Analysis Of Different Phenotypic Characteristics In Chronic Obstucctive Pulmonary Disease Patients With Frequent Exacerbation

Objective The purpose of this study was to analyze the differences in the clinical characteristics of patients with chronic bronchitis,emphysema,and Asthma-COPD overlap with frequent exacerbation and infrequent exacerbation.Methods Prospective analysis of clinical data of 162 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to department of respiratory and critical care medicine in the third affiliated hospital of Anhui Medical University,such as age,medical history,smoking volume,emphysema score and other clinical data.To compare the clinical characteristic differences of patients with frequent exacerbation and infrequent exacerbation patients with the above three different phenotypes using statistics.Results（1）Compared with patients in infrequent exacerbation group,patients with frequent exacerbation group had a longer medical history,higher COPD Assessment Test score（CAT score）,modified British medical research council dyspnea score（m MRC dyspnea score）,arterial blood carbon dioxide partial pressure（Pa CO₂）,lowerthe ratio of FEV₁and forced vital capacity ratio（FEV₁/FVC%）,forced expiratory volume in 1 second ratio（FEV₁%pred）,and admission oxygen saturation（P<0.05）,There was no statistical difference in age,smoking volume,body mass index（BMI）,white blood cell count,neutrophil to lymphocyteratio（NLR）,eosinophils ratio（EOS%）,c-reactive protein（CRP）,bronchial wall thickness grading,potentialof hydrogen（p H）,Partial arterial oxygen pressure（Pa O₂）,and combined disease（P≥0.05）.（2）Compared with infrequent exacerbation group,patients with chronic bronchitis phenotype frequent exacerbation group have a longer medical history and higher smoking volume,CAT score,m MRC score,Pa CO₂,lower FEV₁/FVC%,FEV₁%pred,and admission oxygen saturation（P<0.05）;There were not statistically significant in age,BMI,white blood cell count,NLR,EOS%,CRP,bronchial wall thickness grading,p H,and Pa O₂（P<0.05）.Multivariate analysis found Pa CO₂（OR=0.884,P=0.002）is an independent risk factor for patients with frequent exacerbation chronic bronchitis phenotype.（3）Compared with infrequent exacerbation group,patients with emphysema phenotype of frequent exacerbation group have a longer medical history,higher CAT,higher m MRC scores,and lower FEV₁/FVC%（P<0.05）;Age,smoking volume,white blood cell count,medium.There was no statistically significant difference in age,smoking volume,BMI,CRP,FEV₁%pred,EOS%,emphysema score,bronchial wall thickness score,admission oxygen saturation,p H,Pa O₂and Pa CO₂（P≥0.05）.Multivariate analysis did not find the independent risk factors for patients with frequent exacerbation emphysema phenotype.（4）Compared with infrequent exacerbation group,patients with ACO phenotype of frequent exacerbation group have a longer medical history and higher emphysema score（P<0.05）;age,smoking volume,BMI,white blood cell count,NLR,EOS%,CRP,FEV₁/FVC%,FEV₁%pred,emphysema score,bronchial wall thickness score,dmission oxygen saturation,p H,Pa O₂and Pa CO₂were not statistically different（P≥0.05）.Multivariate analysis did not find the independent risk factors for patients with frequent exacerbation ACO phenotype.Conclusion（1）Frequent exacerbation in patients with different phenotypes of chronic obstructive pulmonary disease may have different characteristics in their clinical manifestations.（2）This study identified independent risk factors for patients with frequent exacerbation of the chronic bronchitis phenotype,which can help identify risk factors for chronic obstructive pulmonary disease that are more likely to increase the frequency of hospitalization for patients.They can provide patients with assistance in the diagnosis and treatment of diseases.（3）The independent risk factors for patients with emphysema phenotype and bronchial asthma-chronic obstructive pulmonary disease overlapping phenotype are unknown,and more research will be needed to confirm it in the future,and the follow-up of patients needs to be improved.To understand the survival and mortality of patients with frequent exacerbation of different phenotypes.