| Objective: To investigate the relationship between HRCT phenotype and airway inflammation and clinical features in patients with Chronic Obstructive Pulmonary Disease(COPD).Methods: A total of 107 COPD patients,including 87 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and 20 patients with stable COPD,were selected from the second affiliated Hospital of Dalian Medical University from November 2015 to April 2017 were collected.The mean age was 72.30 ±8.61 years(70 males),and the age of AECOPD was 52-89 years(mean age 72.30 ±8.61).There were 17 female patients with stable phase,aged 45-76 years,with an average age of 59.25 ±8.38 years(16 males).Four cases of female.According to the thickening of bronchial wall and the degree of emphysema,the patients with AECOPD were divided into two types according to chest high-resolution CT imaging: combined or not complicated with bronchial wall thickening,no or slight emphysema with 2e type: there was emphysema.But there was no bronchial wall thickening in three meters: there was emphysema and there were two manifestations of bronchial wall thickening.Collect smoking index of patients,number of acute exacerbations within one year.The levels of surface active protein(SP-D),fibrinogen,hypersensitive c reactive protein(hs-CRP)were analyzed by spss22.0 software.In the metrological data,t test was used for comparison between the two groups,ANOVA was used for multigroup comparison,and 2 test was used for counting data,which was statistically significant when P< 0.05 suggested.Result:(1)There were 87 patients with AECOPD.Of the 47 patients with type A,the score of LAA was(2.17 ± 1.37)and that of type E was(14.57 ± 4.28).The score of LAA of 19 patients with type M was(14.79 ± 3.90).There was no significant difference in LAA score between the three groups(F = 5.475,P = 0.023).There was no significant difference in LAA score between the three groups.Lower than E and M,the difference was statistically significant(P < 0.01).(2)A smoking index was(21.41 ± 23.28)package years,was significantly lower than that of E type and M type [(38.07 ± 33.84)and(38.71 ± 41.28)package years],the difference was statistically significant(F = 4.429,P < 0.05).Patients with acute exacerbation of a year from admission to more than 1 times the patients(10/47)significantly less than E(9/21)and M(17/19),the difference was statistically significant(F = 9.25,P < 0.05).(3)In patients with AECOPD,FEV1/FVC of patients with type A,E and M were [(59.82 ± 11.17)%、(50.65 ± 9.26)%、(51.75 ± 8.89%],and type A FEV1/FVC was statistically significant(F = 7.459,P < 0.05)compared with E type;The RV/TLC of type A,type E and M-type patients were [(50.66±9.80)%、(74.71 ± 13.75%)%、(77.2 ± 10.56%],and the RV/TLC of type A patients was significantly lower than that of E type and M type,and the difference was statistically significant(F = 6.120,P < 0.05).The serum Fig expression level of type A,E and M patients was(4.26 ± 1.37)g/L,(3.86 ± 1.48)g/L and(5.23 ± 1.67)g/L.The expression of Fig in serum of M patients was significantly higher than that of type A and E,and the difference was statistically significant(F = 4.493,P < 0.05).The expression level of serum hs-CRP in type A,E and M patients was(9.57 ± 13.6)mg/L,(6.28 ± 4.35)mg/L and(37.81 ± 40.8)mg/L,and the expression of hs-CRP in serum of M patients was significantly higher than that of type A and E(F = 7.382,P < 0.05).(4)Serum SP-D、Fig and hs-CRP levels of patients with COPD were significantly lower than that of AECOPD(t = 6.706,5.226,2.06,P < 0.05).(5)The smoking index of patients with LAA score of less than l was 21.41 ±23.28,and the smoking index was significantly lower than that of patients with LAA score of grade 2 or higher.The smoking index was 38.38±36.60,and the difference was statistically significant(t = 2.505,P = 0.015).In addition,the number of patients with acute exacerbation in the past 1 year was 10(21.28%),which was significantly less than the number of patients with LAA or 2(65%),which was statistically significant(P < 0.05).The FEV1/FVC of patients with LAA less than or equal to l was(59.82 ± 11.17)%,higher than that of patients with LAA or greater than 2,and the difference was statistically significant(t =-3.869,P = 0.000).The RV/TLC of patients with LAA less than or equal to l was(50.66 ± 9.80)%,compared with(75.7 ± 12.24)% of patients with LAA greater than or equal to grade 2,and the difference was statistically significant(t =-6.592,P = 0.000).The serum hs-CRP level was(9.57 ± 13.66)mg/L,which was significantly better than that of LAA at(37.8 ± 41.35)mg/L,and the difference was statistically significant(t =-2.194,P = 0.033).However,there was no significant difference between the serum SP-D and Fig levels in the two groups(P>0.05)./5(6)The smoking index of patients with the thickening of bronchial tube wall was 38.81 or 36.06,which was 38.81 or 36.06,which was higher than that of the patients with bronchial tube wall thickening or less than l,and the difference was statistically significant(t = 2.055,P = 0.043).Bronchial wall thickening of grade 2 or more patients with acute aggravating period more than 1 times the number of readmission to the hospital for 21 cases(72.41%),significantly more than the level of patients with bronchial wall thickening or less l 15 cases(35.86%),difference was statistically significant(P = 0.000).The RV/TLC was(72.74 ± 11.26)%,higher than that in the bronchial tube wall,which was higher than that of the bronchial tube wall.The difference was(59.22 ± 17.25)%,and the difference was statistically significant(t =-3.131,P = 0.000).The levels of RV/TLC in patients with a thickened or greater than 2 levels of bronchial tube wall were higher than those of patients with higher or less than l grade of bronchial tube wall,(59.22 ± 17.25)%,and the difference was statistically significant(t =-3.131,P = 0.000).The levels of serum Fig and hs-CRP were respectively(5.25 ± 1.57g/L,47.59 ± 44.29mg/L),respectively,higher than that of the bronchial tube wall,and the difference was statistically significant(t = 4.071,-6.607,P = 0.000、0.000).However,there was no significant difference between FEV1/FVC and SP-D in the two groups(P>0.05).Conclusion: The phenotypes of COPD were different in HRCT,and correlated with smoking index,pulmonary function and serum inflammatory markers. |
PDF Full Text Request