| Objective:Imaging findings of this study is based on HRCT, chronic obstructive pulmonary disease (COPD) patients with plateau is divided into three phenotypes: A phenotype, E phenotypes, M phenotypes, select E phenotypes, M phenotypic stability patients as the research object and use budesonide - f ROM mott and so on carries on the comprehensive treatment.Based on NMR (Nuclear magnetic resonance, NMR) of metabonomics research method to compare before M type treatment group, the M type before, E treatment group after treatment, E group after treatment serum metabolic spectrum, screening serum metabolic markers and to explore its clinical application value.Objective do four groups at the same time the SGRQ questionnaire scores and comparison analysis, to explore the therapeutic effect of different CT with COPD phenotype, guide individualized treatment of patients with COPD.Method:Choose the first affiliated hospital of kunming medical university between December 2015 and December 2015, during hospitalization and outpatient service to meet the requirements of the experiment - E (11 cases), patients with COPD patients with COPD - M type (11 cases).Fasting serum samples before treatment and finish the SGRQ questionnaire scores, use of budesonide - f ROM mott and other comprehensive treatment for 3 months, fasting serum specimens after treatment and collection complete SGRQ questionnaire scores.Before is divided into M type treatment group, the M type before, E treatment group after treatment, E four groups after treatment.Application of 1 h-nmr technology For each group serum metabolomics Analysis samples, the original data import SIMCA - P + software is analyzed, using Principal Component Analysis, Principal Component Analysis, PCA)and Partial Least squares Discriminant Analysis (Partial further Square Discriminant Analysis, PLS - DA) modeling, through the Variable weights (Variable Importance For the Projection, VIP) Analysis, preliminary screening of the largest contribution to the difference between the set of chemical shift (VIP > 1.0).Further application to filter out the chemical shift of univariate analysis, the final screen ratio is greater than,equal to 2 and differences statistically significant (P < 0.05) of the chemical shift,combining domestic and foreign research, identify metabolic spectrum peak recognition software (chenomx NMR suite software) to identify metabolites,metabolic markers have to meet the requirements.Analyzed by SPSS 21.0 software,using t test analysis SGRQ questionnaire score differences between the four groups.Results: 1 COPD - M type group after treatment with COPD before - M type treatment groups: through the study of the comparison of serum metabolites, pattern recognition analysis of the established model can better distinguish between the two groups. Were found between the two groups of five conform to the requirements of the chemical shift, metabolic marker compounds identified by four to meet the requirements.In patients with COPD - M type group after treatment serum guanine nucleoside Guanosine, Tryptophan (Tryptophan) concentration showed a trend of increase, Histidine (Histidine), Uridine (Uridine) concentrations showed a trend of decrease.Through comparison on COPD - M type SGRQ scores before and after the treatment, after treatment the SGRQ three parts value and total value were significantly lower, t test showed that SGRQ three parts value and total score improved significantly after treatment (P < 0.001).2 COPD - E group after treatment with COPD before - E treatment groups:through the study of the comparison of serum metabolites, pattern recognition analysis of the established model can better distinguish between the two groups. Were found between the two groups of 8 conform to the requirements of the chemical shift,the compounds identified two meets the requirements of metabolic markers.In patients with COPD - E group after treatment serum guanine nucleoside Guanosine,Maltose (Maltose) concentration showed a trend of rise.Through comparison on COPD - E SGRQ scores before and after the treatment, after treatment the SGRQ three parts value and total value were significantly lower, t test showed that SGRQ three parts value and total score improved significantly after treatment (P<0.001).3 COPD - E type treatment group was treated with COPD - M before the group:through the study of the comparison of serum metabolites, pattern recognition analysis of the established model can better distinguish between the two groups.Were found between the two groups of 17 conform to the requirements of the chemical shift,metabolic marker compounds identified by 15 to meet the requirements.In patients with COPD before - E type treatment group serum central pentane (Cyclopentane),propyl amine acid (Beta - Alanine), urea (Ornithine), lactic acid (D - Lacticacid),guanine nucleoside Guanosine, Acetone (Acetone), left-handed 1-glutamine (L -glutamine), inosine acid (Inosinicacid), creatinine, creatinine concentration showed a trend of increase, sugar (Sucrose, fructose (fructose), Isopropyl alcohol (Isopropyl alcohol), Pro line (Proline), Tryptophan (Tryptophan), Formate (Formate)concentrations showed a trend of decrease.Through -. E type with COPD treatment group was treated with COPD - M before the group SGRQ scores, COPD before - E treatment group SGRQ three parts of the value and the total score was lower than that in group COPD before - M type treatment, t test showed that SGRQ three parts value and total score between the two groups have significant difference (P < 0.001).4 COPD - E type after treatment group after treatment with COPD - M type:through the study of the comparison of serum metabolites, pattern recognition analysis of the established model can better distinguish between the two groups. Were found between the two groups of 12 conform to the requirements of the chemical shift,metabolic marker compounds identified by 10 to meet the requirements.In patients with COPD - E type after treatment serum Phenylalanine (Phenylalanine), L - Valine(L - Valine), Cyclopentane (Cyclopentane), Asparagine (Asparagine), Citric acid,Citric acid) concentration showed a trend of increase, Uridine (Uridine), amino acetic acid (Glycine), Isopropyl alcohol (Isopropyl alcohol) and Histidine (Histidine),Proline (Proline) concentrations showed a trend of decrease.By COPD -E type group after treatment with COPD - M SGRQ scores after treatment group comparison,COPD - E group after treatment SGRQ three parts of the value and the total score lower than COPD - M type group after treatment, t test showed that respiratory symptoms, activity ability score between the two groups have significant difference (P< 0.01), disease influence score no difference (P > 0.05), there are differences between the total value (P < 0.05).Conclusion: Based on the metabolomics study based on nuclear magnetic resonance(NMR) and the evaluation of the therapeutic effect by SGRQ questionnaire, it was found that the model established by the metabolic profile could distinguish well before and after M-type treatment, before and after E-type treatment,before treatment,E type and M type and after treatment, E type and M type. By comparing the results of serum metabolic test before and after COPD-M and COPD-E treatment, metabolic markers with specific changes were obtained. At the same time, β-agonists +glucocorticoids were effective in the treatment of COPD-E and COPD-M patients, but the effect of COPD-M was better than that of COPD-E.Through the experimental study found that these markers could become to distinguish different CT COPD phenotype, and evaluate therapeutic effect of metabolic markers to scientific evaluation of therapeutic effect and guide clinical individualized treatment and to evaluate the prognosis. |
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