Relationship between blood eosinophils, clinical characteristics, and mortality in patients with COPD.
Relationship between blood eosinophils, clinical characteristics, and mortality in patients with COPD.
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DOI：
10.2147/copd.s129787
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发表时间：
2017
影响因子：
2.8
通讯作者：
Burgel PR
中科院分区：
文献类型：
--
作者：
Zysman M;Deslee G;Caillaud D;Chanez P;Escamilla R;Court-Fortune I;Nesme-Meyer P;Perez T;Paillasseur JL;Pinet C;Jebrak G;Roche N;Burgel PR
在COPD患者中，关于血嗜酸性粒细胞（Eos）水平与1）急性加重频率和2）吸入性皮质类固醇预防急性加重的作用的相关性存在争议。为了确定Eos是否定义了表现出COPD临床表型属性的患者亚组，我们比较了使用不同血液Eos水平阈值分类的倡议BPCO法国队列中COPD患者的临床特征和死亡率。在入选时收集以下数据：病史和吸烟史、职业暴露、呼吸困难、咳嗽和咳痰、前一年的急性加重、过敏和哮喘史、鼻部症状、体重指数、St乔治呼吸问卷（SGRQ）总分、支气管扩张剂后肺功能测定、合并症和药物。采用Kaplan-Meier分析比较两组患者的3年生存率。进行了三组分析，以比较Eos ≥2%与<2%、≥3%与<3%和≥4%与<4%的患者。458例患者（平均年龄：62岁，72%为男性，平均1秒用力呼气量：51%预测值）中Eos可用，包括235例Eos ≥2%（49%）、149例Eos ≥3%（33%）和90例Eos ≥4%（20%）。对于所有临界值，在单变量分析中，Eos+和Eos−组之间没有差异，但糖尿病和SGRQ评分除外（在Eos较低的类别中，分别更频繁和更受损）。特别是，在急性发作率、哮喘史或3年生存率方面没有差异。总之，无论临界值如何，Eos+ COPD患者在症状、肺功能、加重率和预后方面均无特异性。这些结果表明，既往研究中报告的Eos较高与急性加重的相关性可能具有人群特异性，这不支持将Eos作为COPD表型的生物标志物进行推广。
In patients with COPD, there is controversy regarding the association of blood eosinophil (Eos) levels with 1) exacerbation frequency and 2) the effect of inhaled corticosteroids for prevention of exacerbations. To determine whether Eos define subgroups of patients exhibiting attributes of COPD clinical phenotypes, we compared clinical features and mortality rates in COPD patients from the Initiatives BPCO French cohort categorized using different thresholds of blood Eos levels. The following data were collected at inclusion: medical and smoking history, occupational exposures, dyspnea, cough and sputum production, exacerbations in the previous year, history of allergy and asthma, nasal symptoms, body mass index, St George Respiratory Questionnaire (SGRQ) total score, post-bronchodilator spirometry, comorbidities, and medications. Three-year survival between groups was compared using Kaplan–Meier analysis. Three sets of analyses were performed to compare patients with ≥2% versus <2%, ≥3% versus <3%, and ≥4% versus <4% Eos. Eos was available in 458 patients (mean age: 62 years, 72% male, mean forced expiratory volume in 1 second: 51% pred), including 235 patients with Eos ≥2% (49%), 149 with Eos ≥3% (33%), and 90 with Eos ≥4% (20%). For all cutoffs, there was no difference between Eos+ and Eos− groups in univariate analyses except for diabetes and SGRQ score (more frequent and more impaired, respectively, in lower Eos categories). In particular, there was no difference in exacerbation rate, history of asthma, or three-year survival. In conclusion, regardless of the cutoff, Eos+ COPD patients exhibited no specific characteristic in terms of symptoms, lung function, exacerbation rate, and prognosis. These findings suggest that the association of higher Eos with exacerbations reported in previous studies could be population specific, which does not support generalizing the use of Eos as a biomarker for COPD phenotyping.