嗜酸性粒细胞与AECOPD的相关性研究进展
Research Progress on the Correlation between Eosinophils and Acute Exacerbation of Chronic Obstructive Pulmonary Disease
摘要: 慢性阻塞性肺疾病急性加重期(AECOPD)是导致患者肺功能恶化、住院率及死亡率升高的关键阶段,疾病异质性显著,而嗜酸性粒细胞(EOS)作为重要的炎症标志物,在AECOPD的病情评估、治疗指导及预后预测中逐渐受到关注。本文系统梳理近年研究成果,从EOS在AECOPD中的炎症机制、临床特征关联、治疗指导价值及联合预测作用等方面展开综述,分析不同EOS临界值的临床意义及研究争议,旨在为AECOPD的精准诊疗提供参考,同时指出当前研究局限与未来探索方向。
Abstract: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a critical stage leading to the deterioration of patients’ lung function, as well as increased hospitalization and mortality rates, with significant disease heterogeneity. As an important inflammatory marker, eosinophils (EOS) have gradually attracted attention in the disease assessment, treatment guidance, and prognosis prediction of AECOPD. This article systematically reviews recent research findings, focusing on the inflammatory mechanisms of EOS in AECOPD, its association with clinical characteristics, its value in treatment guidance, and its combined predictive role. It also analyzes the clinical significance and research controversies of different EOS cutoff values, to provide references for the precise diagnosis and treatment of AECOPD, and highlights the limitations of current research and future directions.
文章引用:刘瑶, 白智远. 嗜酸性粒细胞与AECOPD的相关性研究进展[J]. 临床医学进展, 2025, 15(11): 2056-2067. https://doi.org/10.12677/acm.2025.15113319

参考文献

[1] 王恬鑫, 贾建厚. 低外周血嗜酸性粒细胞AECOPD患者临床特征及其联合D-二聚体对无创呼吸支持的预测价值[D]: [硕士学位论文]. 延安: 延安大学, 2024.
[2] 曾心怡, 谭小武. 嗜酸性粒细胞型慢性阻塞性肺疾病患者急性加重期临床特征分析[D]: [硕士学位论文]. 衡阳: 南华大学, 2023.
[3] Wang, C., Xu, J., Yang, L., Xu, Y., Zhang, X., Bai, C., et al. (2018) Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease in China (the China Pulmonary Health [CPH] Study): A National Cross-Sectional Study. The Lancet, 391, 1706-1717. [Google Scholar] [CrossRef] [PubMed]
[4] Adeloye, D., Song, P., Zhu, Y., Campbell, H., Sheikh, A. and Rudan, I. (2022) Global, Regional, and National Prevalence Of, and Risk Factors For, Chronic Obstructive Pulmonary Disease (COPD) in 2019: A Systematic Review and Modelling Analysis. The Lancet Respiratory Medicine, 10, 447-458. [Google Scholar] [CrossRef] [PubMed]
[5] 韩慧珊, 张成, 汪利宗. PCT、CRP、EOS、NLR对慢性阻塞性肺疾病急性加重期患者的病情评估及预后预测[J]. 分子诊断与治疗杂志, 2022, 14(3): 516-520.
[6] Trudo, F., Kallenbach, L., Vasey, J., Chung, Y., Wilk, A., Slipski, L., et al. (2019) Clinical and Economic Burden of Eosinophilic COPD in a Large Retrospective US Cohort. International Journal of Chronic Obstructive Pulmonary Disease, 14, 2625-2637. [Google Scholar] [CrossRef] [PubMed]
[7] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 等. 慢性阻塞性肺疾病诊治指南(2021年修订版) [J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205.
[8] Global Burden of Disease Collaborative Network (2022) Global Burden of Disease Study 2021 (GBD 2021) Results.
[9] 玛日耶姆·阿卜杜瓦伊提, 齐曼古力·吾守尔. 慢阻肺急性加重期患者外周血嗜酸性粒细胞与炎症指标及肺功能相关性的探讨[D]: [硕士学位论文]. 乌鲁木齐: 新疆医科大学, 2024.
[10] Vestbo, J., Hurd, S.S., Agustí, A.G., Jones, P.W., Vogelmeier, C., Anzueto, A., et al. (2013) Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary. American Journal of Respiratory and Critical Care Medicine, 187, 347-365. [Google Scholar] [CrossRef] [PubMed]
[11] 杜柳杨, 朱炳豹, 黄忠. 心律失常患者疲劳状况调查及危险因素分析[J]. 中国疗养医学, 2021, 30(5): 463-466.
[12] 薛瑾, 崔亚楠, 陈平, 等. 血嗜酸粒细胞对慢性阻塞性肺疾病急性加重期激素治疗反应性和再入院的预测价值[J]. 中华结核和呼吸杂志, 2019, 42(6): 426-431.
[13] Bafadhel, M., Greening, N.J., Harvey-Dunstan, T.C., Williams, J.E.A., Morgan, M.D., Brightling, C.E., et al. (2016) Blood Eosinophils and Outcomes in Severe Hospitalized Exacerbations of COPD. Chest, 150, 320-328. [Google Scholar] [CrossRef] [PubMed]
[14] 赵赟, 王锐英, 许建英, 等. 不同水平血嗜酸粒细胞的慢性阻塞性肺疾病急性加重期患者的临床特征[J]. 国际呼吸杂志, 2020, 40(17): 1309-1313.
[15] Wedzicha, J.A. and Seemungal, T.A. (2007) COPD Exacerbations: Defining Their Cause and Prevention. The Lancet, 370, 786-796. [Google Scholar] [CrossRef] [PubMed]
[16] Lange, P., Vestbo, J., Pressler, T., Mortensen, J. and Groth, S. (2001) The Natural History of Chronic Obstructive Pulmo-nary Disease. American Journal of Respiratory and Critical Care Medicine, 163, 1207-1215.
[17] Frat, J., Thille, A.W., Mercat, A., Girault, C., Ragot, S., Perbet, S., et al. (2015) High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. New England Journal of Medicine, 372, 2185-2196. [Google Scholar] [CrossRef] [PubMed]
[18] Bertoletti, L., Quenet, S., Laporte, S., Sahuquillo, J., Conget, F., Pedrajas, J., et al. (2013) Pulmonary Embolism and 3-Month Outcomes in 4036 Patients with Venous Thromboembolism and Chronic Obstructive Pulmonary Disease: Data from the RIETE Registry. Respiratory Research, 14, Article 75. [Google Scholar] [CrossRef] [PubMed]
[19] Watz, H., Tetzlaff, K., Wouters, E.F.M., Kirsten, A., Magnussen, H., Rodriguez-Roisin, R., et al. (2016) Blood Eosinophil Count and Exacerbations in Severe Chronic Obstructive Pulmonary Disease after Withdrawal of Inhaled Corticosteroids: A Post-Hoc Analysis of the Wisdom Trial. The Lancet Respiratory Medicine, 4, 390-398. [Google Scholar] [CrossRef] [PubMed]
[20] MacLeod, M., Papi, A., Contoli, M., Beghé, B., Celli, B.R., Wedzicha, J.A., et al. (2021) Chronic Obstructive Pulmonary Disease Exacerbation Fundamentals: Diagnosis, Treatment, Prevention and Disease Impact. Respirology, 26, 532-551. [Google Scholar] [CrossRef] [PubMed]
[21] Hoogendoorn, M., Hoogenveen, R.T., Rutten-van Mölken, M.P., Vestbo, J. and Feenstra, T.L. (2010) Case Fatality of COPD Exacerbations: A Meta-Analysis and Statistical Modelling Approach. European Respiratory Journal, 37, 508-515. [Google Scholar] [CrossRef] [PubMed]
[22] Wang, J., Mahmud, S.A., Thompson, J.A., Geng, J., Key, N.S. and Slungaard, A. (2006) The Principal Eosinophil Peroxidase Product, HOSCN, Is a Uniquely Potent Phagocyte Oxidant Inducer of Endothelial Cell Tissue Factor Activity: A Potential Mechanism for Thrombosis in Eosinophilic Inflammatory States. Blood, 107, 558-565. [Google Scholar] [CrossRef] [PubMed]
[23] Wang, J.G., Mahmud, S.A., Thompson, J.A., Geng, J. G., et al. (2020) Relationship of Blood Eosinophils with Fractional Exhaled Nitric Oxide and Pulmonary Function Parameters in Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Medical Science Monitor, 26, e921182. [Google Scholar] [CrossRef] [PubMed]
[24] Pavord, I.D., Chanez, P., Criner, G.J., Kerstjens, H.A.M., Korn, S., Lugogo, N., et al. (2017) Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 377, 1613-1629. [Google Scholar] [CrossRef] [PubMed]
[25] Brightling, C.E., Bleecker, E.R., Panettieri, R.A., Bafadhel, M., She, D., Ward, C.K., et al. (2014) Benralizumab for Chronic Obstructive Pulmonary Disease and Sputum Eosinophilia: A Randomised, Double-Blind, Placebo-Controlled, Phase 2a Study. The Lancet Respiratory Medicine, 2, 891-901. [Google Scholar] [CrossRef] [PubMed]
[26] Li, T., Gao, L., Ma, H., Wei, Y., Liu, Y., Qin, K., et al. (2020) Clinical Value of IL-13 and ECP in the Serum and Sputum of Eosinophilic AECOPD Patients. Experimental Biology and Medicine, 245, 1290-1298. [Google Scholar] [CrossRef] [PubMed]
[27] 邓炜静, 郑湘毅, 钟艳璋, 等. 外周血嗜酸性粒细胞与慢性阻塞性肺疾病急性加重期的相关性研究——66例回顾性分析[J]. 中国疗养医学, 2021, 30(5): 460-463.
[28] 胡甜甜, 薄建萍. 慢阻肺急性加重期患者外周血嗜酸性粒细胞与NLR、FeNO和肺功能的相关性研究[D]: [硕士学位论文].太原: 山西医科大学, 2023.
[29] Hastie, A.T., Martinez, F.J., Curtis, J.L., Doerschuk, C.M., Hansel, N.N., Christenson, S., et al. (2019) Association of Sputum and Blood Eosinophil Concentrations with Clinical Measures of COPD Severity: An Analysis of the SPIROMICS Cohort. The Lancet Respiratory Medicine, 5, 956-967.
[30] Sivapalan, P., Lapperre, T.S., Janner, J., Laub, R.R., Moberg, M., Bech, C.S., et al. (2019) Eosinophil-Guided Corticosteroid Therapy in Patients Admitted to Hospital with COPD Exacerbation (CORTICO-COP): A Multicentre, Randomised, Controlled, Open-Label, Non-Inferiority Trial. The Lancet Respiratory Medicine, 7, 699-709. [Google Scholar] [CrossRef] [PubMed]
[31] 盛伟利, 薛磊, 李洋, 等. 慢性阻塞性肺疾病急性加重期住院患者血嗜酸性粒细胞与患者住院结局分析[J]. 临床肺科杂志, 2022, 27(8): 1225-1229.
[32] Jackson, D.J., Akuthota, P. and Roufosse, F. (2022) Eosinophils and Eosinophilic Immune Dysfunction in Health and Disease. European Respiratory Review, 31, Article 210150. [Google Scholar] [CrossRef] [PubMed]
[33] Chau-Etchepare, F., Hoerger, J.L., Kuhn, B.T., Zeki, A.A., Haczku, A., Louie, S., et al. (2019) Viruses and Bacteria in Sputum Samples of Children with Stable Cystic Fibrosis: Chronic Infections and Multiple Interactions. Journal of Investigative Medicine, 67, 1029-1041. [Google Scholar] [CrossRef] [PubMed]
[34] Harb, H. and Chatila, T.A. (2020) Mechanisms of Dupilumab. Clinical and Experimental Allergy, 50, 5-14.