Objective: To investigate the impact of type 2 inflammation markers blood eosinophils (EOS) and fractional exhaled nitric oxide (FeNO) on bronchodilator responsiveness (BDR) in patients with chronic obstructive pulmonary disease (COPD).
Methods: This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October, 2019 to October, 2023, who all underwent bronchial dilation test (BDT) of the large and small airways. Based on smoking history, blood EOS, and FeNO, these patients were divided group A (blood EOS < 300/μL + FeNO < 35 ppb + smoking history < 20 pack-years), group B (blood EOS < 300/μL+FeNO < 35 ppb+smoking history ≥20 pack-years), group C (blood EOS ≥300/μL or FeNO≥35 ppb+smoking history ≥20 pack-years), and group D (blood EOS ≥300/μL or FeNO ≥35 ppb+smoking history < 20 pack-years) for analyzing the relationship between clinical indexes and BDR.
Results: BDR evaluation based on forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and maximum mid-expiratory flow (MMEF) yielded consistent results, all showing a younger mean age, higher FeNO levels, and higher blood EOS counts and percentages in patients positive for BDT (P < 0.05). The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D. The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D. In the overall patients, age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF (P < 0.05).
Conclusion: Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients, and their clinical significance needs further investigation.
目的: 探讨2型炎症指标血嗜酸性粒细胞（EOS）和呼出气一氧化氮（FeNO）对慢性阻塞性肺疾病（慢阻肺）患者支气管舒张反应性（BDR）的影响。
方法: 纳入我院2019年10月~2023年10月临床确诊的389例慢阻肺患者，根据大气道的支气管舒张试验（BDT）分为BDT阳性组（n=197）和BDT阴性组（n=192）、以及小气道舒张试验阳性与否分为最大呼气中期流量（MMEF）阳性组（n=118）和MMEF阴性组（n=271）。再根据吸烟史、血EOS和FeNO水平将慢阻肺患者分为4组：A组：血EOS < 300个/μL+FeNO < 35 ppb+吸烟史 < 20包年；B组：血EOS < 300个/μL+FeNO < 35 ppb+吸烟史≥20包年；C组：血EOS≥300个/μL或FeNO≥35 ppb+吸烟史≥20包年；D组：血EOS≥300个/μL或FeNO≥35 ppb +吸烟史 < 20包年，分析临床相关指标与BDR的关系。
结果: 以第1秒用力呼气容积（FEV1）、用力肺活量（FVC）和MMEF评估的BDR所得的结果一致，均表现为舒张阳性组的平均年龄更小、FeNO水平以及血EOS计数和百分比都更高（P < 0.05）。A组患者的FEV1改善值（P=0.005）和FEV1改善率（P=0.024）均显著低于D组。B组患者的FEV1改善值（P=0.001）、FEV1改善率（P=0.035）和MMEF改善率（P=0.025）也显著低于D组。在所有患者中，年龄和FeNO水平与FEV1改善值、FEV1改善率、MMEF改善率有显著关联（P < 0.05）。
结论: 2型炎症指标对慢阻肺大、小气道BDR具有不同的影响，其临床意义值得进一步探讨。
Keywords: bronchodilator responsiveness; chronic obstructive pulmonary disease; small airway; type 2 inflammation.