摘要
简介：《 2019年全球慢性阻塞性肺疾病倡议》（GOLD）建议在慢性阻塞性肺疾病患者的药理管理中使用绝对血嗜酸性粒细胞计数作为吸入性糖皮质激素（ICS）升级和降级的指南（ COPD）。在本系统评价中，我们通过绝对血液嗜酸性粒细胞阈值评估了ICS治疗逐步升级和降级的患者中度或重度加重的风险。 方法：通过对截至2019年4月的Pubmed / MEDLINE，EMBASE和临床试验站点进行全面文献检索，我们确定了相关研究。我们使用具有固定效果估计值的通用逆方差方法，比较暴露于吸入性糖皮质激素（ICS）的非嗜血性粒细胞增多的COPD患者与非ICS治疗组中度或重度加重的风险，以风险比表示。 结果：共纳入10项研究（8项随机对照试验和2项观察性研究），共计85,059名COPD患者。在我们的汇总分析中，我们发现在ICS逐步升高的患者中，绝对血液嗜酸性粒细胞阈值范围从≥100至≥340细胞/μL的患者中中度或重度加重的风险总体降低了（RR，0.77，95％CI，0.73-0.81 ）。对于评估ICS降级对中度至重度加重的影响的研究，血液中嗜酸性粒细胞阈值≥300至≥340细胞/μL，在ICS降级后中度或重度加重的风险增加（RR，1.66， 95％CI，1.31-2.10）。 结论：这项研究证实了推荐的绝对血嗜酸性粒细胞绝对计数阈值对于COPD患者ICS升高和降低的有效性。但是，此建议是针对先前加重的COPD患者，而不是针对本研究中观察到的新诊断的COPD患者。具有当前或过去哮喘病史的COPD患者代表独特的表型组，应进一步评估。
关键词: 慢性阻塞性肺疾病，血液嗜酸性粒细胞增多，恶化，吸入皮质类固醇，嗜酸性粒细胞，药理学。
图形摘要
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