CHEST: COPD急性加重患者嗜酸粒细胞与再入院几率增加相关

2017-03-23 MedSci MedSci原创

COPD亚群患者显示组织或血液中有嗜酸粒细胞性炎症。以往研究中有关嗜酸粒细胞水平的增加与低的再入院结果相矛盾。本研究的目标是通过随访嗜酸粒细胞水平升高的重度COPD急性加重患者,研究血液中高嗜酸粒细胞水平与不良临床结局之间的相关性。

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背景: COPD亚群患者显示组织或血液中有嗜酸粒细胞性炎症。以往研究中有关嗜酸粒细胞水平的增加与低的再入院结果相矛盾。本研究的目标是通过随访嗜酸粒细胞水平升高的重度COPD急性加重患者,研究血液中高嗜酸粒细胞水平与不良临床结局之间的相关性。


方法:观察性研究,数据源于回顾性收集重度COPD急性加重患者住院信息。患者临床数据包括入院之前以及之后一年的信息。如果血液嗜酸粒细胞水平≥200 个/ μL和/或≥2%全血细胞计数则患者进入嗜酸粒细胞组。研究终点包括12月COPD相关再入院,12月全因再入院,住院时间和至COPD相关再入院时间。研究终点通过logistic,负二项分布和Cox回归模型进行统计分析。

结果:共有167例患者被纳入本研究,其中嗜酸粒细胞组55例。嗜酸粒细胞与增加12月COPD相关再入院(OR,3.59 [95% CI, 1.65-7.82]; P=.0013),12月全因再入院(2.32 [95% CI, 1.10-4.92]; P=.0277)以及缩短首次至COPD相关再入院时间(HR,2.74 [1.56-4.83]; P=.0005)等风险相关(图1)。住院时间在嗜酸粒细胞组与非嗜酸粒细胞组未见显着统计学差异。采用不同嗜酸粒细胞升高定义进行敏感性分析显示嗜酸粒细胞计数增加与预测12月再入院在效应值方面成比例增加。通过不同嗜酸粒细胞升高定义对主要研究终点进行检测(图2),更高嗜酸粒细胞水平与12月COPD相关再入院和全因再入院保持基本相同的定义即细胞计数≥200 个/ μL或百分比≥2%。与较低嗜酸粒细胞水平相比(100个/ μL或0.7%),中等水平嗜酸粒细胞计数(100-200个/ μL)和百分比(0.7%-2.0%)未显示增加再入院风险的统计学相关性(COPD或全因)。

1:嗜酸粒细胞与研究终点相关性

 

嗜酸粒细胞组

非嗜酸粒细胞组

校正OR

例数(%

例数(%

12COPD相关再入院

2647.3

2825.0

3.59 [1.65-7.82]a

12月全因再入院

3767.3

6053.6

2.32 [1.10-4.92]b

 

中位[IQR]

中位[IQR]

校正exp(β)

住院时间,天

5[2-6]

5[3-7]

1.19[0.91-1.55]

ORlogistic回归)或wxpβ)(负二项回归)[95% CI]IQR=四分位差

aP<.01; bP<.05

表2:不同嗜酸粒细胞升高定义与研究终点相关性

嗜酸粒细胞水平定义

12月COPD相关再入院

12月全因再入院

校正OR

校正OR

1.   <200个/ μL和<2%(n=112)

-

-

     ≥200 个/ μL或≥2% (n=55)

3.59 [1.65-7.82]a

2.32 [1.10-4.92] b

2.   <300个/ μL和<3%(n=131)

-

-

≥300个/ μL或<3%(n=36)

3.21 [1.34-7.71] a

1.42 [0.62-3.26]

3.   <200个/ μL(n=116)

-

-

≥200个/ μL(n=51)

3.12 [1.42-6.88] a

2.17 [1.01-4.66] b

4.   <100个/ μL(n=68)

-

-

100-200个/ μL(n=48)

1.45 [0.59-3.58]

1.41 [0.63-3.18]

≥200个/ μL(n=51)

3.66 [1.51-8.91] a

2.51 [1.09-5.78] b

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    2018-01-13 xiangyuzhou971
  2. [GetPortalCommentsPageByObjectIdResponse(id=2050621, encodeId=8978205062199, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sat Jan 13 12:40:00 CST 2018, time=2018-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1894381, encodeId=6ca318943814a, content=<a href='/topic/show?id=db705221569' target=_blank style='color:#2F92EE;'>#急性加重#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52215, encryptionId=db705221569, topicName=急性加重)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Thu Jan 25 13:40:00 CST 2018, time=2018-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929305, encodeId=b4ac192930581, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Thu Jun 15 03:40:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182182, encodeId=b8cb18218259, content=嗯嗯这个可以观察一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Mar 23 13:25:27 CST 2017, time=2017-03-23, status=1, ipAttribution=)]
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    2017-06-15 Smile2680
  4. [GetPortalCommentsPageByObjectIdResponse(id=2050621, encodeId=8978205062199, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sat Jan 13 12:40:00 CST 2018, time=2018-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1894381, encodeId=6ca318943814a, content=<a href='/topic/show?id=db705221569' target=_blank style='color:#2F92EE;'>#急性加重#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52215, encryptionId=db705221569, topicName=急性加重)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Thu Jan 25 13:40:00 CST 2018, time=2018-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929305, encodeId=b4ac192930581, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Thu Jun 15 03:40:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182182, encodeId=b8cb18218259, content=嗯嗯这个可以观察一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Mar 23 13:25:27 CST 2017, time=2017-03-23, status=1, ipAttribution=)]
    2017-03-23 smartxiuxiu

    嗯嗯这个可以观察一下

    0

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