2024 年第 3 期 第 19 卷

慢性阻塞性肺疾病频繁急性加重表型与非频繁急性加重表型的临床特点对比分析

Comparative analysis of clinical characteristics of frequent acute exacerbation phenotype and non-frequent acute exacerbation phenotype in chronic obstructive pulmonary disease

作者：郑琪秦斌斌沈斌黄颖骏朱佳嫣胡婧玮郑兴东宋雅君

英文作者：Zheng Qi Qin Binbin Shen Bin Huang Yingjun Zhu Jiayan Hu Jingwei Zheng Xingdong Song Yajun

单位：上海交通大学医学院附属第九人民医院黄浦分院呼吸科，上海200010

英文单位：Department of Respiratory Huangpu Branch Shanghai Ninth People′s Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200010 China

关键词：慢性阻塞性肺疾病；频繁急性加重；临床特点；肺功能；炎症因子；血气指标

英文关键词：Chronicobstructivepulmonarydisease;Frequentacuteexacerbation;Clinicalcharacteristics;Lungfunction;Inflammatoryfactors;Bloodgasindicators

• 摘要：

• 目的 对比分析慢性阻塞性肺疾病（COPD）频繁急性加重表型与非频繁急性加重表型的临床特点。方法 选择2019年10月至2022年5月上海交通大学医学院附属第九人民医院黄浦分院门急诊及呼吸科住院的60例COPD患者作为研究对象。根据年急性发作频率分为非频繁急性加重表型组（年急性加重次数0～1次，30例）和频繁急性加重表型组（年急性加重次数≥2次，30例）。就诊当日抽取静脉血检测计算2组中性粒细胞与淋巴细胞比值（NLR）、C反应蛋白（CRP）、降钙素原、白细胞介素6（IL-６）、动脉血氧分压（PaO2)、动脉血二氧化碳分压(PaCO2)及第1秒用力呼气容积占预计值百分比(FEV1%)，评价COPD患者自我评估测试问卷（CAT)评分、改良版英国医学研究委员会呼吸问卷（mMRC）评分，进行组间比较；分析相关指标与疾病严重程度的相关性。结果 频繁急性加重表型组患者NLR、CRP、降钙素原、IL-6、PaCO2水平及CAT、mMRC评分均高于非频繁急性加重表型组，PaO2、FEV1%低于非频繁急性加重表型组［（9.6±1.1）kPa比（10.8±2.5）kPa、（44±9）%比（57±5）%］，差异均有统计学意义（均P<0.05）。COPD患者NLR、CRP、降钙素原、IL-6、PaCO2水平与年急性加重次数均呈正相关，PaO2、FEV1%水平与年急性加重次数均呈负相关(均P<0.05）。结论 COPD频繁急性加重表型患者肺部炎症水平较非频繁急性加重患者高，肺功能差、症状严重，应给予早期干预，改善患者预后。

• Objective To compare the clinical characteristics of frequent acute exacerbation phenotype and non-frequent acute exacerbation phenotype in chronic obstructive pulmonary disease (COPD). Methods Sixty COPD patients who were hospitalized in the outpatient, emergency and respiratory departments of Huangpu Branch, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from October 2019 to May 2022 were selected as the research objects. According to the annual frequency of acute exacerbations, the patients were divided into non-frequent acute exacerbation phenotype group(30 cases with 0-1 annual exacerbations) and frequent acute exacerbation phenotype group(30 cases with ≥ 2 annual exacerbations). The neutrophil to lymphocyte ratio(NLR) and levels of C-reactive protein(CRP), procalcitonin, interleukin-6(IL-6), arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), and forced expiratory volume in one second as percentage of predicted volume(FEV1%) were tested and calculated in two groups based on venous blood extracted on the day of visit. The scores of COPD self-assessment questionnaire test(CAT) score and modified version of the British Medical Research Council respiratory questionnaire(mMRC) score were evaluated and compared between groups. The correlation between the related indicators and the severity of the disease was analyzed. Results The NLR, CRP, procalcitonin, IL-6, PaCO2 levels, CAT and mMRC scores of patients in the frequent acute exacerbation phenotype group were higher than those in the non-frequent acute exacerbation phenotype group; PaO2 and FEV1% were lower than those in the non-frequent acute exacerbation phenotype group ［(9.6±1.1)kPa vs (10.8±2.5)kPa, (44±9)% vs (57±5)%］ (all P<0.05). The levels of NLR, CRP, procalcitonin, IL-6, and PaCO2 in COPD patients were positively correlated with the annual number of acute exacerbations, PaO2 and FEV1% were negatively correlated with the annual number of acute exacerbations (all P<0.05). Conclusion Patients with frequent acute exacerbations phenotype of COPD have higher levels of pulmonary inflammation, poorer lung function and more severe symptoms. Early intervention should be given to improve the prognosis of patients.