ObjectiveTo describe clinical significance of eosinopenia in patients with coronavirus disease 2019 (COVID-19).MethodsThis was a retrospective study conducted in three tertiary hospitals from Anhui province, China. A total of 59 patients with COVID-19 were consecutively reviewed from January 23, 2020 to March 10, 2020.ResultsThe median age of patients with COVID-19 was 39 years old, and 32 were male, 30 with eosinopenia. Cough, sputum and fatigue were more common symptoms in eosinopenia patients compared with non-eosinopenia patients. The counts of blood lymphocytes (median: 101 cells/μL) in eosinopenia patients were significantly less than those of non-eosinopenia patients (median: 167 cells/μL, P<0.001). COVID-19 patients with eosinopenia had a higher proportion of corticosteroids therapy than patients with non-eosinopenia (50.0% vs. 13.8%, respectively, P=0.005). Decreased blood lymphocytes count was an independent risk factor for eosinopenia in COVID-19 patients (odds ratio 6.566, 95%CI 1.101 - 39.173, P=0.039).ConclusionsBlood eosinopenia is frequent in COVID-19 patients. Patients with eosinopenia have different clinical features compared to patients with non-eosinopenia. Decreased lymphocyte count is an independent risk factor for eosinopenia in COVID-19 patients.
Objective To determine the airway wall thickness at the segmental and subsegmental levels in patients with bronchial asthma and eosinophilic bronchitis ( EB) by high resolution CT scanning,and evaluate its relationship with airway hyperresponsiveness. Methods High resolution CT scanning was performed in 14 subjects with asthma,15 subjects with EB, 15 subjects with cough variant asthma ( CVA) ,and 14 healthy volunteers. Total airway and lumen diameter, total airway cross sectional area and lumen area which corrected by body surface area ( BSA) were measured. The percentage of airway wall area to total airway cross sectional area ( WA% ) and wall thickness to airway diameter ratio ( T/D) were calculated for the right upper lobe apical segmental bronchus ( RB1) and all airways clearly visualized with a transverse diameter of 1-6 mm. Results T/D/BSA and WA% in the asthma patients were all significantly higher than those in the subjects with EB, CVA and healthy volunteers. T/D/BSA and WA% in the EB patients were significantly higher than the healthy volunteers, and similar with the CVA patients. Al /BSA in the patientswith asthma and CVA was less than the subjects with EB and the healthy volunteers. However, Al /BSA in the EB patients was similar with the healthy volunteers. Conclusions The airway wall thickness and remodeling can be measured and assessed by high resolution CT. Airway wall thickness and remodeling inEB patients are milder than asthma patients, which may be associated with airway hyperresponsiveness that presents in asthma but not in EB.
Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.
To investigate the diagnosis, pathological characteristics and clinical treatment of gastric eosinophilic granuloma (GEG). Twenty two cases with GEG diagnosed by operation and pathology were analyzed. In this series 14 cases subjected to partial gastrectomy, 6 cases to subtotal gastrectomy, 1 case to total gastrectomy, and 1 case to radical gastrectomy. After 1-10 years of follow-up, 1 case, who was combined with gastric carcinoma at the first operation, died of the recurrence and extensive metastasis of gastric carcinoma on the 4th year after operation, 2 cases were reoperated on the 2nd or 6th year respectively after operation for forward complication, and the others recoverd well. The authors consider that gastrofiberscopic diagnosis is key to lessen the preoperative misdiagnosis, and the scope of dissection mainly depends on the size and type of focus. It is no need for extensive dissection.
ObjectiveTo analyze the features and clinical significance of blood eosinophils (EOS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsThe general data, laboratory examination and treatment of patients with AECOPD admitted to this department from January 2014 to December 2016 were analyzed retrospectively. Based on the inclusion of treatment targets for blood EOS according to 2018GOLD, patients were divided into group A (EOS<100 cells/μL), group B (100 cells/μL≤EOS≤300 cells/μL), and group C (EOS>300 cells/μL) with two cut-off levels. The differences in general data, severity, and glucocorticoid use between group A, group B and group C were compared.ResultsA total of 515 patients with AECOPD were enrolled. 10.87% of patients had blood EOS>300 cells/μL, and 39.03% of patients had blood EOS≥100 cells/μL. Patients in group B and C were younger, with shorter disease duration, intensive care unit stay time, non-invasive mechanical ventilation use time. The time of glucocorticoid administration was significantly shortened, and the cumulative dose of venous glucocorticoid, hospitalization cost, and total drug cost were also lower than those of group A (all P<0.05).ConclusionsPatients in group B and C are younger, shorter in disease duration, lower in severity and more responsive to glucocorticoid therapy. Blood EOS can be used as a marker to guide glucocorticoid therapy in patients with AECOPD.
Objective To systematically evaluate the effectiveness and safety of mepolizumab in treating eosinophilic asthma. Methods Databases including PubMed, Embase, ISI Web of Science, Cochrane CENTRAL, MEDLINE, VIP and CNKI were searched to collect randomized controlled trials (RCTs) about mepolizumab for eosinophilic asthma from inception to October 2016. The references of these articles and relevant conference information were also manually retrieved. Meta-analysis was performed by RevMan 5.1 software after two researchers independently selected the literatures, extracted data and evaluated the quality according to the inclusion and exclusion criteria. Results A total of 9 RCTs involving 2273 patients were included. Compared with the control group, the acute exacerbation rate of asthma was decreased significantly in the mepolizumab treatment group [RR=0.67, 95%CI (0.53, 0.85), P=0.0009], eosinophil count in blood was significantly reduced [MD=–0.22, 95%CI (–0.29, –0.15), P<0.00001], eosinophil count in sputum was also significantly reduced [MD=–6.37, 95%CI (–9.68, –3.06), P<0.0002], and the proportion of patients with increased asthma-related quality of life (ACQ) score was higher significantly. The overall incidence of adverse reactions was similar between two groups [RR=0.90, 95%CI (0.71, 1.14), P=0.39]. The incidence of serious adverse reactions of mepolizumab treatment was superior to that of placebo [RR=0.45, 95%CI (0.23, 0.89), P=0.02]. The overall incidence of cardiovascular events was comparable between placebo and mepolizumab treatment [RR=0.95, 95%CI(0.40, 2.22), P=0.90]. Mepolizumab treatment may have a role in improving lung function, but the effect was not obvious. Conclusion Mepolizumab treatment can reduce the number of eosinophils in blood and sputum, reduce the exacerbation rate, and improve the quality of life of asthmatic patients with better safety.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
ObjectiveTo explore the clinical characteristics and long term mortality of patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.MethodsA retrospective review of the clinical data and long-term follow up was performed for 510 patients with first diagnosis of acute exacerbation of COPD (AECOPD) requiring hospital admission between January 2015 and December 2016. The follow-up was completed in January 1, 2020. These patients were divided into three groups according to routine blood test: an eosinophilic exacerbation group, with peripheral blood eosinophils >2%; a neutrophilic exacerbation group, with peripheral blood neutrophils >65% or leukocytes >11×109/L; a paucigranulocytic exacerbation group, any case did not belong to the above two groups. The differences of clinical characteristics were compared among three groups. Cox regression model was used for analysis of independent risk factors of all-cause mortality of AECOPD patients.ResultsA total of 510 AECOPD patients were enrolled (180 eosinophilic, 273 neutrophilic and 57 paucigranulocytic, respectively). Compared with the neutrophilic exacerbation group, the eosinophilic exacerbation group had shorter time since onset of symptoms, the lower proportion of comorbid heart failure, the lower proportion of mechanical ventilation, dual antibiotics and systematic corticosteroid treatment, the shorter length of hospitalization and lower hospital mortality (all P<0.05). The average follow-up duration was 41 months for 485 AECOPD patients who completed long term follow-up. Compared with the eosinophilic exacerbation group, the neutrophilic exacerbation group was associated with a higher long-term mortality of AECOPD (HR=1.691, 95%CI 1.205 - 2.373, P=0.002).ConclusionCOPD patients with neutrophilic exacerbations have more serious clinical features and higher mortality than those with eosinophilic exacerbations.
ObjectiveTo explore the effects of Aspergillus fumigatus (A. fumigatus) on airway inflammation, airway responsiveness and total serum IgE in asthmatic rats. MethodsEighteen male Wistar rats were divided into three groups randomly, ie. a normal control group, an asthmatic model group, and an A. fumigatus group. The rats in the model group and the A.fumigatus group were sensititized and challenged with ovalbumin to establish asthmatic model. After establishment of asthmatic model, the rats in the A. fumigatus group were treated with chronic A. fumigatus spores inhalation. Subsequently, airway responsiveness/sensitivity to methacholine(Ach), levels of serum IgE and airway inflammation were assessed and compared among three groups. ResultsCompared with the asthmatic rats, the rats treated with A. fumigatus showed higher airway responsiveness (Penh/baselin value was significantly increased at the Mch concentration of 12.5, 25 and 50 mg/mL), increased inflammatory cells infiltration in pulmonary tissue slices and increased serum IgE level (P < 0.05). Most importantly, serum IgE level was detected in close relationship with PC100 which was defined as the dose of Mch causing 100% increase of enhance pause (Penh) value without Mch challenge (r=-0.873, P < 0.01). Serum IgE level was also closely related to the percentage of eosinophils in bronchoalveolar lavage fluid (r=0.937, P < 0.01). ConclusionsChronic A. fumigatus inhalation aggravates airway inflammation, bronchial hyperresponsiveness and serum IgE level in asthma. IgE may play an important role in facilitating the development of bronchial responsiveness and eosinophilic inflammation.
ObjectiveTo explore the effect of Aspergillus fumigatus on airway eosinophilia and hyperresponsiveness in rat model of chronic asthma. MethodsWistar rats were sensitized by intraperitoneal injections with ovalbumin (OVA) followed by chronic inhalation of nebulized OVA or physiologic saline. Rats were administered via the airways with placebo or aerosolized Aspergillus fumigatus spores suspension mimicking chronic Aspergillus fumigatus exposure. The Penh after acetylcholine provocation was detected using WBP system. The concentrations of IL-5 and eotaxin in BALF were measured by ELISA. The extents of eosinophil infiltration were evaluated on hematoxylin and eosin-stained(HE) and Wright-Giemsa stained BALF cells smear. ResultsAspergillus fumigatus worsened allergic airway inflammation in OVA-challenged rats,as evidenced by enhanced bronchial responsiveness to inhaled acetylcholine and increased bronchial eosinophilia. Elevated airway eosinophilia corresponded with higher levels of IL-5 and eotaxin in the Aspergillus Fumigatus exposure group. Aspergillus fumigatus,however,did not affect bronchial responses,numbers of eosinophils,IL-5 and eotaxin levels in saline challenged mice. ConclusionThe Results show that chronic Aspergillus fumigatus exposure aggravates eosinophilic airway inflammation in asthma rats by enhancing IL-5 and eotaxin production. Aspergillus fumigatus also increases bronchial hyperresponsiveness in asthma rats.