The Significance Of Blood Eosinophils In The Stratified Treatment Of AECOPD Inpatients

Objective:To investigate the relationship between peripheral blood eosinophils and acute exa-cerbation of chronic obstructive pulmonary disease?COPD?.Observe the glucocorticoid treatment response and clinical outcome of AECOPD patients with elevated eosinophilia in peripheral blood,so as to provide evidence for guiding stratified treatment of AECOPD patients.Methods:From June 2016 to December 2017,Selecte 208 patients who were diagnosed with AECOPD in the Department of respiratory medicine in Affiliated Hospital of TaiShan Medical University as the subjects.All patients were in accordance with the 2016 version of the COPD diagnostic guide.Detailde medical history collection and physical examination were carried on all patients,and the general informations?age,sex,smoking history,course of disease,and complication?of patients were recorded in patients.Collected the percent of eosinophils in the blood cell analysis?EOS?,neutrophil/lymphocyte?NLR?,D-Dimer,C-reactive protein?CRP?in the day of hospitalization?or the next day?,procalcitonin?PCT?and blood gas analysis.The patients were divided into eosinophil group?EOS%>2%?and non eosinophil group?EOS%<2%?according to EOS%.The basic clinical data,laboratory indicators,time of hospitalization,rate of mechanical ventilation and rate of deterioration during hospitalization?transferred to ICU+automatic discharge+death?were analyzed in two groups of patients.To select 66 patients in the above patients further more.According to peripheral blood eosinophil roportion and whether hormone therapy,These AECOPD patients can be divided into eosinophil and hormone therapy group?group A?,non eosinophil group and hormone therapy group?group B?,eosinophili and non hormone therapy group?C group?,non eosinophilic and non hormone therapy group?group D?.A/B groups were treated with routine treatment and methylprednisolone 40 mg/time,once a day,continuous 3 days reduced to 20 mg/time,once a day for 3 days consecutively.Group C and D were treated with routine treatment.The results of eosinophils roportion?EOS?,C-reactive protein?CRP?,blood gas analysis and CAT score were measured and analyzed in the day of admission?or the next day?and the seventh days.Result:1.Compare and analysis of two groups of eosinophils and non eosinophilic:The time of hospitalization,rate of mechanical ventilation and rate of deterioration,neutr-onphil/lymphocyte,D-Dimer,C-reactive protein,procalcitonin?PCT?in eosinophil group are all lower than those in non eosinophil group.The difference is statistically significant?p<0.05?.2.Compared related indicators between eosinophil and hormone therapy group?group A?,non eosinophil group and hormone therapy group?group B?,eosinophili and non hor-mone therapy group?C group?,non eosinophilic and non hormone therapy group?group D?.The peripheral blood EOS,CRP,PaO₂,PaCO₂ and CAT decreased after treatment in group A.The difference is statistically significant?p<0.05?;While between group B and D,group C and D,there is no significant difference in the improvement rate of EOS,CRP,PaO₂ and CAT?p>0.05?.3.The level of peripheral blood EOS,CRP,CAT,PaO₂ and PaCO₂ before treatment were analyzed by Spearman related analysis.There was a negative correlation between EOS and CRP,positive correlation with CAT score?p<0.05?,and no correlation with PaO₂ and PaCO₂?p value>0.05?.Conclusion and significance:1.Peripheral blood eosinophils with high levels of AECOPD in patients with shorter hospital stay.The rate of mechanical ventilation and the rate of deterioration is low in these part of patients.NLR,PCT,CRP,two D-dimer levels are low.This indicates that the percentage of eosinophils in peripheral blood have important value in assessing the severity and prognosis of AECOPD patients.2.Glucocorticoid can reduce the degree of inflammation in AECOPD patients with high level of eosinophilic effectively and induce apoptosis of eosinophils.It is demonstrated that eosinophils can predict the response of AECOPD to glucocorticoid therapy.