良临床结局有关，但将两者结合评估临床预后的价值尚不清楚。在这项研究中，我们探讨了血液和痰嗜酸性粒细胞联合计数在评估COPD预后方面的价值。方法：按血（≥300个细胞/µL）和痰（≥3%）嗜酸性粒细胞计数（低血低痰、低血高痰、高血低痰、高血高痰）将患者分为4组。在基线时进行肺活量测定、问卷调查、CT扫描、脉冲振荡测定、血液实验室检查和诱导痰检查。每年进行肺活量测定和随访问卷调查。泊松回归计算急性加重的相对危险度（RR）。混合效应模型用于评估肺功能的年下降。结果：与低血、低痰嗜酸性粒细胞组相比，高血、高痰嗜酸性粒细胞组在基线时肺功能较差，气道阻力更严重，肺气肿和空气潴留更严重。高血、高痰嗜酸性粒细胞组发生咳嗽（校正OR=1.87, 95% CI 1.20 ~ 2.92, p=0.006）和喘息（校正OR=2.19, 95% CI 1.32 ~ 3.64, p=0.002）的风险较高。低血高痰嗜酸性粒细胞组痰多（校正OR=1.53, 95% CI 1.04 ~ 2.24, p=0.029）和呼吸困难（校正OR=1.68, 95% CI 1.13 ~ 2.50, p=0.010）的风险较高。高血和高痰嗜酸性粒细胞组表现出更高的总（调整后RR=1.36, 95% CI 1.15至1.60）。结论：血和痰嗜酸性粒细胞计数升高与COPD患者肺功能恶化和加重风险增加有关。

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Assessment of the clinical prognosis of patients with chronic obstructive pulmonary disease using combined blood and sputum eosinophil counts.

Background: High blood or sputum eosinophil counts are linked to poor clinical outcomes in chronic obstructive pulmonary disease (COPD), yet the value of combining both for the assessment of clinical prognosis remains unclear. In this study, we explore the value of combined blood and sputum eosinophil counts for assessing COPD outcomes.

Methods: Patients were divided into four groups by blood (≥300 cells/µL) and sputum (≥3%) eosinophil counts (low blood and low sputum, low blood and high sputum, high blood and low sputum, high blood and high sputum). Spirometry, questionnaires, CT scans, impulse oscillometry, blood laboratory tests and induced sputum tests were performed at baseline. Spirometry and follow-up questionnaires were performed annually. Poisson regression was used to compute the relative risk (RR) for acute exacerbation. The mixed-effects model was used to assess annual lung function decline.

Results: Compared with the low blood and low sputum eosinophils group, the high blood and high sputum eosinophils group had poorer lung function, more severe airway resistance and worse emphysema and air trapping at baseline. The high blood and high sputum eosinophils group had higher risks of cough (adjusted OR=1.87, 95% CI 1.20 to 2.92, p=0.006) and wheezing (adjusted OR=2.19, 95% CI 1.32 to 3.64, p=0.002). The low blood and high sputum eosinophils group had higher risks of phlegm (adjusted OR=1.53, 95% CI 1.04 to 2.24, p=0.029) and dyspnoea (adjusted OR=1.68, 95% CI 1.13 to 2.50, p=0.010). The high blood and high sputum eosinophils group demonstrated higher total (adjusted RR=1.36, 95% CI 1.15 to 1.60, p<0.001) and moderate-to-severe (adjusted RR=1.42, 95% CI 1.14 to 1.76, p=0.001) exacerbation risks. There was no significant difference in annual lung function decline among the groups.

Conclusion: Elevated blood and sputum eosinophil counts are linked to worse lung function and a higher exacerbation risk in patients with COPD.

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.