| 魏霞,李洁,丁琦,许淑娣,米九运,任京婷,李瑞丽,姚静,金晨望,郭佑民.伴嗜酸性粒细胞增高慢性阻塞性肺疾病急性加重期肺功能及影像学特征[J].中国医学影像技术,2020,36(3):356~361 |
| 伴嗜酸性粒细胞增高慢性阻塞性肺疾病急性加重期肺功能及影像学特征 |
| Pulmonary function and imaging characteristics of acute exacerbation of chronic obstructive pulmonary disease with elevated eosinophils |
| 投稿时间：2020-01-15 修订日期：2020-02-09 |
| DOI：10.13929/j.issn.1003-3289.2020.03.008 |
| 中文关键词: 肺疾病,慢性阻塞性 嗜酸性细胞 呼吸生理现象 体层摄影术,X线计算机 |
| 英文关键词:pulmonary disease,chronic obstructive oxyphil cells respiratory physiological phenomena tomography,X-ray computed |
| 基金项目: |
| 作者 | 单位 | E-mail | | 魏霞 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | wx2005hope@126.com | | 李洁 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 丁琦 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 许淑娣 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 米九运 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 任京婷 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 李瑞丽 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 姚静 | 西安市第九医院呼吸与危重症医学科, 陕西 西安 710054 | | | 金晨望 | 西安交通大学第一附属医院医学影像科, 陕西 西安 710061 | | | 郭佑民 | 西安交通大学第一附属医院医学影像科, 陕西 西安 710061 | |
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| 中文摘要: |
| 目的 分析外周血嗜酸性粒细胞（EOS）≥300/μl和<300/μl的慢性阻塞性肺疾病急性加重期（AECOPD）患者临床、炎症标记物、传统肺功能、脉冲振荡阻力测定（IOS）参数及容积CT参数特征，观察其特征差异。方法 纳入357例AECOPD，其中EOS≥300/μl组（研究组）41例，EOS<300/μl组（对照组）316例，比较2组慢性阻塞性肺疾病（COPD）评估测试（CAT）评分、医学研究委员会呼吸困难量表（mMRC）评定等临床指标、炎症指标以及传统肺功能、IOS指标、肺容积、肺气肿指数及肺气肿密度等影像学参数的差异。结果 ①研究组中性粒细胞比率低于对照组（64.70% vs 73.00%，P<0.001），纤维蛋白原（3.59 vs 3.97，P=0.031）及C反应蛋白减低（3.30 mg/L vs 8.63 mg/L，P=0.012），吸烟量亦相对较低（25包/年vs 40包/年，P=0.009）；②研究组RV/TLC低于对照组（51.91% vs 57.44%，P=0.041），而R5（0.56 vs 0.49，P=0.036）和R5% pred（178.65% vs 155.70%，P=0.027）较高；③研究组全肺、右肺和左肺肺气肿平均密度和PD15均高于对照组（P均<0.05），提示肺实质破坏更严重。结论 EOS≥300/μl的AECOPD患者气道阻力增加更明显，而肺气肿损害程度较EOS<300/μl者轻微。 |
| 英文摘要: |
| Objective To explore the characteristic differences of clinical data, inflammatory markers, pulmonary function test, impulse oscillometry system (IOS) and CT parameters of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with peripheral blood eosinophils (EOS) ≥ 300/μl and those EOS<300/μl, in order to provide strategic guidance for treatment. Methods A total of 357 AECOPD patients were enrolled, including 41 cases in EOS ≥ 300/μl group (study group) and 316 cases in EOS<300/μl group (control group).Then the clinical indicators, such as inflammation indicators from chronic obstructive pulmonary disease (COPD) assessment test (CAT) score and modified medical research council dyspnea scale (mMRC) assessment, traditional lung functions, IOS indicators, lung volume, emphysema index, emphysema density and other imaging parameters were compared between groups. Results ①Neutrophils ratio in study group was lower than in control group (64.70% vs 73.00%,P<0.001), while fibrinogen lower (3.59 vs 3.97, P=0.031), C reactive protein lower (3.30 mg/L vs 8.63 mg/L, P=0.012) as well as smoking number lower (25 pack/years vs 40 pack/years, P=0.009) in study group were all lower than those in control group. ②RV/TLC in study group was lower than that in control group (51.91% vs 57.44%,P=0.041), whereas R5 (0.56 vs 0.49, P=0.036) and R5%pred (178.65% vs 155.70%, P=0.027) were higher in study group than those in control group. ③Mean pulmonary emphysema density and PD15 in the whole lung, right lung and left lung in study group were all higher than those in control group (all P<0.05), suggesting that patients in control group had more serious pulmonary parenchymal destruction. Conclusion AECOPD patients with EOS ≥ 300/μl have more significant pulmonary function impairment due to increased airway resistance, in whom emphysema is less severe than those with EOS<300/μl. |
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