A Comprehensive Analysis of the Stability of Blood Eosinophil Levels.
A Comprehensive Analysis of the Stability of Blood Eosinophil Levels.
复制标题
DOI：
10.1513/annalsats.202010-1249oc
复制
发表时间：
2021-12
影响因子：
8.3
通讯作者：
Bafadhel M
中科院分区：
文献类型：
--
作者：
Chipps BE;Jarjour N;Calhoun WJ;Iqbal A;Haselkorn T;Yang M;Brumm J;Corren J;Holweg CTJ;Bafadhel M
理由：血嗜酸性粒细胞计数用于诊断/治疗嗜酸性哮喘。目的：检查血液中嗜酸性粒细胞的变异性，确定影响嗜酸性粒细胞水平的因素，为临床解释提供依据。方法：利用四项随机对照哮喘试验的数据进行事后分析，了解嗜酸性粒细胞的变异性。我们使用基线数据（n = 2,612）检验了1)内在/外在因素（合并症、药物和患者病史）的影响；2)使用安慰剂治疗患者数据的月度变化（n = 713）；3)在1年期间每月测量的安慰剂治疗患者中，嗜酸性粒细胞分类的稳定性（<150、150 - 299和大于或等于300细胞/μl） （n = 751）；4)技术因素的影响（实验室到实验室的差异和从采集到分析的时间）。结果：在检查的内在/外在因素中，鼻息肉增加了38%的嗜酸性粒细胞水平，而目前吸烟减少了23%的水平。观察到嗜酸性粒细胞计数的显著季节性差异，7月和1月之间的差异约为20%。在150和299细胞/μl之间的嗜酸性粒细胞水平是最不稳定的，44%的患者在10次测量中的7次中保持相同的分类，而在<150和大于或等于300细胞/μl亚组中分别有59%和66%的患者。不同实验室的测量结果显示高相关性（Spearman相关系数，R = 0.89）；然而，嗜酸性粒细胞计数减少，从收集到分析的时间较长，并且随着嗜酸性粒细胞计数的增加，变异性增加。结论：一些内在的、外在的和技术性的因素可能会影响到临床对嗜酸性粒细胞计数的解释，这些因素应该被考虑在内。此外，当使用嗜酸性粒细胞计数诊断/治疗嗜酸性粒细胞哮喘时，单一测量可能是不够的。
Rationale: Blood eosinophil counts are used to inform diagnosis/management of eosinophilic asthma. Objectives: Examine blood eosinophil variability and identify factors affecting eosinophil levels to inform clinical interpretation. Methods: Post hoc analysis to understand eosinophil variability using data from four randomized controlled asthma trials. We examined 1) influence of intrinsic/extrinsic factors (comorbidities, medication, and patient history) using baseline data (n = 2,612); 2) monthly variation using placebo-treated patient data (n = 713); 3) stability of eosinophil classification (<150, 150–299, and ⩾300 cells/μl) in placebo-treated patients with monthly measurements over a 1-year period (n = 751); and 4) impact of technical factors (laboratory-to-laboratory differences and time from collection to analysis). Results: Of intrinsic/extrinsic factors examined, nasal polyps increased eosinophil levels by 38%, whereas current smoking decreased levels by 23%. Substantial seasonal differences in eosinophil counts were observed, with differences of ∼20% between July and January. Eosinophil levels between 150 and 299 cells/μl were least stable, with 44% of patients remaining in the same classification for seven of 10 measurements versus 59% and 66% of patients in the <150 and ⩾300 cells/μl subgroups, respectively. Measurements at different laboratories showed high association (Spearman’s correlation coefficient, R = 0.89); however, eosinophil counts were reduced, with longer time from collection to analysis, and variability increased with increasing eosinophil counts. Conclusions: Several intrinsic, extrinsic, and technical factors may influence, and should be considered in, clinical interpretation of eosinophil counts. Additionally, a single measurement may not be sufficient when using eosinophil counts for diagnosis/management of eosinophilic asthma.