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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2025, Vol. 18 ›› Issue (06) : 955 -960. doi: 10.3877/cma.j.issn.1674-6902.2025.06.017

论著

慢性阻塞性肺疾病伴肺气肿患者嗜酸性粒细胞计数与肺泡损伤的关系研究
杨苗苗1, 顾翔2, 杨柳1, 孙天宇1, 王梦林1, 张拓1,†(), 王婷2   
  1. 1223800　宿迁，江苏省人民医院宿迁医院检验科
    2223800　宿迁，江苏省人民医院宿迁医院呼吸科
  • 收稿日期:2025-09-09 出版日期:2025-12-25
  • 通信作者: 张拓
  • 基金资助:
    江苏省卫生健康委科研项目(M2020035)

Sttudy on relationship between blood eosinophil count and alveolar damage in patients and chronic obstructive pulmonary disease with emphysema

Miaomiao Yang1, Xiang Gu2, Liu Yang1, Tianyu Sun1, Menglin Wang1, Tuo Zhang1,†(), Ting Wang2   

  1. 1Department of Laboratory, Jiangsu Provincial People′s Hospital Suqian Hospital, Suqian 223800, China
    2Department of Respiratory Medicine, Jiangsu Provincial People′s Hospital Suqian Hospital, Suqian 223800, China
  • Received:2025-09-09 Published:2025-12-25
  • Corresponding author: Tuo Zhang
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引用本文：

杨苗苗, 顾翔, 杨柳, 孙天宇, 王梦林, 张拓, 王婷. 慢性阻塞性肺疾病伴肺气肿患者嗜酸性粒细胞计数与肺泡损伤的关系研究[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 955-960.

Miaomiao Yang, Xiang Gu, Liu Yang, Tianyu Sun, Menglin Wang, Tuo Zhang, Ting Wang. Sttudy on relationship between blood eosinophil count and alveolar damage in patients and chronic obstructive pulmonary disease with emphysema[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 955-960.

目的

探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)伴肺气肿患者嗜酸性粒细胞(eosinophil, EOS)计数与肺泡损伤的关系。

方法

选择2021年1月至2025年6月我院收治的186例COPD伴肺气肿患者。检测EOS计数，患者接受胸部计算机断层(computerized tomography, CT)扫描、肺功能检查和心肺运动试验(cardiopulmonary exercise testing, CPET)。使用Spearman分析EOS计数与CT参数、肺功能、CPET参数的相关性，采用多元线性回归校正混杂因素。

结果

186例中EOS表型COPD患者82例(EOS≥300/μl)，非EOS表型104例(EOS<300/μl)。EOS表型者支气管舒张剂使用63例(76.83%)高于非EOS表型者56例(53.85%)(P＝0.001)，中性粒细胞计数低于非EOS表型者(P＝0.027)。Spearman相关性分析显示，EOS表型者EOS计数与肺密度呼吸比值(expiratory to the inspiratory ratio of mean lung density, E/I)(rs＝0.484，P＝0.000)、顶端节段第5级支气管壁面积(wall area, WA)百分比(B1 5 th WA%)(rs＝0.396，P＝0.000)、顶端节段第5级气道壁厚(wall thickness, WT)(B1 5th WT)(rs＝0.245，P＝0.041)呈正相关，与峰值每分钟通气量(peak of minute ventilation, VEpeak)(rs＝－0.239，P＝0.030)、最大分钟通气量(maximum voluntary ventilation, MVV)(rs＝－0.442，P＝0.000)、峰值心率(peak of heart rate, HRpeak)(rs＝－0.336，P＝0.002)、血氧饱和度(oxygen saturation, SpO2)(rs＝－0.230，P＝0.037)、第一秒用力呼吸容积Z评分(Z score of forced expiratory volume in one second, FEV1 Z-score)(rs＝－0.484，P＝0.000)、FEV1与用力肺活量比值Z评分(Z score of FEV1 to forced vital capacity ratio, FEV1/FVCZ-score)(rs＝－0.488，P＝0.000)、一氧化碳弥散量Z评分(Z score of diffusion capacity for carbon monoxide of lung, DLCO Z-score)(rs＝－0.230，P＝0.038)、肺泡通气量Z评分(Z score of alveolar ventilation, VAZ-score)(rs＝－0.231，P＝0.037)呈负相关。非EOS表型者EOS计数与单位肺容积的一氧化碳弥散量(diffusion capacity for carbon monoxide per liter of alveolar volume, KCO)(rs＝－0.200，P＝0.042)呈负相关。多元线性回归显示，EOS表型者EOS计数与E/I(P＝0.000)、B1 5th WA%(P＝0.000)、B1 5th WT(P＝0.041)、VEpeak(P＝0.008)、MVV(P＝0.000)、VR(P＝0.004)、FEV1 Z-score(P＝0.000)、FEV1/FVCZ-score(P＝0.000)、VAZ-score(P＝0.029)相关；非EOS患者中无相关性。

结论

COPD伴肺气肿患者肺泡损伤与气道嗜酸性炎症相关，EOS表型肺气肿和肺泡损伤严重。

关键词: 肺疾病，慢性阻塞性, 肺气肿, 嗜酸性粒细胞, 肺泡损伤, 肺功能
Objective

To investigate the relationship between eosinophil (EOS) count and alveolar damage in patients with chronic obstructive pulmonary disease (COPD) complicated with emphysema.

Methods

A total of 186 patients with COPD and emphysema admitted to our hospital from January 2021 to June 2025 were selected. EOS counts were measured, and patients underwent chest computerized tomography (CT) scans, pulmonary function tests, and cardiopulmonary exercise testing (CPET). Spearman analysis was used to analyze the correlations between EOS count and CT parameters, pulmonary function, and CPET parameters. Multiple linear regression was employed to adjust for confounding factors.

Results

Among the 186 patients, 82 were identified as the EOS phenotype (EOS ≥300/μl) and 104 as the non-EOS phenotype (EOS<300/μl). The use of bronchodilators was higher in the EOS phenotype group 63 cases( 76.83%) compared to the non-EOS phenotype group 56 cases(53.85%) (P=0.001), and the neutrophil count was lower in the EOS phenotype group (P=0.027). Spearman correlation analysis showed that in the EOS phenotype group, EOS count was positively correlated with the expiratory to inspiratory ratio of mean lung density (E/I) (rs=0.484, P=0.000), the wall area percentage of the 5th generation apical segment bronchus (B1 5th WA%) (rs=0.396, P=0.000), and the wall thickness of the 5th generation apical segment airway (B1 5th WT) (rs=0.245, P=0.041). It was negatively correlated with the peak of minute ventilation (VEpeak) (rs=-0.239, P=0.030), maximum voluntary ventilation (MVV) (rs=-0.442, P=0.000), peak heart rate (HRpeak) (rs=-0.336, P=0.002), oxygen saturation (SpO2) (rs=-0.230, P=0.037), Z score of forced expiratory volume in one second (FEV1 Z-score) (rs=-0.484, P=0.000), Z score of FEV1 to forced vital capacity ratio (FEV1/FVCZ-score) (rs=-0.488, P=0.000), Z score of diffusion capacity for carbon monoxide of the lung (DLCO Z-score) (rs=-0.230, P=0.038), and Z score of alveolar ventilation (VAZ-score) (rs=-0.231, P=0.037). In the non-EOS phenotype group, EOS count was negatively correlated with diffusion capacity for carbon monoxide per liter of alveolar volume (KCO) (rs=-0.200, P=0.042). Multiple linear regression showed that in the EOS phenotype group, EOS count was associated with E/I (P=0.000), B1 5th WA% (P=0.000), B1 5th WT (P=0.041), VEpeak (P=0.008), MVV (P=0.000), VR (P=0.004), FEV1 Z-score (P=0.000), FEV1/FVCZ-score (P=0.000), and VAZ-score(P=0.029). No such associations were found in non-EOS patients.

Conclusion

Alveolar damage in patients with COPD and emphysema is associated with airway eosinophilic inflammation. The EOS phenotype is associated with more severe emphysema and alveolar damage.

Key words: Chronic obstructive pulmonary disease, Emphysema, Eosinophils, Alveolar damage, Lung function
表1 COPD不同EOS表型患者临床资料结果比较
临床资料 EOS表型(n＝82) 非EOS表型(n＝104) t/χ2/Z值 P值
体质量指数[kg/m2，(±s)] 25.82±3.63 26.31±3.61 －0.909 0.364
吸烟史[n(%)] 60(48.78) 64(51.92) 2.792 0.095
β受体阻滞剂[n(%)] 27(32.93) 26(25.00) 1.414 0.234
支气管扩张剂[n(%)] 63(76.83) 56(53.85) 10.510 0.001
实验室指标[M(Q25，Q75)]        
白细胞计数(×103/μl) 7.50(6.00，8.80) 6.85(5.35，8.20) －1.866 0.062
红细胞计数(×103/μl) 4.01(3.72，4.42) 3.94(3.64，4.19) －1.564 0.118
单核细胞计数(×103/μl) 0.50(0.34，0.63) 0.44(0.33，0.56) －1.174 0.240
中性粒细胞计数(×103/μl) 4.96(3.80，6.16) 4.45(3.26，5.60) －2.206 0.027
EOS计数(个/μl) 417.00(341.50，625.10) 91.50(15.75，223.50) －11.622 0.000
图1 COPD伴肺气肿患者典型CT图像。图A为EOS型COPD伴肺气肿患者CT图，大片透亮区，肺小叶破坏严重，呈低密度、无壁、不规则状；图B为非EOS型COPD伴肺气肿患者CT图，小叶中央型气肿区域较小，呈斑片状，肺纹理和小血管数量减少
表2 EOS表型COPD患者EOS计数与CT参数相关性分析
CT参数 M50(P25，P75)(±s) Spearman相关性 多元线性回归
rs P值 B(95%CI) S.E. t值 P值
E/I 5.30(3.11，10.92) 0.484 0.000 8.885(6.185~11.585) 1.355 6.557 0.000
B1 3rd WA% 70.92±8.15 0.216 0.053 － － － －
B1 5th WA% 85.95(83.30，88.36) 0.396 0.000 6.636(3.804~9.468) 1.421 4.670 0.000
B1 3rd WT(mm) 1.03(0.71，1.12) 0.029 0.809 － － － －
B1 5th WT(mm) 0.98(0.75，1.09) 0.245 0.041 85.996(3.575~168.418) 41.232 2.086 0.041
B10 3rd WA% 70.91±6.78 0.005 0.969 － － － －
B10 5th WA% 84.30(80.45，87.46) 0.023 0.840 － － － －
B10 3rd WT(mm) 0.98(0.68，1.09) 0.116 0.334 － － － －
B10 5th WT(mm) 0.99(0.68，1.09) 0.141 0.238 － － － －
表3 EOS表型COPD患者EOS计数与CPET指标相关性分析
CPET指标 M50(P25，P75)(±s) Spearman相关性 多元线性回归
rs P值 B(95%CI) S.E. t值 P值
VO2(ml/min) 1.36(1.02，1.67) －0.198 0.075 － － － －
VCO2(ml/min) 1.49(1.10，1.80) 0.169 0.128 － － － －
RER 1.07±0.12 0.009 0.937 － － － －
VEpeak(L/min) 54.31(43.98，68.83) －0.239 0.030 －1.341(－2.320~－0.363) 0.491 －2.732 0.008
MVV(L/min) 69.16±26.96 －0.442 0.000 －1.621(－2.307~－0.936) 0.344 －4.710 0.000
VR(L/min) 0.17(0.01，0.24) －0.336 0.002 －109.641(－184.052~－35.231) 37.344 －2.936 0.004
HRpeak(次/min) 135.07±21.42 －0.147 0.187 － － － －
SpO2(%) 94.00(91.75，96.00) －0.230 0.037 －3.545(－8.763~1.673) 2.619 －1.354 0.180
表4 COPD患者EOS计数与肺功能相关性分析
肺功能 M50(P25，P75)(±s) Spearman相关性 多元线性回归
rs P值 B(95%CI) S.E. t值 P值
EOS表型              
FEV1 Z-score －2.72(－3.35，－1.66) －0.484 0.000 －32.606(－47.790~－17.421) 7.621 －4.279 0.000
FVCZ-score －0.68(－1.55，0.00) －0.196 0.078 － － － －
FEV1/FVCZ-score －3.12±1.01 －0.488 0.000 －40.611(－57.187~－24.035) 8.319 －4.882 0.000
DLCO Z-score －2.88(－3.98，－2.27) －0.230 0.038 －9.219(－26.081~7.643) 8.463 －1.089 0.280
VAZ-score －1.32(－2.13，－0.81) －0.231 0.037 －16.411(－31.049~－1.773) 7.346 －2.234 0.029
KCOZ-score －2.23(－3.03，－1.35) －0.001 0.993 － － － －
非EOS表型              
FEV1 Z-score －1.64(－2.56，－1.15) 0.048 0.632 － － － －
FVCZ-score －0.08(－1.26，0.55) 0.072 0.467 － － － －
FEV1/FVCZ-score －2.61±0.77 －0.111 0.261 － － － －
DLCO Z-score －0.93(－1.50，－0.38) －0.145 0.142 － － － －
VAZ-score －0.14(－0.92，0.69) 0.126 0.204 － － － －
KCOZ-score －0.88(－1.83，0.10) －0.200 0.042 －4.349(－11.717~3.019) 3.712 －1.172 0.244
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