| Objective:To analyze the clinical characteristics,days of hospitalization,proportion of patients with critically ill,respiratory failure,routine blood test and changes in inflammatory indexes in patients with corona virus disease 2019(COVID-19)combined with chronic obstructive pulmonary disease(COPD).It provides some reference value for the early identification and severity assessment of COVID-19 combined with COPD patients.Methods:1.Study subjects and grouping: 64 patients with corona virus disease 2019 and56 patients with corona virus disease 2019 complicated with chronic obstructive pulmonary disease who visited the First Affiliated Hospital of Hainan Medical College from December 2022 to February 2023 were selected as the study objects for retrospective analysis.The experiment was divided into corona virus disease 2019group(referred to as the COVID-19 group)and corona virus disease 2019 with chronic obstructive pulmonary disease(referred to as the COVID-19+COPD group).2.The general data of the study subjects,including age,gender,smoking status,days of hospitalization,etc.,were collected through the inpatient medical record system;the two groups of patients were studied and analyzed to calculate the proportion of patients with critically ill and the proportion of patients with respiratory failure in each group;The laboratory parameters of the patients were analyzed: white blood cell count,neutrophil count,lymphocyte count,interleukin-6,procalcitonin,C-reactive protein,D-dimer,etc;The lung imaging characteristics of the two groups were further analyzed by collecting the lung CT of the patients.3.All data collected in this study were analyzed by the statistical software Graphpad prism,and general data such as age and gender as well as serological parameters such as blood routine and inflammatory parameters were compared between the two groups.Results:1.General data comparison: a total of 149 patients were included in the study,excluding 29 patients who did not meet the inclusion criteria,64 patients in the corona virus disease 2019 group(COVID-19 group)and 56 patients in the corona virus disease 2019 combined with chronic obstructive pulmonary disease group(COVID-19+COPD group).The statistical analysis of age,gender,and smoking status and hospitalization days between the COVID-19 and COVID-19+COPD groups showed that there were 27 cases(42.19%)of women and 37 cases(57.81%)of men in the COVID-19 group and 21 cases(37.5%)of women and 35 cases(62.5%)of men in the COVID-19+COPD group,and there was no statistically significant difference between the male and female ratios of the two groups;the mean age of patients with COVID-19+COPD [(77.16 ± 1.23)years] was higher than that of patients with COVID-19 alone [(59.95±2.46)years],and the difference between the two groups was statistically significant(P<0.05);Also,statistical analysis of the number of days of hospitalization in the two groups revealed that the mean number of days of hospitalization in patients with COVID-19+COPD(12 days)was higher than that of patients with COVID-19 patients(8.5 days),and the difference was statistically significant(P<0.05);while the difference in smoking index between the two groups was not statistically significant(P>0.05).2.Among the COVID-19 group,there were 59 non critically ill patients(92.19%)and 5 critically ill patients(7.81%).The COVID-19+COPD group had 37 non critically ill patients(66.07%)and 19 critically ill patients(33.93%),indicating that the proportion of critically ill patients in the COVID-19+COPD group was higher than that in the COVID-19 group,and the differences were statistically significant(P<0.05);The number of patients with respiratory failure in the COVID-19 group was17(26.56%),and the number of patients with respiratory failure in the COVID-19+COPD group was 41(73.21%),indicating that the proportion of patients with respiratory failure in the COVID-19+COPD group was higher than that in the COVID-19 group,and the differences were statistically significant(P<0.05).3.Comparison of laboratory indicators: Lymphocyte count in patients with COVID-19+COPD group(109/L)was higher than the COVID-19 group(0.98±0.07 vs 0.74±0.08),CRP(mg/L)was higher in the COVID-19+COPD group than in the COVID-19 group(56.83 ± 9.97 vs 29.35 ± 5.32),IL-6(pg/ml)was higher in the COVID-19+COPD group than in the COVID-19 group(13.96±1.68 vs 5.67±0.81),D-dimer(mg/L)was higher in the COVID-19+COPD group than in the COVID-19group(7.59±2.76 vs 1.26±0.41),and the differences were statistically significant(P<0.05).However,there were no significant statistical differences in the changes of white blood cell count,neutrophil count,procalcitonin.4.Pulmonary CT comparison: The early focus of COVID-19 is mainly distributed under the pleura on the back of both lungs,focusing on the lower lobes.Single or multiple ground glass density shadows can be seen in both lungs.Lung markings can be seen in it.If the lobule and the interstitial thickening in the lobule,the imaging will show grid changes,and can also be accompanied by thickening of blood vessels.The long axis of some focus is parallel to the pleura,not distributed according to the lung segment.The lesions usually have no cavity formation,no pleural effusion,and no significant enlargement of mediastinal lymph nodes.The internal bronchi of the lesion run smoothly,without significant distortion or deformation,and rarely see tree bud signs.As the disease progresses,the scope of the lesion rapidly increases and expands,advancing along the bronchovascular bundle from the periphery to the center,and can also be distributed in a reverse butterfly shape.In the severe stage,it shows a large range of increased lung tissue density and consolidation,with a few showing signs of white lung.In the dissipative stage,the flaky inflammatory lesions can be completely absorbed,and can also evolve into fibrosis.When corona virus disease 2019 complicated with chronic obstructive pulmonary disease,both lungs can show the impact characteristics of COPD,such as emphysema,pulmonary bullae,bronchiectasis,etc.On CT,the manifestations are as follows: widened costal space,the diaphragm muscle drops(lower than the 10 th posterior rib),barrel chest,emphysema,pulmonary bullae,bronchiectasis,etc.The texture of both lungs at non viral infection sites is disordered,varying in thickness,sparsely distributed,and some of them are arranged in a grid shape,mixed with small pieces of shadow in the middle,and the edge is fuzzy,Manifestations such as enlargement of the right ventricle.Most patients have a more severe range and degree of lesions than those in the COVID-19 group alone,and the condition progresses rapidly.Conclusions:1.Chronic obstructive pulmonary disease increases the number of days of hospitalization in patients with corona virus disease 2019,which predicts that chronic obstructive pulmonary disease can increase the difficulty of treatment of corona virus disease 2019 to some extent.2.Chronic obstructive pulmonary disease increases the proportion of critically ill and the proportion of respiratory failure in corona virus disease 2019.3.The presence of chronic obstructive pulmonary disease in combination with corona virus disease 2019 increases the intensity of the inflammatory response in the blood and may even result in a storm of inflammatory factors,which correlates with poor disease prognosis.4.Further understanding of the imaging features of corona virus disease 2019 and chronic obstructive pulmonary disease is beneficial to the early identification and diagnosis of the disease and timely treatment. |
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