| Objective:1.To discuss the clinical characteristics of COPD patients classified into different phenotypes by general clinical data, pulmonary function test, and inflammation bio-markers, we also include some study variables involving,bronchi wall thickening and emphysema which measured by HRCT.2.To explore the possible relationship between the two phenotypes, as assessed by HRCT, and pulmonary function, and analyze the correlation between inflammations.Methods:1. This is a clinical prospective case-control study, COPD patients are divided into two groups which one have chronic bronchitis,and another don’t have chronic bronchitis, the diagnose of COPD according to the 2013 Global Initiative (GOLD guidelines). All subjects should meet the date from December 2014 to August 2015 in our hospital. We collect general clinical data(sex,age,smoking-pack years,body mass index), as well as the previous year due to acute exacerbations, pulmonary function test(FEV1/FVC,FEV1%pre,RV/TLC),CT image and index of emphysema(PI-950). Airway wall thickeness, outer diameter (D), an lumen diameter (L), Wall thickness:WT= (D-L)/2; T/D-ratio of wall thickness and bronchial diameter:T/D= WT/D; AO-total bronchi area:A0= n (D/2) 2; AL lumen area:AL = π (L/2) 2; WA wall area:WA= AO-AL; the percentage wall area of the bronchial wall area accounted WA%:WA%= (WA/AO) x 100. CAT, mMRC score. Induced sputum specimens, sputum smear Serum samples are collected after patient spit out within 2 hours. Finally, enzyme-linked immunosorbent ascess induced sputum and serum IL-8, TNF-α.2. The depend on the definition of chronic bronchitis, COPD patients are divided into two groups, with and without chronic bronchitis group. Compare sputum cell counts, inflammatory markers, general clinical data, pulmonary function test, HRCT between two different phenotypes. To detect the correlation between inflammatory markers, between HRCT and lung function test,between inflammatory markers cell counts and inflammation, in patients with chronic obstructive pulmonary disease.Results:1. General information:The study included 62 cases of COPD qualified.53 cases are male,9 are females. Age 51-80 years, mean 68.73 ± 8.56 years old. Among 62 cases of a total,43 patients had a history of smoking were male. Smoking history is 945.58 ± 422.03. pulmonary function of GOLD classification, grade l,4cases, accounting for 6.45%; grade 2,16 cases accounting for 25.81%; grade 3,26cases, accounting for 41.93%grade 4,16 cases accounting for 25.81%.(1)There were no significant difference between without chronic bronchitis and chronic bronchitis group:age, BSA, mMRC score, (P> 0.05).(2)Chronic bronchitis group, has a high smoking index (1070.74 ±459.07,734.38 ± 240.05) difference is statistically significant. (2.71, p= 0.01); BMI (22.04 ±3.25,20.46 ± 2.52) difference is statistically significant (t= 2.138, p= 0.037); exacerbations (2.53 ± 1.07,1.43 ± 0.77) difference was statistically significant (t= 4.582, p<0.001); CAT score (18.78 ± 4.56,15.40 ± 4.20) difference is statistically significant (t= 3.03, p= 0.004).(3) There were no difference between chronic bronchitis patients with and without chronic bronchitis in pulmonary function test:FEV1/FVC, FEV1%pre, RV/TLC. 2.HRCT measurements (1)There were no difference between chronic bronchitis patients with and without chronic bronchitis in emphysema.The airway wall thickness in chronic bronchitis group is higher than those in without chronic bronchitis group. Among them, the bronchial wall thickness WT, airway wall thickness and airway outer diameter ratio T/D, the airway wall area WA, airway wall area percentage of airway wall area WA%was higher than the group without chronic bronchitis. (P<0.05).(2) airway and lung function indicatorsGeneral information:there were no correlated between WT,T/D, WA, WA% with BMI. (P> 0.05);WT,T/D,WA,WA% have positive correlation with the frequency of acute exacerbation.WT,T/D,WA% are positively correlated with CAT,WA has no correlation with CAT. Pulmonary function test:WT is negatively correlated with FEV1% pre and FEV1/FVC, positively correlated with RV/TLC.T/D is negatively correlated with FEV1% pre, there are no correlation with FEV1/FVC and RV/TLC.WA is negatively correlated with FEV1% pre, positively correlated with RV/TLC,and no correlation with FEV1/FVC,WA% was negatively correlated with FEV1% pre, positively correlated with RV/TLC, and no correlation with FEV1/FVC.3. With or without chronic bronchitis inflammation(1)Serum inflammatory markers:Compared with and without chronic bronchitis, chronic bronchitis has higher IL-8 (t= 2.678, P= 0.010), TNF-α (t= 2.706, P= 0.009), difference was statistically significant. sputum inflammatory markers:IL-8,Compared with the group without chronic bronchitis, chronic bronchitis group induced sputum IL-8 (t= 2.325, p= 0.023), TNF-α (t= 2.076, p= 0.009), the difference is statistically significant.when we compared the serum inflammatory to the induce sputum,there is no correlation between them.(2)Chronic bronchitis sputum smear cytology comparison counts 300 cells are counted per smear two patients averaged. Count the percentage of neutrophils, lymphocytes, macrophages, eosinophils cells.The neutrophils (%) is 62.59±4.90,65.17±5.27, t=-1.991,p=0.051, and has no ststistical difference.macrophages (%)is 29.31±5.24,26.60±5.01, t=2.08,p=0.042,and has ststistical difference. Lymphocytes(%) is 6.16 ± 2.10,7.03 ± 2.78, t=-1.407,p=0.165,and has no ststistical difference.Eosinophils counts (%) (2.06±1.54, 1.10±1.32, t=2.628,p=0.011),has ststistical difference.(4) sputum cell counts in induced sputum inflammatory markers and correlation Conclusions:1.There were no difference between chronic bronchitis and without chronic bronchitis in age, BSA, mMRC score.Chronic bronchitis smoking pack-year index is high. body mass index (BMI)is high. Chronic bronchitis in patients with COPD often have frequent acute exacerbation, high score in CAT, This reflects the poor quality of life in the Chronic bronchitis phenotype.2. Serum and induced sputum:IL-8, TNF-a were higher than those without chronic bronchitis.Combing with sputum macrophages, and neutrophils, the group of chronic bronchitis has more inflammation.3. Airway wall thickness, increased eosinophils in induce sputum are two characters in Chronic bronchitis phenotype, it also reflect the positive response to glucocorticoid treatment. This maybe a new way for clinical therapy.4.WT, WA%, T/D negative correlated with FEV1%pre, since FEV1%pre is a reflection of the large airway airflow limitation,it is described a change involving into structure in the large airways. WA%was positively correlated with RV/TLC, indicating that airway wall thickening result in a gas trapping.5.There are no correlation between T/D,WA,WA%and BM. WT,T/D, WA%are positively correlated with CAT Our former study found that there is a negative correlation between BMI and,PI-950, so the bronchial wall thickness was not associate with BMI..This indicates that the airway wall thickness may be the good reaction of the quality of life. The combination of CAT,exacerbations and Pulmonary function test, WA%is a more sensitive relative indicator of airway wall thickeness.6.Serum and induced sputum:IL-8, TNF-a were higher in COPD, But the inflammatory markers didn’t show the any correlation of sputum and serologic.7.Chronic bronchitis phenotype can be distinguished by clinical features and HRCT imaging findings. |
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