Correlation Study Of Severity In AECOPD Patients With HRCT, IL-17, And Hs-CRP Levels

Objective:Chronic Obstructive Pulmonary Disease(COPD),a commonpreventable and treatable disease,is characterized by persistent airflowlimitation that is usually progressive and associated with an enhanced chronicin-flammatory response in the airways and the lung to noxious particles orgases.Exacerbations and comorbidities contribute to the overall severity inindividual patients.Different pathological changes between different patients,resulting in clinical disease showed heterogeneity and different phenotypes.There is currently a lack of parameters which could be able to timely andaccurately evaluate the occurrence,development and prognosis of acuteexacerbation of chronic obstructive pulmonary disease (AECOPD),so it isimportant to research sensitive indicator on AECOPD occurrence,developmentand prognosis.Infection is an important factor in the development of COPD.Inthis research,healthy subjects and AECOPD patients were studied,correlationbetween AECOPD severity with HRCT type,serum IL-17,hs-CRP levels andothers were assessed.The research will provide new ideas for clinicalprevention and treatment of AECOPD.Methods:1SubjectsSelect AECOPD patients hospitalized in respiratory division and healthyvolunteer for medical examination in the Second Hospital of Hebei MedicalUniversity from March2013to January2014.According to2013ChineseMedical Breathing Branch of COPD group revised the diagnosis and treatmentof COPD and acute exacerbation of diagnostic criteria to select AECOPDpatients,and there were70patients(55male,15female,average age69.2±6.1years);healthy control group had15patients(11male,4female,average age66.7±8.5years).On the day of admission,the patients had checked routingly bloodcount,erythrocyte sedimentation rate(ESR) and lung HRCT examination.Three days after symptoms improved, the patients had reviewed bloodindicators and pulmonary function tests. Based on acute exacerbation andremission criteria of COPD which was raised by Anthorisen,the study subjectswere divided into①A ECOPD patients,②S table COPD patients.According tothe COPD treatment guidelines of2013subjects were divided into:①group A:low-risk,less symptoms;②group B:low risk,more symptoms;③group C:high-risk,less symptoms;④group D:high risk,more symptoms.According tothe results of the study of lung HRCT,subjects were divided into①emphysematype;②b ronchitis type;③m ixedtype.2Measurement of serum IL-17, hs-CRP levels2.1Specimen collection:all selected for the control group and the experimentalgroup(AECOPD patients)were collected blood3ml of cubital vein on fasting.The blood was injected into dry vacuum non-anticoagulant tube,centrifugated15min by4℃3000r/min.Supernatant was collected into EP tube,and saved inthe-80℃r efrigerator.2.2ELISA assay serum IL-17, hs-CRP levelsResults:1Serum IL-17, hs-CRP, WBC, NE%, ESR in AECOPD and stablepatients were significantly higher than that in control group (P<0.05).SerumIL-17, hs-CRP, WBC, NE%, ESR in AECOPD were significantly higher thanthat in stable group (P<0.05).2Serum IL-17,hs-CRP,WBC,NE%,ESR in different groups ofcomprehensive assessment AECOPD patients were significantly higher thanthose in control group(P<0.05).Serum IL-17,hs-CRP levels of group D weresignificantly higher than those of group A,B,C(P<0.05);Serum IL-17,hs-CRPof group C were higher than those of group A and group B(P<0.05),there wasno significant difference between the rest of the groups.WBC and NE%levelsof group D were higher than those of group A,group B and group C(P<0.05),there was no significant difference between the remaining groups.ESR levelsof group B,D were higher than that of group A,C(P<0.05). 3Serum IL-17,hs-CRP,WBC,NE%,ESR in different groups ofcomprehensive assessment stable COPD patients were significantly higherthan those in control group(P<0.05).Serum IL-17level of group D wassignificantly higher than that in group A,B,C(P<0.05).Serum hs-CRP level ofgroup B was significantly higher than that in group A,B,C(P<0.05)Theremaining groups had no significant difference.WBC,NE%and ESR had nosignificant difference between the groups(P>0.05).4Serum IL-17,hs-CRP,WBC,NE%,ESR in AECOPD patients withdifferent type of HRCT were significantly higher than those in controlgroup(P<0.05).Serum IL-17,hs-CRP levels of bronchitis and mixed groupswere significantly higher than those of emphysema type(P<0.05).WBC andNE%levels of mixed type were higher than those of other groups(P<0.05),there was no significant difference between other groups.ESR levelof bronchitis type was higher than that of other groups(P<0.05).5Serum IL-17,hs-CRP,WBC,NE%,ESR in Stable COPD patients withdifferent type of HRCT were significantly higher than those in controlgroup(P<0.05).FEV1/predicted%of bronchitis type was significantly higherthan that of other groups(P<0.05).RV/TLC of bronchitis type was significantlylower than that of other groups(P<0.05).6IL-17was positively correlated with hs-CRP in AECOPD patients(r=0.556,P<0.05).There was a negative linear correlation between IL-17serum levels and FEV1/predicted%(r=-0.416,P<0.05).There was a negativelinear correlation between hs-CRP serum levels and FEV1/predicted%(r=-0.366,P<0.05).IL-17,hs-CRP and WBC,NE%,ESR had weak positivecorrelation(r=0.11~0.23,P<0.05).Conclusions:IL-17,hs-CRP,WBC,NE%,ESR of AECOPD patients werehigher than those of control group,IL-17,hs-CRP,WBC,NE%,ESR ofAECOPD patients were higher than those of stable group. The result indicatedthat IL-17,hs-CRP,WBC,NE%,ESR reflect exacerbations process.The resultsshowed that the degree of airflow limitation was positively correlated withIL-17and hs-CRP,which indicated that inflammation increased breathing difficulties. The more severe the disease,the higher of IL-17,hs-CRP and otherindicators of infection,indicating that inflammation was directly proportionalto the degree of severity of the disease.The degree of airflow limitation andgas retention with mixed type were the most severly,and the levels ofIL-17,hs-CRP were highest.In conclusion, IL-17and hs-CRP levels werecorrelated with clinical parameters.IL-17and hs-CRP may play importantroles in mechanisms of airway inflammation and the destruction of lungtissue,airway remodeling,airflow limitation and other pathological processes.IL-17,hs-CRP could become the clinical prediction index to assess COPD.