作者：尹婧婧，张巍，张茗，严之红，王昱

单位：

航天中心医院老年医学二科

Units：

Second Department of Geriatrics, Aerospace Center Hospital, Beijing 100049, China

关键词：

肺疾病,慢性阻塞性; 嗜酸粒细胞; 短期预后; 急性加重;

Keywords：

　Pulmonary disease, chronic obstructive; Eosinophils; Short-term prognosis; Acute exacerbation

CLC：

　R 563.9

DOI：

10.12114/j.issn.1008-5971.2023.00.107

Funds：

中国航天科工集团有限公司2019年医疗卫生科研项目（2019-LCYL-012）；

摘要：

目的 探讨外周血嗜酸粒细胞（EOS）与老年慢性阻塞性肺疾病急性加重（AECOPD）患者临床特征及短期预后的关系。方法 选取2019—2020年航天中心医院收治的AECOPD患者143例。将外周血EOS百分比≥2%的患者作为阳性组（n=62）,<2%的患者作为阴性组（n=81）。比较阳性组与阴性组一般资料、实验室检查指标、肺功能指标、慢性阻塞性肺疾病自我评估（CAT）评分、呼出气一氧化氮（FeNO）。记录患者出院后30 d内因急性加重再次入院情况，采用多因素Logistic回归分析探讨外周血EOS与老年AECOPD患者出院后30 d内因急性加重再次入院的关系。结果 阳性组近12个月内急性加重次数≥2次者占比高于阴性组，住院时间及住院期间全身性糖皮质激素使用天数短于阴性组（P<0.05）。阳性组C反应蛋白（CRP）、降钙素原（PCT）及FeNO高于阴性组（P<0.05）。31例患者出院后30 d内因急性加重再次入院，将其作为再入院组，其余患者作为非再入院组。再入院组近12个月内急性加重次数≥2次者占比、外周血EOS阳性者占比、FeNO高于非再入院组（P<0.05）。多因素Logistic回归分析结果显示，近12个月内急性加重次数≥2次、外周血EOS阳性及FeNO升高是老年AECOPD患者出院后30 d内因急性加重再次入院的独立危险因素（P<0.05）。结论 外周血EOS百分比≥2%的老年AECOPD患者急性加重次数更多，CRP、PCT、FeNO更高，但住院时间及住院期间全身性糖皮质激素使用时间较短，且外周血EOS百分比≥2%是老年AECOPD患者出院后30 d因内急性加重再次入院的独立危险因素。

Abstract：

Objective To explore the relationship between peripheral blood eosinophils (EOS) and clinical features and short-term prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . Methods A total of 143 patients with AECOPD admitted to the Aerospace Center Hospital from 2019 to 2020 were selected. Patients with peripheral blood EOS percentage ≥ 2% were included in the positive group (n=62) and patients with peripheral blood EOS percentage < 2% were included in the negative group (n=81) . General data, laboratory examination indexes, pulmonary function indexes, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scores, and fractional exhaled nitric oxide (FeNO) were compared between the positive group and negative group. The readmission due to acute exacerbation within 30 days after discharge was recorded. Multivariate Logistic regression analysis was used to investigate the relationship between peripheral blood EOS and readmission due to acute exacerbation in elderly patients with AECOPD within 30 days after discharge. Results The proportion of patients with acute exacerbation ≥ 2 times in the past 12 months in positive group was higher than that in negative group, the length of hospitalization and days of systemic glucocorticoid use during hospitalization were shorter than those in negative group (P < 0.05) . C-reactive protein (CRP) , procalcitonin (PCT) and FeNO in positive group were higher than those in negative group (P < 0.05) . Thirty-one patients were readmitted to hospital due to acute exacerbation within 30 days after discharge and were classified as readmission group, while the rest patients were classified as non-readmission group. The proportion of patients with acute exacerbation ≥ 2 times in the past 12 months, the proportion of patients with positive EOS in peripheral blood and FeNO in the readmission group were higher than those in the non-readmission group (P < 0.05) . Multivariate Logistic regression analysis showed that acute exacerbation ≥ 2 times in the past 12 months, positive EOS in peripheral blood and elevated FeNO were independent risk factors for readmission due to acute exacerbation in elderly patients with AECOPD within 30 days after discharge (P < 0.05) . Conclusion Elderly AECOPD patients with peripheral blood EOS percentage ≥ 2% had more acute exacerbations, higher CRP, PCT and FeNO, but shorter hospital stay and systemic glucocorticoid use during hospitalization. In addition, peripheral blood EOS percentage ≥ 2% is an independent risk factor for readmission due to acute exacerbation in elderly patients with AECOPD within 30 days after discharge.

ReferenceList：