应用糖皮质激素治疗急性加重期慢性阻塞性肺疾病的效果观察

目的 观察不同嗜酸性粒细胞水平的慢性阻塞性肺疾病急性加重期(AECOPD)患者接受不同剂量布地奈德治疗的效果。方法 将本医院收治的242例AECOPD患者随机分为对照组(雾化布地奈德 4 mg/d)和观察组(雾化布地奈德 8 mg/d),依据外周血嗜酸性粒细胞水平进一步分为四个组,对照A组85例,(EOS<2%)、对照B组39例(EOS≥2%)、观察C组76例(EOS<2%)和观察D组42例(EOS≥2%)。比较各组治疗后肺功能指标、慢性阻塞性肺疾病评估测试问卷(COPD assessment test,CAT)评分、药物副作用发生率。结果 各组治疗后用力肺活量(FVC)均有明显增加(A:204±52 mL,B:279±50 mL,C:235±61 mL,D:341±60 mL),各组之间差异均有统计学意义(F=60.053,P<0.001)。各组治疗后第一秒用力呼气容积(FEV1)均有明显增加A:(162±69)mL,B:(224±73)mL,C:(191±64)mL,D:(276±79)mL],各组之间差异均有统计学意义(F=42.415,P<0.001)。各组治疗前CAT评分差异无统计学意义(A:28±5,B:27±4,C:27±5,D:26±4;F=2.382,P=0.070),治疗后CAT评分下降A:(6±2),B:(9±4),C:(11±3),D:(16±5)],D组评分下降值最高(F=32.217,P<0.01)。各组副作用发生率差异无统计学意义(A:4.7%,B:2.6%,C:3.9%,D:4.8%;χ2=0.361,P=0.948)。结论 高EOS组较低EOS组对吸入激素治疗效果更好,且对高剂量ICS的治疗反应更好。外周血嗜酸性粒细胞水平可以作为评估COPD患者吸入ICS治疗反应的标记物。

Effects of glucocorticoid on acute exacerbations of chronic obstructive pulmonary disease

Objective To observe the effects of different doses of budesonide in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with different blood eosinophilic counts. Methods A total of 242 AECOPD patients admitted to a hospital were randomly divided into a control group (inhalation of budesonide suspension 4 mg/d) and an observation group (inhalation of budesonide suspension 8 mg/d). The above patients were further divided into four subgroups according to their peripheral blood eosinophils: 85 patients in a control subgroup A (EOS<2%), 39 patients in a control subgroup B (EOS≥2%), 76 patients in an observation subgroup C (EOS<2%) and 42 patients in an observation subgroup D (EOS≥2%). The improvement of lung function indexes, changes in CAT score, incidence of side effects of inhaled drugs and other aspects after treatment were compared among the subgroups. Results FVC was significantly increased in each subgroup after the treatment , and the differences among all subgroups were statistically significant (F=60.053, P<0.001). FEV1 was significantly increased in each subgroup after the treatment , and the differences among all subgroups were statistically significant (F=42.415, P<0.001). There were no significant differences in CAT scores among all subgroups before the treatment . CAT scores decreased significantly in each subgroup after the treatment , and the differences among all subgroups were statistically significant (F=32.217, P<0.001). There were no significant differences in the incidence of side effects among the four subgroups (A: 4.7%, B: 2.6%, C: 3.9%, D: 4.8%; χ2=0.361, P=0.948). Conclusion Regardless of high dose inhaled corticosteroid (ICS) or conventional dose ICS, the high EOS subgroups respond better to inhaled hormone therapy than the low EOS subgroups. Moreover, the high EOS subgroups respond better to the treatment of high dose ICS than the low EOS subgroups. The study results support using blood eosinophilic counts as a biomarker of ICS response in patients with COPD.