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目的论证痰检嗜酸粒细胞阳性的慢性阻塞性肺疾病(COPD)患者是否预示吸入糖皮质激素的临床和功能反应较好,而痰嗜酸粒细胞计数阴性的患者糖皮质激素治疗效果较差。方法28例痰检嗜酸粒细胞阳性的慢性阻塞性肺疾病加重期(AECOPD)患者设为治疗组,按随机配对原则入选痰检嗜酸粒细胞阴性的AECOPD患者28例设为对照组,均用糖皮质激素(静脉予甲基强的松龙40mg/d,0～3d后序贯口服泼尼松治疗后吸入糖皮质激素,出院后院外继续吸入糖皮质激素)及常规治疗共6个月。常规治疗包括:控制性氧疗,抗感染,化痰,止咳,使用支气管舒张剂等。治疗前及治疗后10、30d测FEV1、FEV1占预计值百分比、FEV1/FVC,统计6个月内首次COPD严重急性发作时间和COPD急性加重发生率,结果治疗组FEV1、FEV1占预计值百分比、FEV1/FVC均有明显提高,2组之间差异有统计学意义(P<0.05),治疗组首次COPD严重急性发作时间〔(106.78±42.52)d〕,较对照组〔(71.44±32.62)d〕明显延长(t=3.49,P<0.01),治疗组的COPD急性加重发生率(29.6%)明显少于对照组(43.4%)。结论痰检嗜酸粒细胞阳性患者预示吸入糖皮质激素的临床和功能反应较好,痰检嗜酸粒细胞阳性是临床COPD患者使用糖皮质激素治疗的较好指标,值得临床推广应用。
Objective To demonstrate whether sputum eosinophils in patients with chronic obstructive pulmonary disease (COPD) are predictive of good clinical and functional response to inhaled glucocorticoid, whereas patients with sputum eosinophil counts have poorer outcomes with glucocorticoid . Methods Twenty-eight patients with sputum eosinophilia and chronic obstructive pulmonary disease (AECOPD) exacerbated (AECOPD) were enrolled as the treatment group. According to the random matching principle, 28 patients with sputum eosinophil-negative AECOPD were selected as control group With glucocorticoid (intravenous methylprednisolone 40mg / d, 0 ~ 3d after oral administration of prednisone after inhaled corticosteroids, discharged from the hospital after continuous corticosteroids) and routine treatment for 6 months . Conventional treatment include: controlled oxygen therapy, anti-infection, phlegm, cough, the use of bronchodilators and so on. FEV1, FEV1 percentage of predicted value, FEV1 / FVC were measured before treatment and at 10 and 30 days after treatment. The first acute exacerbation of COPD and the incidence of acute exacerbation of COPD within 6 months were statistically analyzed. Results The percentages of FEV1 and FEV1 in the treatment group were predicted, (P <0.05). The first acute exacerbation of COPD was (106.78 ± 42.52) d in the treatment group, which was significantly higher than that in the control group [(71.44 ± 32.62) d (T = 3.49, P <0.01). The incidence of acute exacerbation of COPD in the treatment group (29.6%) was significantly less than that in the control group (43.4%). Conclusions Phlegm eosinophils positive patients predict good clinical and functional response to inhaled glucocorticoid. Positive sputum eosinophils are a good indicator of glucocorticoid therapy in clinical COPD patients, which is worthy of clinical application.