Predictive value of eosinophils and neutrophils on clinical effects of ICS in COPD
Predictive value of eosinophils and neutrophils on clinical effects of ICS in COPD
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DOI：
10.1111/resp.13312
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发表时间：
2018-11-01
期刊：
影响因子：
6.9
通讯作者：
van den Berge, Maarten
中科院分区：
文献类型：
--
作者：
Hartjes, Floor J.;Vonk, Judith M.;van den Berge, Maarten
背景和目的慢性阻塞性肺疾病患者存在不同程度和不同成分的炎症。本研究探讨了血液、痰、气道壁活检和支气管肺泡灌洗(BAL)中嗜酸性粒细胞和中性粒细胞的相关性，以及它们作为吸入性糖皮质激素(ICS)临床疗效的生物标志物的可能性。方法共纳入114例格罗宁根莱顿大学阻塞性肺疾病(GLUCOLD)患者，在30个月的随访中使用ICS或安慰剂。在基线时评估血液、痰、活检和BAL中的细胞计数。此外，在基线、6个月和30个月时，评估1s用力呼气流量(FEV1)、残气量/总肺活量(超充气)和临床COPD问卷。基线横断面分析显示，血中高嗜酸性粒细胞与痰、活检和BAL中高嗜酸性粒细胞计数显著相关。然而，血液中的中性粒细胞与其他隔室中的中性粒细胞计数没有明显的相关性。无论测量哪个间隔，基线的嗜酸性粒细胞和中性粒细胞都不能预测FEV1的纵向变化。在6个月和30个月的ICS治疗期间，较高的基线活检嗜酸性粒细胞与症状的增加相关。此外，与安慰剂相比，在ICS治疗的6个月中，较高的活检中性粒细胞与更明显的减少过度膨胀有关。结论我们的研究结果表明，在ICS初治的COPD患者中，血液中的嗜酸性粒细胞反映其他部位的嗜酸性粒细胞，而不是中性粒细胞。基线嗜酸性粒细胞和中性粒细胞都不能预测ICS引起的6-30个月的肺功能变化。在ICS治疗期间，活检嗜酸性粒细胞与呼吸道症状恶化和活检中性粒细胞与改善高充气之间的关系值得进一步研究。
Background and objectiveInflammation is present to a variable degree and composition in patients with COPD. This study investigates associations between both eosinophils and neutrophils in blood, sputum, airway wall biopsies and bronchoalveolar lavage (BAL) and their potential use as biomarkers for clinical response to inhaled corticosteroids (ICS).MethodsResultsIn total, 114 steroid-naive COPD patients of the Groningen Leiden Universities Corticosteroids in Obstructive Lung Disease (GLUCOLD) study using ICS or placebo during 30-month follow-up were included. Cell counts in blood, sputum, biopsies and BAL were evaluated at baseline. In addition, at baseline, 6 and 30months, forced expiratory flow in 1s (FEV1), residual volume/total lung capacity (hyperinflation) and Clinical COPD Questionnaire were evaluated.Cross-sectional analyses at baseline showed that higher blood eosinophils were significantly associated with higher eosinophil counts in sputum, biopsies and BAL. However, blood neutrophils did not significantly correlate with neutrophil counts in the other compartments. Baseline eosinophils and neutrophils, in whichever compartment measured, did not predict longitudinal FEV1 changes. Higher baseline biopsy eosinophils were associated with an increase in symptoms during 6- and 30-month ICS treatment. In addition, higher biopsy neutrophils were associated with a more marked reduction in hyperinflation during 6-month ICS treatment compared with placebo.ConclusionOur findings indicate that blood eosinophils reflect eosinophils in other compartments, in contrast to neutrophils, in ICS-naive COPD patients. Both baseline eosinophils and neutrophils do not predict ICS-induced lung function changes over a period of 6-30months. The associations of biopsy eosinophils with worsening respiratory symptoms and biopsy neutrophils with improvement in hyperinflation during ICS treatment deserve further investigation.