The Significance Of Exhaled Breath Condensate PH In Chronic Obstructive Pulmonary Disease Patients

objective:The aim of this study is according to detecting pH of the exhaled breath condensatein(EBC)in with or without gastroesophageal reflux(GRE)of acute exacerbation chronic obstructive pulmonary disease(AECOPD)patients and normals,to evaluate weather airway pH can be used as the monitoring index of AECOPD and the severity of the disease,to explore the influence of GRE on the acidity of air way and pulmonary ventilation function in AECOPD patients,and the significance of anti-reflux treatment.Meanwhile,by detecting pulmonary function (FEV₁,FEV₁/FVC,FEV₁/expected yalue),to understand the relationship between the changes in EBC pH and in pulmonary function;and the changes of serum uric acid, WBC,N%in COPD patients.Menthods:We studied Sixty-five hospitalized AECOPD patients and 20 healthy volunteers.According to"GRE survey"questionnaire,AECOPD patients were allocated into GRE group and non-GRE group and EBC pH and pulmonary function were detected.All subjects were measured white blood cell count,neutrophil ratio in peripheral,uric acid,blood gas analysis(PaCO₂,PaO₂),when admitted to hospital. using exhaled breath condensate collection equipment to collect specimens,and then pH electrode detect EBC pH.We randomly chose 25 cases from the 45 cases of non-reflux AECOPD,which were given conventional anti-inflammatory,antispasmodic, antiasthmatic.Meanwhile,the other non-reflux AECOPD and 20 reflux cases of AECOPD weregivenconventional treatment as well as anti-reflux treatment(omeprazole 20mg,daily 2 times;Motilium 10mg,3 times a day).after 1-2weeks,review EBC pH,and comparing the difference of EBC pH between pre-treatment positive group GRE and GRE-negative group,also investigate Whether or not EBC pH is significant difference before and after treatment,and the changes of the level of EBC pH after anti-reflux treated the GRE-positive group and negative group GRE.Evaluate the correlation between EBC pH and pulmonary function (FEV1,FEV1/expected values)in pre-treatment AECOPD.Understanding the changes of serum uric acid,WBC,N%,in pre-treatment AECOPD.Clinical evaluation included a complete medical history,pulmonary function testing and detection EBC pH At the same time,compared with the differences between each group and PH correlation with lung function by statistical methodsResults:The incidence of AECOPD combined GRE was 30.8%(20/65). AECOPD with GRE-positive and GRE-negative patients in terms of age,gender, body mass index(BMI),serum albumin(Alb),blood gas(PaCO2,PaO2)were no significant difference(p all＞0.05).AECOPD with GRE-positive patients the pH value of EBC was significantly lower than GRE-negative patients and the control group(p all＜0.05).GRE-negative patients with AECOPD also significantly lower than the control group(p＜0.05).The pulmonary function of AECOPD with GRE-positive group were significantly lower than GRE-negative group.The EBC pH of all AECOPD groups after treatment were higher than before treatment,but still significantly lower than the control group(p＜0.05).The AECOPD with GRE-positive after anti-reflux treatment the level of EBC pH increased greater than the GRE-negative group.The increased levels of pH was no significant difference between two GRE negative AECOPD after different treatments.There is no correlation between EBC pH and pulmonary function in each group AECOPD patients,and the WBC,N%,serum uric acid in all AECOPD was significantly higher than the normal group.Conclusions:EBC is a simple,non-invasive detection methods with high reproducibility.EBC pH value can reflect the acidity or alkalinity of airway. AECOPD patients with GRE has a higher incidence,and AECOPD patients with a certain degree of airway acidification,after treatment can significantly improve the level of airway acidification.It is more obvious airway acidification in AECOPD with GRE patients,and the airway acidification are probably an important factor in the occurrence and development of COPD.At the same time,the GRE not only affects airway acidity,but also increase the pulmonary function.Anti-reflux treatment can be significantly elevate airway pH in patients with AECOPD merGRE GRE,but to the patients without reflux,anti-reflux treatment in improving the role of airway acidification was not obvious.AECOPD patients with WBC,N%,serum uric acid are higher than control group,indicating that AECOPD patients with more obvious inflammatory response,at the same time may also be accompanied by hypoxemia and disorders of metabolism.