Clinical Treatment And Curative Effect Observation Of Chronic Obstructive Pulmonary Disease Patients With Radiologic Phenotypes

Objective:1.To investigate the clinical individual therapy effect in patients wit-h chronic obstructive pulmonary disease radiologic phenotypes.2.According to the degree of emphysema and (or) bronchial wall thi-ckening,COPD can be divided into different phenotypes, observing the clinical therapy effect of the ICS+LABA or ICS+LABA+LAM of chronic obstructive pulmonary disease(COPD) and to explore the effect of different treatment met-hods for patients with radiological phenotype is different.Methods:1. This is a clinical prospective case and control study. The diagnosis of COPD refers to the diagnostic and treatment guide in GLOD (Revised 2013). Standard choice between August 2013 and March 2015 in our hospital outpatient and the inpatient in C (High Risk, Less Symptoms, Spirometric Classification 3-4, acute exacerbation≥2 times/year, mMRC< 2 grade, the CAT score< 10), D (High Risk, More Symptoms, Spirometric Classification 3-4, acute exacerbation or 2 times per-year, mMRC≥2 grade, the CAT score≥10) standard set of patients as the research object. We collected HRCT date of the cases who measure up to standards, rebuilt CT image and measured indexes of emphysema (PI-950 and LAA scores), measured bronchial wall thickening and adjacent pulmonary artery diameter and calculated the ratio, We divided the cases into three phenotypes depending on the LAA scores and the bronchial wall thickening:A phenotype, E phenotype, M phenotype complete the pulmonary function and bronchial diastolic test inspection, record the age, smoking index, the CAT scores, lung function related data (FEV1, RV/TLC, FEV1% Pre), detection of C-reactive protein.2. Standard choice between August 2013 and March 2015 in our hospital outpatient and the inpatient in C、D standard set of patients as the research object. A total of 143 patients were recruited. Completely randomized design, were randomly divided into the three types of two treatment groups, (A group) Budesonide/ Formoterol Powder for Inhalation (160ug/4.5ug, daily twice), (group B) tiotropium bromide Powder for Inhalation(18ug, bedtime inhalation,1 day)+ budesonide /formoterol inhalation powder. Respectively before the medication, medication after 3 months determination:pulmonary function (FEV1, RV/TCL, FEV1% Pre); detection of C-reactive protein, and do questionnaire COPD Assessment Test (CAT scores) to evaluate the quality of life.Results:1. A phenotype, E phenotype, M phenotype of COPD patient budesonide /formoterol inhalation powder (A group), budesonide/formoterol inhalation powder +Tiotropium group (group B) before and after treatment in lung function parameters, CAT scores, CRP level changes.(1)General information and clinical data:A total of 143 patients were recruited.136 cases of male, female 8 cases, Age of COPD group is 65.07±7.98 (rang from 43 to 80). There are 65 smokers in COPD group (90.28%), smoking index is 1035.85±629.29 piece-years, Including 98 people in the group C, accounted for 65.53%, group D 45 people, accounting for 31.47%.(2)A phenotype of group A and group B before PTF (FEV1, RV/TLC, FEV1% Pre), CAT score, CRP no statistical difference After treatment, improvement in FEV1 values (1.21 ± 0.11,1.19 ± 0.24), two between treatment groups (t= 1.929, P> 0.05) was no difference, there are differences among the same group before and after treatment (P= 0.001, P= 0.01); After treatment, the RV/TLC improve value (46.54 ± 7.79,44.23 ± 8.32) between the two treatment groups (t= 1.051, P> 0.05) was no difference among the same group before and after treatment (P= 0.007, P= 0.033) differences; After treatment, improvement in FEV1% Pre value (60.67 ± 12.07,59.84 ± 9.71), between the two treatment groups (t=-1.362, P> 0.05) was no difference, (P = 0.043, P= 0.037) differences among the same group before and after treatment; After treatment, improve value CAT (9.20 ± 3.70,7.29 ± 4.03), between the two treatment groups (t= 1.601, P> 0.05) was no difference, there are differences among the same group before and after treatment (P= 0.001, P= 0.002); both groups improved after treatment CRP value (5.88 ± 4.39,5.78 ± 3.80), between the two treatment groups (t= 0.492, P> 0.05) was no difference, there are differences among the same group before and after treatment (P= 0.028, P= 0.001).bronchodilator efficacy of A phenotype for single or combined bronchodilator is significantly, and the two treatment has no significant difference between the efficacy of the program.(3) E phenotype of group A and group B before treatment pulmonary function (FEV1, RV/TLC, FEV1% Pre), CAT score, CRP no difference After treatment, improvement in FEV1 values (0.82 ± 0.12,0.85 ± 0.31), two between treatment groups (t= 0.344, P<0.05) differences, A therapy group before and after treatment (t =-1.36, P= 0.189) no difference, B before and after treatment (t=-2.135, P= 0.046) have difference; After treatment, RV/TLC improved to (49.91 ± 9.84,48.70 ± 7.79), between the two treatment groups (t= 2.251, P<0.05) differences, among the same group before and after treatment (P= 0.046, P= 0.02) differences; After treatment, improvement in FEV1% Pre value (40.50 ± 8.74,43.15 ± 9.87), between the two treatment groups (t=-2.071, P<0.05) differences, A group before and after treatment (t=-0.211, P= 0.835) no significant difference in group B before and after treatment (t= 12.610, P= 0.017) differences; After treatment, CAT improve value (13.16 ± 4.82,12.56 ± 4.8), between the two treatment groups (t= 0.076, P<0.05) There are differences among the same group before and after treatment (P= 0.039, P= 0.000) differences; After treatment, improvement in CRP values (4.48 ± 3.75,4.81 ± 2.42), the two treatment groups comparison between (t= 0.677, P> 0.05) was no difference, there are differences among the same group before and after treatment (P= 0.020, P= 0.001). Single Bronchodilators can improve patient RV/TLC, CAT score, CRP indicators joint bronchodilators improve lung function in patients with type E, CAT score is better than a single bronchodilator group, no significant difference in CRP between the two treatment groups.(4) M phenotype of group A and group B before treatment pulmonary function (FEV1, RV/TLC, FEV1% Pre), CAT score, CRP no difference After treatment, improvement in FEV1 values (1.02 ± 0.14,1.04 ± 0.21), two between treatment groups (t= 0.66, P> 0.05) was no difference, there are differences among the same group before and after treatment (P= 0.002, P= 0.001); After treatment, the RV/TLC improve value (49.54 ± 8.30,44.66 ± 7.75) between the two treatment groups (t= 2.204, P<0.05) differences, among the same group before and after treatment (P= 0.022, P= 0.029) differences; After treatment, improvement in FEV1% Pre value (52.46 ± 11.21,53.47 ± 8.01), between the two treatment groups (t=-2.151, P> 0.05) was no difference, (P= 0.036, P= 0.03) there are differences among the same group before and after treatment; After treatment, improve value CAT (13.33 ± 3.61,10.26 ± 4.93), between the two treatment groups (t= 2.440, P<0.05) There are differences among the same group before and after treatment (P= 0.049, P= 0.001) differences; two CRP improved treatment value (8.77 ± 4.19,4.96 ± 2.83), between the two treatment groups (t= 3.85, P<0.05) there are differences, there are differences among the same group before and after treatment (P= 0.022, P= 0.000). Single or combined bronchodilator bronchodilators can improve lung function in patients with type M, CAT scores and CRP targets, improving RV/TLC and CAT scores, on CRP markers in a single bronchodilator superior.(5) A treatment group A phenotype, E phenotype, M phenotype pretreatment FEV1, RV/TLC, FEV1% Pre, CAT score, CRP were different, in line with the results of previous studies in our department, three types of treatment to improve the value of the difference in FEV1 after (F= 40.852, P= 0.000), RV/TLC value improved treatment difference (F= 1.224, P= 0.123), FEV1% Pre improve value differences after treatment (F= 6.609, P= 0.002), improved post-CAT treatment difference (F= 8.935, P= 0.000), improved treatment CRP value difference (F= 7.152, P= 0.001), After single bronchodilator therapy, A phenotype reactions to a single bronchodilator is better than that of M and E, M phenotype of patient’s response to A single bronchodilator is better than that of E. A phenotype, M phenotype of hormone response is better than that of E.(6) B treatment group A phenotype, E phenotype, M phenotype pretreatment FEV1, RV/TLC, FEV1% Pre, CAT score, CRP were different, in line with the results of previous studies in our department, three types of treatment to improve the value of the difference in FEV1 after (F= 20.06, P= 0.030), RV/TLC value improved treatment difference (F= 15.83, P= 0.045), FEV1% Pre improve value after treatment difference (F= 4.419, P= 0.016), CAT improve difference after treatment (F= 8.116, P= 0.001), improved treatment CRP value difference (F= 5.327, P= 0.306). After united bronchodilator therapy, A, M-phenotype FEV1, FEV1% Pre is better than the E-phenotype, M-phenotype FEV1, RV/TLC, CAT improvement is superior to E. M-type airway inflammation leads to airway remodeling, peripheral airways is the main site of airway remodeling, M3 receptors are distributed in the airways. Combination therapy can relax the airway levels, improve lung function and quality of life, and has more effective than the E phenotype.2. A group or group B FEV1 values were improved with the PI-950, bronchial wall thickening and adjacent pulmonary artery diameter and calculated the ratio. Relevance CAT scores after treatment, CRP value change(1)General information and clinical data:A study for the first part of the group (75 cases) and group B (68 cases) in patients with COPD, after ICS+LABA treatment, FEV1 improved value Statistical treatment:<30ML (15 cases), improved 30～40ML (18 cases),40～50ML (31 cases), improved> 50ML (11 cases); after ICS+LABA+ LAMA treatment, after treatment FEV1 improved statistical value:<30ML (9 cases), improved 30～40ML (14 cases),40～50ML (28 cases), improve> 50ML (17 cases).(2)A group FEVI improve the value of PI-950 (r=-0.534, P= 0.000) were negatively correlated with bronchial wall thickness/diameter of the adjacent pulmonary level (r=-0.554, P= 0.000) were negatively correlated. FEV1 value and improve after treatment CAT Scale scores (r= 0.474, P= 0.002) were positively correlated with changes in the value of CRP (r= 0.209, P= 0.189) irrelevant; group B FEVI improve the value of PI-950 (r=-0.531, P= 0.000) were negatively correlated with bronchial wall thickness/diameter of the adjacent pulmonary level (r=-0.558, P = 0.000) were negatively correlated, FEVI improved value and improve the value of CAT scores (r= 0.522, P= 0.004) were positively correlated with changes in the value of CRP (r= 0.358, P= 0.172).Conclusion:1. A phenotype compared with other two types of patients, is characterized by mild clinical symptoms, high quality of life, obvious emphysema, bronchial wall thickening is not obvious, bronchodilator efficacy of A phenotype for single or combined bronchodilator is significantly, and the two treatment has no significant difference between the efficacy of the program.2.E phenotype characterized by heavier conditions, poor quality of life and decreased obviously, pulmonary ventilation, shows small airway closure, the single bronchodilator can improve patients with airway closure, and the quality of life, but the effect of improving the FEV1, FEV1% Pre is not good, joint bronchodilator can improve E phenotype patients airway closure conditions and quality of life. Tips for E phenotype patients need larger doses or multiple pathways drug combination therapy.3. M phenotype patients, compared with other two type of airway inflammation apparent. After the single and combined bronchodilator response is good, but combination curative effect is better, mechanisms are different between two the combination can relax the airway levels, improve anti-inflammatory effect, relieve airway spasm.4. After single bronchodilator therapy, A phenotype reactions to a single bronchodilator is better than that of M and E, M phenotype of patient’s response to A single bronchodilator is better than that of E. A phenotype, M phenotype of Inhaled corticosteroids is better than that of E.5.After united bronchodilator therapy, A, M phenotype FEVI, FEV1% Pre is better than the E phenotype, M phenotype FEV1, RV/TLC, CAT improvement is superior to E. M phenotype airway inflammation leads to airway remodeling, peripheral airways is the main site of airway remodeling, M3 receptors are distributed in the airways. Combination therapy can relax the airway levels, improve lung function and quality of life, and has more effective than the E phenotype.6. The effect of the treatment of patients close link between the degree of emphysema and bronchial wall thickening. Improved FEV1 values are positively correlated with the CAT to improve value.7. HRCT in COPD condition assessment, efficacy assessment, follow-up, prognosis and prediction of efficacy has important significance.