外周血嗜酸性粒细胞计数水平对慢阻肺患者肺康复治疗获益价值的影响

目的评估不同外周血嗜酸性粒细胞(Eosinophils,EOS)计数水平对慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者行肺康复治疗获益价值的影响。方法连续收集于重庆医科大学附属第一医院就诊的COPD患者,采用前瞻性随机对照法,分为康复组和对照组,根据入组时血EOS%将两组患者分别分为两个亚组(EOS≥2%组和EOS<2%组)。在康复治疗结束时及康复治疗结束后第6月随访6MWD、CAT评分及Borg评分。结果共计37例患者完成试验,康复组19例(EOS≥2%组11例和EOS<2%组8例),对照组18例(EOS≥2%组11例和EOS<2%组7例)。在康复治疗结束时,是否行肺康复和血EOS水平,在对6MWD和CAT评分的影响上均存在交互作用(P<0.05),但对Borg评分的影响不存在交互作用(P>0.05)。在康复治疗结束后第6月,是否行肺康复和血EOS水平在对6MWD、CAT评分和Borg评分的影响上均存在交互作用(P<0.05)。结论肺康复能提高COPD患者的运动能力、减轻症状负担及改善疲劳程度。相较于外周血EOS<2%的COPD患者,EOS≥2%的COPD患者能从康复训练中获益更多。     

糖皮质激素治疗嗜酸粒细胞阳性慢性阻塞性肺疾病急性加重期患者的临床疗效观察

目的观察糖皮质激素治疗嗜酸粒细胞(EOS)阳性慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效。方法选取2014年11月—2015年3月在重庆市南川区人民医院呼吸科就诊的AECOPD患者47例,根据痰EOS比例及是否采用激素治疗分为EOS阳性激素治疗组(A组,n=10)、EOS阴性激素治疗组(B组,n=12)、EOS阳性非激素治疗组(C组,n=11)及EOS阴性非激素治疗组(D组,n=14)。4组患者均给予常规治疗,A、B组患者在常规治疗基础上给予雾化吸入布地奈德混悬溶液治疗,所有患者于入院当日及治疗第8天测定呼出气一氧化氮(FENO)、痰EOS、血气分析指标并评估COPD评估测试(CAT)评分。结果 A组患者治疗后FENO、痰EOS比例均低于治疗前(P0.05);C组患者治疗后FENO低于治疗前(P0.05),而痰EOS比例与治疗前比较,差异无统计学意义(P0.05);B、D组患者治疗后FENO、痰EOS比例与治疗前比较,差异无统计学意义(P0.05)。AECOPD患者治疗前、后FENO均与痰EOS比例呈正相关(r=0.702、0.804,P0.01)。4组患者治疗后PO2均高于治疗前,CAT评分均低于治疗前(P0.05);4组患者治疗后PCO2与治疗前比较,差异均无统计学意义(P0.05)。结论 EOS阳性AECOPD患者对糖皮质激素治疗反应较好,FENO可反映气道EOS浸润程度及评估AECOPD患者糖皮质激素治疗疗效。     

嗜酸粒细胞与慢性阻塞性肺疾病患者激素治疗及预后关系的研究进展

慢性阻塞性肺疾病(COPD)是一种以气流受限为主要特征的可预防、可治疗疾病。2017慢性阻塞性肺疾病全球倡议(GOLD)指出,COPD是导致慢性病患病的主要原因,也是全球范围内四大死亡原因之一。近年研究表明,嗜酸粒细胞(EOS)可能在10%～40%的COPD患者中发挥着重要作用,但EOS是否可以指导COPD患者的激素治疗尚存在争议。本文主要综述了EOS与COPD患者激素治疗及预后的关系,以期为临床有效提高COPD患者治疗效果及改善患者预后提供参考。     

慢性阻塞性肺疾病稳定期患者外周血嗜酸性粒细胞表型及临床特征分析全文替换

目的 探讨慢性阻塞性肺疾病(COPD)稳定期患者外周血嗜酸性粒细胞(EOS)表型及其临床特征。方法 纳入COPD稳定期患者227例,根据外周血EOS计数将其分为高EOS组(EOS计数≥300个/μl)37例、中EOS组(100个/μl≤EOS计数<300个/μl)74例及低EOS组(EOS计数<100个/μl)166例。收集所有患者一般临床资料、实验室检查结果、血气分析结果、肺功能检查结果及呼出气一氧化氮(FeNO)水平并分组进行比较。采用多元线性回归分析评估COPD稳定期患者EOS计数的相关因素。结果 高EOS组年龄、近1年内COPD急性加重次数、男性及COPD C组患者比例、FeNO水平均明显高于中EOS组和低EOS组,吸烟指数明显低于中EOS组和低EOS组;高EOS组及中EOS组过去1年规律使用吸入糖皮质激素(ICS)患者比例均明显高于低EOS组,D-二聚体、纤维蛋白原水平均明显低于低EOS组(P<0.05)。多元线性回归分析结果显示,年龄、性别、吸烟指数、D-二聚体及FeNO与COPD稳定期EOS计数相关(P<0.05)。结论 高EOS型COPD稳定期患...     

慢性阻塞性肺疾病急性加重期患者穴位电脑中频刺激的促排痰效果

目的观察电脑中频刺激穴位促进慢性阻塞性肺疾病(COPD)急性期患者排痰的效果。方法 60例COPD急性期患者随机分为对照组和治疗组各30例。对照组采取常规促进排痰措施,治疗组在常规措施的基础上使用电脑中频穴位(丰隆穴、天突、肺俞、定喘穴)刺激以促进排痰,2次/d,20 min/次,7 d为1个疗程。第1、3、5、7天进行效果评估。结果穴位电脑中频刺激可以缓解患者排痰困难情况并提高血中氧分压含量。结论穴位电脑中频刺激有促进COPD患者急性发作期排痰的作用。     

临床指标与气道炎症标志物对预示COPD病情的意义

目的研究慢性阻塞性肺疾病（COPD）急性发作与缓解期，部分临床指标（FEV1％、SRGQ、吸烟指数、血气）及气道炎症标记物（CRP、IL-6）的变化与相关性，探讨这些终点指标对证实急性发作和预测急性发作严重性的价值。方法分析COPD急性发作住院患者治疗前后圣乔治呼吸调查问卷（SGRQ）和肺功能、血气及血与痰CRP、痰IL-6、细菌谱的变化。结果急性发作期间SGRQ评分、痰量及血和／或痰CRP、IL-6增加，肺功能下降；FEV1％与SGRQ、吸烟指数、血、痰CRP及痰IL-6浓度高度负相关（P〈0．05或0．01）；而血、痰CRP及痰IL-6浓度分别与吸烟指数、每日痰量显著正相关（P〈0．05或0．01）；血CRP与痰CRP、IL-6及痰CRP与IL-6分别正相关（P〈0.01）。两组痰菌均以革兰阴性菌为主，重度组百分率显著高于中度组（P〈0．05）。结论SGRQ、吸烟指数、血CRP及痰炎症指标（CRP、IL-6）结合痰量变化可有效地证实COPD急性发作或病情演变。     

支气管哮喘患者不同时期诱导痰及血嗜酸粒细胞水平的观察

目的探讨诱导痰及末梢血嗜酸粒细胞(EOS)比例、诱导痰嗜酸粒细胞阳离子蛋白(ECP)水平在支气管哮喘（简称哮喘）发病不同时期的变化及应用价值。方法检测哮喘发作期40例（发作组）、哮喘缓解期48例（缓解组）、40名正常健康体检者（对照组）的诱导痰及末梢血EOS占白细胞百分比,同时分别测定痰ECP。结果 ①末梢血中EOS比...     

下呼吸道细菌定植对稳定期COPD患者免疫细胞和炎性因子水平的影响分析

目的探讨下呼吸道细菌定植对稳定期慢性阻塞性肺疾病(COPD)患者免疫细胞和炎性因子水平影响。方法选取2014年2月至2015年12月在我院诊治的稳定期COPD患者为研究对象,根据患者痰培养结果,将患者分为合并有下呼吸道细菌定植的定植组(57例)以及无下呼吸道细菌定植的对照组(37例),检测比较两组患者中性粒细胞、抑制性T细胞、巨噬细胞、辅助T细胞及痰液白介素-6(IL-6)、痰液和血白介素-8(IL-8)、血超敏C反应蛋白(hs-CRP)、血肿瘤坏死因子-α(TNF-α)水平。结果定植组COPD患者中性粒细胞、抑制性T细胞水平(%)高于对照组,巨噬细胞、辅助T细胞水平(%)低于对照组,差异有统计学意义(P0.05);定植组COPD患者痰液IL-6、痰液和血IL-8、血hs-CRP、血TNF-α水平均高于对照组,差异有统计学意义(P0.05)。结论存在下呼吸道细菌定植的稳定期COPD患者免疫功能较低,炎症反应较重,临床上应根据药敏试验等结果,选择敏感抗生素对患者进行针对性治疗,以缓解炎症反应、提高机体免疫力,改善患者的肺功能和生活质量。     

诱导痰嗜酸性粒细胞对AECOPD患者糖皮质激素治疗的指导意义

目的 本研究旨在观察慢性阻塞性肺疾病急性加重期(AECOPD)患者诱导痰嗜酸性粒细胞(EOS)水平与糖皮质激素治疗反应性的关系，并探讨诱导痰EOS水平与外周血EOS比例之间的相关性。方法 纳入2021年9月至2022年5月于南京医科大学连云港临床医学院呼吸与危重症学科因AECOPD住院的患者为研究对象，记录患者一般资料、临床资料及随访数据。根据诱导痰EOS比例分为A1组(EOS≥3%)、A2组(EOS<3%);根据外周血EOS比例分为B1组(EOS≥2%)、B2组(EOS<2%)。分析诱导痰与外周血EOS比例有无相关性以及诱导痰EOS比例对AECOPD患者糖皮质激素治疗的指导意义。结果 共有71例患者入组。治疗前各组患者的一般情况差异均无统计学意义(P>0.05)。A1组治疗7天后△FEV₁为(112.50±14.70)mL,A2组△FEV₁为(74.70±9.02)mL,差异有统计学意义(P<0.05);A1组住院时长为(11.79±1.03)天，A2组为(22.29±2.49)天，差异有统计学意义(P<0.0...     

射干麻黄汤对哮喘患者血清IgE,EOS调节的观察与分析

目的观察射干麻黄汤治疗前后哮喘患者血IgE,EOS的水平。方法60例哮喘患者随机分为射干麻黄汤治疗组30例,丙卡特罗口服对照组30例,观察治疗后哮喘患者血IgE、EOS及肺功能的变化。结果射干麻黄汤治疗哮喘急性发作时,在降低血IgE、EOS明显优于对照组(P0.05),肺功能有明显的改善。结论射干麻黄汤是治疗哮喘急性发作的有效中药。     

Sputum eosinophilia in Churg-Strauss syndrome

Sputum induction (IS) can be used to study airway inflammation in asthmatics and other lung diseases. However, no data are available for patients with Churg-Strauss syndrome (CSS). A study was carried out to evaluate eosinophil counts and eosinophil cationic protein (ECP) levels in induced sputum during the follow-up of three patients with CSS. Induced sputum was carried out in 10 patients with corticosteroid-dependent asthma (used as a control group). Patients with CSS had significantly higher eosinophils percentages and ECP levels in sputum than those with stable corticosteroid-dependent asthma. During the follow-up, patients with CSS presented increased ECP levels sputum and eosinophils in sputum as well as increased blood eosinophils, despite their oral corticosteroid and immunosuppressive treatment. Eosinophil percentage in sputum and the total number of eosinophils in peripheral blood were more predictive of exacerbations of CSS than sputum ECP.     

The diagnostic consultant

Eleven patients with chronic bronchial asthma were studied during a noninfectious exacerbation. Each patient received 80 mg of prednisone daily for three days. Spirometric values, total blood eosinophil counts, and 24-hour quantitation of sputum eosinophils were studied. Three patients had total blood eosinophil counts of less than 250 at the time of presentation. Statistical comparisons with findings on Day 0 showed significant improvements for the one-second forced expiratory volume, total blood eosinophil count, and sputum eosinophil number. On Day 7, the one-second forced expiratory volume maintained a statistically significant difference from that on Day 0, but the total blood eosinophil count did not. Analysis of correlation coefficients showed significant relation between the total blood eosinophil count and one-second forced expiratory volume, the sputum eosinophil count and one-second forced expiratory volume, and the sputum eosinophil and total blood eosinophil counts. The conclusions are (1) blood eosinophilia is not an invariable feature of acute exacerbations of asthma; (2) numbers of blood and sputum eosinophils reflect the response of an acute exacerbation of asthma to corticosteroids; (3) sputum eosinophils may be more meaningful for monitoring the stable postcorticosteroid state; (4) there is no support for the belief that eosinophils disappear from the sputum of asthmatic patients with clinically effective doses of corticosteroids.     

糖皮质激素治疗AECOPD有效的预测因素

目的探讨糖皮质激素治疗AECOPD有效的预测因素。方法选取AECOPD患者189例,在常规治疗的基础上给予甲泼尼龙针,同步吸入布地奈德。观察动脉血气、肺部啰音、呼吸困难评分、血中嗜酸性粒细胞等指标。结果有效128例,治疗前肺部哮鸣音范围、体重、既往激素疗效、痰的性状及24小时痰量、血中嗜酸性粒细胞,治疗后两组呼吸困难分级评分及FEV1等指标存在显著性差异(P<0.05),有统计学意义,余指标无统计学意义。结论①既往激素疗效,②双肺哮鸣音范围及分布,③体重,④痰的性状,24小时痰量,⑤血中嗜酸性粒细胞等可作为糖皮质激素治疗AECOPD有效的预测因素。     

Increased response of blood eosinophils to various chemotactic agents in quiescent Crohn disease

BACKGROUND: The number of eosinophils is increased in the mucosae of the digestive and the respiratory tracts in Crohn disease, even clinically quiescent. The mechanisms underlying this panmucosal eosinophilia are unknown. METHODS: The response of blood eosinophils to various chemotactic agents was assessed in 15 patients with clinically quiescent Crohn disease. The results were compared with 15 healthy controls. After purification, eosinophils were placed in Boyden microchambers and the chemotactic effect of PAF (10(-7) M), RANTES (50 ng/ml), IL-5 (0-20 ng/ml), IL-8 (0-50 ng/ml), Eotaxin (0-50 ng/ml) was evaluated. The number of eosinophils in induced sputum of these Crohn disease patients and controls was also assessed and the correlation between chemotaxis and eosinophil count in induced sputum was studied. RESULTS: PAF and RANTES induced a chemotactic effect both in Crohn disease patients and controls. The chemotactic index was significantly higher in Crohn than controls for PAF (2.09+/-0.24 versus 1.37+/-0.14; P < 0.05) but not RANTES. With IL-5, IL-8 and Eotaxin, there was no detectable chemotactic effect in controls while in Crohn, we observed a significant dose-dependent chemotactic effect. Furthermore, with Eotaxin 50 ng/ml, the chemotactic index was significantly higher in Crohn disease patients than controls (2.42+/-0.18 versus 1.56+/-0.28; P < 0.05). A significant increase in sputum eosinophil count and a significant decrease in sputum macrophage count in Crohn disease were observed. However, there was no correlation between eosinophil chemotaxis and sputum eosinophil count in individual patients. CONCLUSION: There is an increased response of blood eosinophils to various chemotactic agents, mainly PAF and Eotaxin, in clinically quiescent Crohn disease. This may participate in the mucosal infiltration by eosinophils in this disease.     

Emphysematous Phenotype is Characterized by Low Blood Eosinophils: A Cross-Sectional Study

Sputum and blood eosinophils are proposed as candidate biomarkers for the identification of chronic obstructive pulmonary disease (COPD) patients at risk for exacerbation and treatment response. In this study, we evaluated the associations of eosinophils with the presence of emphysema in COPD patients. Induced sputum and blood eosinophil measurements were performed in consecutive COPD patients. Patients underwent lung function testing and high resolution computed tomography (HRCT) of the chest and the presence of emphysema was quantified. Patients with emphysematous lesions in ≥15% of the pulmonary parenchyma were considered having significant emphysema. Ninety-eight patients were included in the study. Patients with significant emphysema had lower blood eosinophil counts compared to patients without emphysema [median (IQR) 34.6 (0.0, 63.0) vs. 169.0 (110.0, 260.0) cells/µL, p < 0.001]; similar results were observed for the percentage (%) of blood eosinophils, but no difference was observed for sputum eosinophils. The differences were evident in frequent and non-frequent exacerbators and irrespective of the use of inhaled corticosteroids (ICS). Patients with significant emphysema in HRCT present lower levels of blood eosinophils and these differences were present irrespective of the frequent exacerbator history or the use of ICS. Blood eosinophils may not represent a clinically relevant biomarker in the presence of emphysema.     

Induced sputum in the investigation of airway inflammation of COPD

During the last decade, the method of sputum induction (SI) has offered the opportunity to study inflammation in patients with chronic obstructive pulmonary disease (COPD). This paper reviews methodological aspects of SI and summarizes its uses in the research of inflammation in COPD, including sputum cellularity and soluble markers. SI is a relatively safe, reliable, and reproducible technique, used to investigate different aspects of airway inflammation. Although various methods of induction and processing have been proved safe and highly reproducible, a generally accepted method is needed. Sputum analysis has given evidence for increased numbers of macrophages and neutrophils in COPD patients compared to normal subjects. In some studies, increased numbers of eosinophils have been also reported. Changes in various mediators have been found in sputum supernatant of COPD patients (IL-8, LTB-4 and TNF-a). The clinical usefulness of the method in the follow-up of the disease has not been explored extensively. A number of observations in patients with different clinical characteristics could be proven useful in identifying patterns of inflammation associated with different prognosis. Finally, SI could also guide treatment; such as, sputum eosinophilia in COPD could predict response to inhaled corticosteroids.     

未控制支气管哮喘患者痰嗜酸粒细胞水平与肺功能相关性分析

目的:分析未控制支气管哮喘(哮喘)患者不同水平痰嗜酸粒细胞的临床特点,探讨未控制哮喘患者痰嗜酸粒细胞与肺功能的相关性。方法:纳入2017年8月至2019年9月就诊于内蒙古自治区人民医院呼吸与危重症医学科的未控制哮喘患者167例病例资料进行回顾性研究,根据诱导痰嗜酸粒细胞百分比结果将患者分为2组,以痰嗜酸粒细胞百分比≥2...     

Reduction of eosinophilic inflammation in the airways of patients with asthma using montelukast

OBJECTIVE: Leukotrienes (LTs) are involved in airway eosinophilic inflammation in patients with asthma. We examined the effects of a cysteinyl LT 1-receptor antagonist, montelukast, on sputum eosinophil levels, and the correlation between sputum eosinophils and bronchodilatation in patients with asthma. DESIGN: Double-blind, randomized, crossover study. SETTING: University hospital and private hospital. PATIENTS: Twenty-nine patients with mild-to-moderate asthma. INTERVENTIONS: Montelukast, 10 mg, and placebo tablet, once daily, each for 4 weeks. MEASUREMENTS: Sputum eosinophils analyzed using hypertonic saline solution-induced sputum and airway hyperresponsiveness to histamine were evaluated before and after treatment. In addition, morning and evening peak expiratory flow (PEF), asthma symptoms, and peripheral blood eosinophil levels were assessed. RESULTS: The percentage of eosinophils in sputum decreased from 24.6 +/- 12.3% at baseline to 15.1 +/- 11.8% after montelukast treatment, for a change of - 9.5 +/- 12.7% (n = 20). During placebo administration, the percentage of eosinophils fell from 21.3 +/- 12.1% to 21.0 +/- 11.5%, resulting in a decrease of - 0.3 +/- 10.8% (n = 20). There was a statistically significant difference in the change in sputum eosinophil levels between these two periods (p < 0.005). The number of peripheral blood eosinophils also significantly decreased after montelukast treatment (314.1 +/- 237.6/mL) compared with placebo (413.1 +/- 232.1/mL; p < 0.005, n = 21). Although morning and evening PEF values were significantly improved from baseline after montelukast treatment (p < 0.01, n = 20), asthma symptoms and airway responsiveness to histamine were not significantly altered. Furthermore, there was no significant correlation between the decrease in sputum eosinophils and the increase in PEF. CONCLUSION: These results suggest that montelukast has anti-inflammatory effects on the airway in patients with asthma, and that its bronchodilatory effect is not solely dependent on a decrease in airway eosinophilia.     

Apoptotic eosinophils in sputum from asthmatic patients correlate negatively with levels of IL-5 and eotaxin

BACKGROUND: Eosinophilic inflammation of the airways is a key characteristic of asthma. A defect in eosinophil apoptosis might contribute to the chronic tissue eosinophilia associated with asthma. OBJECTIVE: Our purpose was to examine whether the occurrence of apoptotic eosinophils in induced sputum from asthmatic patients correlate with interleukin (IL)-5 and eotaxin. METHODS: Thirty stable and 30 exacerbated asthmatic patients were recruited. Twenty healthy subjects were enrolled as a control group. Induced sputum was obtained from asthmatic patients and from control subjects. The number of apoptotic eosinophils in sputum was assessed by flow cytometry. In sputum supernatant, eosinophil cationic protein (ECP) was measured by sensitive radioimmunoassay, and IL-5 and eotaxin by sandwich enzyme linked immunosorbant assay. RESULTS: Levels of eosinophils, apoptotic eosinophils, IL-5, ECP and eotaxin from asthmatic patients were higher than those from healthy subjects. Thirty exacerbated asthmatics showed higher proportions of eosinophils (median 29.3%, range 13.4%-40.9%), more detectable levels of IL-5 (50.44, 32.99-67.01 pg/ml) and eotaxin (644.6, 197.4-937.7 pg/ml) in their sputum than the patients with stable asthma (P<0.05). There were significant inverse correlations between the levels of sputum IL-5 and the proportion of sputum eosinophil apoptosis in patients with exacerbated and stable asthma (r=-0.85 and -0.79, P<0.01 and P<0.05, respectively). Also inverse correlations were found between the levels of eotaxin and the proportion of sputum eosinophil apoptosis in exacerbated (r=-0.85, P<0.01), or stable asthma (r=-0.69, P<0.05). Additional positive correlations between the levels of sputum IL-5 and eotaxin in either exacerbatated (r=0.93, P<0.01) or stable asthma (r=0.82, P<0.05) were observed. CONCLUSIONS: Apoptosis of eosinophils might be suppressed by proinflammatory cytokines and chemokines such as IL-5 and eotaxin leading to their accumulation in the lung. Stimulation of eosinophils in airway with IL-5 and eotaxin may play a crucial role in allergic inflammation.