| ObjectTo observe and analyze the relationship between blood eosinophil,IL-5,IL-17 levels and acute exacerbation of chronic obstructive pulmonary disease and its clinical significance.MethodA prospective study was used to select hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and patients with stable chronic obstructive pulmonary disease who met the diagnostic criteria of the 2020 Global Initiative for Chronic Obstructive Pulmonary Disease（GOLD）in our hospital from November 2020 to June 2021.Lung disease（COPD）patients.The hospitalized patients with AECOPD were taken as the test group,and the patients with stable COPD were taken as the control group.According to the percentage of eosinophils（EOS）in the blood routine（2%）,the patients were divided into group A（AECOPD,EOS%≥2%）.,Group B（AECOPD,EOS%<2%）,Group C（stable COPD,EOS%≥2%）and Group D（stable COPD,EOS%<2%）.The changes of blood IL-5,IL-17 and blood gas analysis in each group at the first admission and before discharge were observed and analyzed,and the inflammatory indexes,pulmonary function indexes,treatment plan,hospitalization time of groups A and B were compared,and they were followed up for 1 month after discharge.Months,6 months with no recurrence of moderate or severe exacerbations.Result1.Distribution of blood EOSThe blood eosinophil percentage（1.3%vs.1.5%;P=0.523）and count ratio（100 vs.101;P=0.722）of the experimental group and the control group were not statistically significant.2.general clinical dataThere were no significant differences in gender,age,BMI,smoking index,allergy history,disease duration,GOLD grade and comorbidities between groups A and B（P>0.05）.The MMEF%of group A was 42%,and the MMEF%of group B was 28%.The results of the two groups were statistically significant（P=0.042）.The incidence of respiratory failure in group A（19.4%）was lower than that in group B（40.6%）,and the difference was statistically significant（P=0.031）.There was no significant difference in the incidence of pulmonary heart disease between the two groups（P>0.05）.3.laboratory examinationThe test results of IL-5 in the experimental group,after treatment,and in the control group were 48.5±2.8,45.8±2.7,42.4±3.1,respectively,and there were significant statistical differences among the three groups（P<0.001）;17 The test results were 41.5±1.9,20.5±1.4,19.1±1.4,and there were significant statistical differences between the groups（P<0.001）.The serum IL-5 level of group A was higher than that of group B at the time of AECOPD admission（49.4±2.8 vs.48.1±2.6;P=0.032）,and the serum IL-17 level of B group was higher than that of group A at the time of AECOPD admission（41.9±2.1 vs.1.2;P=0.028）,the result was statistically significant.The percentage of neutrophils in groups A and B（61.0±10.2 vs.71.9±10.1;P=0.000）,the percentage of lymphocytes（24.3±8.3 vs.17.9±8.4;P=0.000）,and C-reactive protein（4.5 vs.16.5;P=0.046）,procalcitonin（0.035 vs 0.052;P=0.001）,the difference was statistically significant.4.the response of drug treatmentThere was no significant difference in PO2 and PCO2 between group A and group B before treatment.After treatment,PO2 in group A improved more significantly than that in group B（89.2±13.3vs79.3±14.9;P=0.039）,which was statistically significant.The PCO2 of group A was lower than that of group B（43.8±7.4 vs 44.5±7.3;P=0.753）,but there was no statistical significance.There was no statistical significance in the use rate and dose of nebulized hormone and the use rate and dose of intravenous hormone in groups A and B.There was no significant difference in the antibiotic usage rate between group A and group B,but the antibiotic usage time in group A was significantly less than that in group B（8 vs.10;P=0.046）,which was statistically significant.There was no statistical difference in the usage rates of oxygen therapy and non-invasive assisted ventilation between the two groups.The median length of hospital stay in the high EOS group was 9 days shorter than that in the low EOS group,which was 10 days（P=0.211）,but the difference was not statistically significant.A separate analysis of patients on corticosteroids yielded similar results.5.Analysis of severe acute exacerbations in the 6 months after dischargeThere was no statistically significant difference between group A and group B in the occurrence of moderate or severe acute exacerbation at 1 month and 3 months after discharge,and the rate of moderate or severe acute exacerbation in group A was significantly higher than that in group B at 6 months after discharge（19（52.8%）vs 20（31.3%）;P=0.034）,the result was statistically significant.Conclusion1.There was no difference in EOS distribution between acute exacerbation and stable COPD,suggesting that EOS cannot be used to predict whether COPD is stable.2.Both IL-5 and IL-17 may be involved in the process of acute exacerbation of COPD,and can be used as indicators of acute exacerbation to a certain extent.3.The level of IL-17 is associated with decreased responsiveness of COPD to glucocorticoid therapy.4.Patients with acute exacerbation of COPD with elevated EOS have lower neutrophil percentage,C-reactive protein,and procalcitonin levels,suggesting that the acute exacerbation of the disease may be related to non-bacterial infection factors,and these patients are more sensitive to glucocorticoids.sensitive.5.Patients with acute exacerbation of COPD with elevated EOS have a higher risk of recurrent moderate or severe acute exacerbation within half a year after discharge.Blood EOS may become a biomarker for predicting moderate to severe acute exacerbation of COPD.6.Patients with acute exacerbation of COPD and elevated EOS were less likely to have respiratory failure,suggesting that EOS may be used as an index to evaluate the complications of AECOPD. |
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