The Dynamic Changes And Clinical Significance About Plasma Cortisol,Renin,Angiotensin â…¡ In Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE Through observing the dynamical changes of plasma cortisol, angiotensin Ⅱ level and renin activity of the patients with chronic obstructive pulmonary disease (COPD) in their stable stages and acute exacerbated stages, we discuss their clinical significance.METHODS All the patients who were in the acute exacerbated stage of chronic obstructive pulmonary disease (AECOPD) and hospitalized in the senile respiratory disease ward of the first affiliated hospital of Guangxi Medical University from March2011to March2012were included. They were detected plasma cortisol (Cor),adrenal cortical hormone (ACTH), angiotensin Ⅱ (AT Ⅱ) level and renin activity (PRA) and conducted APACHE Ⅱ system score within24hours after admission. All the patients reSceived standard treatment corresponding to the COPD treatment guidelines and were conducted APACHE Ⅱ system score again before being out of hospital, five weeks after the patients were in stable condition and out of the hospital,we reviewed the index.RESULTS After excluding the patients who were with endocrine disease and hypotension, we totally included22cases among whom were19males and 3females with the average age of83.4±5.5.There were8cases whose plasma cortisol levels were less than240nmol/L, accounting to36.4%, Compared to their plasma cortisol levels of the stable stage, the patients’plasma cortisol levels was significantly lower (301.11±83.85vs355.21±86.77, P<0.01)in acute exacerbated stage, while adrenocorticotropic hormone level (42.97±19.41vs29.57±10.54, P<0.01), plasma angiotensin Ⅱ level (68.71±35.92vs50.45±16.33, P<0.01), plasma renin activity(2.05±1.28vs0.88±0.63, P<0.01) and APACHE Ⅱ system score(16.27±1.72vs15.73±1.42, P<0.05) were higher. The Pearson correlation analysis showed that the FEV1%pred, FEV1/FVC%was not significantly correlated to plasma cortisol levels (r=0.376, P=0.084; r=0.333, P=0.130), adrenocorticotropic hormone levels (r=-0.329, P=0.135; r=-0.284, P=0.200), renin activity (r=-0.128, P=0.570; r=0.114, P=0.615), angiotensin Ⅱ levels (r=-0.230, P=0.302; r=0.019, P=0.993)and APACHE Ⅱ system score (r=-0.067, P=0.767; r=-0.285, P=0.198). The length of hospitalized period was negative correlated to plasma cortisol levels(r=-0.445, P<0.05), while not significantly to adrenocorticotropic hormone Ievels(r=0.364, P=0.126), renin activity (r=-0.093, P=0.681), angiotensin II levels(r=-0.089, P=0.692) and the APACHE II system score (r=0.330, P=0.134).CONCLUSIONS The plasma renin and angiotensin II levels being increased while plasma cortisol levels being decreased in the patients with AECOPD suggest that these patients might be with adrenal dysfunction, the APACHE Ⅱ system score of acute exacerbated stage was higher than that of stable stage. Plasma cortisol levels was negative correlated to the length of hospitalized period in the patients with AECOPD, which contributed to assessing the severity and evaluating the prognosis.