| Objectives:1. To analyze the clinical features of ACOS, compared ACOS to only COPD and asthma;2.To investigate the radiologic phenotypes of ACOS, divided them into phenotype asthma-ACOS and COPD-ACOS according to their onset form start with asthma or COPD. Discusses the clinical features of each type;3. observing the response of each phenotype of ACOS to clinical therapy of ICS and comparing the effect of treatment for patients with only COPD and asthma.Methods:1. This is a clinical prospective case and control study. We designed three different groups according to the lung function index:cases of ACOS (experimental group), cases of COPD and cases of asthma (control groups). The diagnosis of COPD refers to the diagnostic and treatment guide in GLOD (Revised 2014)[1], the diagnosis of asthma refers to 2014 global agreement on the prevention and treatment of asthma (GINA) , the diagnosis of ACOS is reference to a Spainish study made by Soler-Catalua. Standard choice choose group B and group C standard set of patients as the research object. We collected HRCT date of the cases who measure up to standards, rebuilt CT image and measured indexes of emphysema (PI-950 and LAA scores), measured bronchial wall thickening and adjacent pulmonary artery diameter and calculated the ratio, completed the patients’ pulmonary function and bronchial diastolic test inspection, recorded the history and general linical data, lung function related data, detection inflammation index of C-reactive protein, IL-8 andMMP-9 both in peripheral blood and induced sputum.2. All the patients in this search were divided into two treatment groups:group B:regular inhaled budesonide/formoterol powder for Inhalation (160ug/4.5ug,2 times/day) for three months; group C:regular inhaled tiotropium bromide Powder for Inhalation(18ug, bedtime inhalation,1 time/day)+budesonide/formoterol inhalation powder (160ug/4.5ug,2 times/day) for three months. Medication after 3 months exam pulmonary function (FEV1, RV/TLC, FEV1% Pre) and do questionnaire COPD Assessment Test (CAT scores) again to evaluate the quality of life.Results:1 The clinical features of ACOS and the difference among ACOS% COPD and asthma:60 ACOS cases,43 cases of them are male,17 cases are female, there are differences on their age 65.25± 11.54 (rang from 28 to 84), smoking index is 200 pack-years (rang from 0 to 800), the BMI is 23.20±4.42km/m2,34 cases (56.67%) of them had a history of allergy, the frequency of acute exacerbation over the past year is 1.73±0.12 times/year, CAT score is 10.50 (rang from 8.00 to 14.75), mMRC grade: 1.90±0.13; The difference of FEV1 (1.36±0.61,1.00±0.11,2.30±0.68) is significant (F=34.782,P<0.001)in the three groups FEV1%pre (53.68±19.59,44.48±3.98, 95.58±12.02) also has significant difference (F=68.438,P<0.001), RV/TLC (47.43±8.31,44.02 ±6.47,40.24±5.03) also has significant difference (F=10.269, P< 0.001). Systemic inflammatory date:the concentration of MMP-9 in peripheral blood (470.47+30.59ng/ml,651.07+103.19ng/ml,305.93+98.53ng/ml) has significant difference (F=18.672, P<0.001).Airway inflammatory date:the concentrations of MMP-9 in induced sputum (283.62±28.68ng/ml,459.48±46.61ng/ml,13.064± 13.69ng/ml) has significant difference (P< 0.001, F=19.16);neutral granulocyte count (58.42±11.06% and 62.07±9.91%,40.56±4.65) has significant difference (P< 0.001) F=46.620; eosinophilia eosinophile cell count (2.20 ± 0.26% and 107 ± 0.77% and 2.47 ± 0.26) has significant difference (F=6.432, P= 0.002).2 The clinical features of ACOS phenotypes depend on HRCT.Body mass index (23.15 ± 4.68,21.18 ± 3.58,24.78 ± 4.21) hassignificant difference (F=3.544, P=0.045); mMRC grade (1.40 ± 0.21,2.00 ± 0.23,2.52 ± 1.01) also has difference (F=3.080, P= 0.035). PI-950%(7.41 ± 1.39%,21.04 ± 1.92%,23.68 ± 8.84%) has significant difference (F=28.340, P< 0.001). Bronchial wall thickening/adjacent pulmonary artery diameter is (29.49 ± 5.37%,25.31 ± 3.16%33.23 ± 7.69%) has significant difference (F=7.862, P= 0.001).The concentration of CRP in peripheral blood (12.37 ± 2.97mg/L and 9.63± 43mg/L,15.04 ± 2.72mg/L) has significant difference (F=10.285, P< 0.001),the concentration of IL-8 (11.41±10.20pg/ml, 103.09± 35.87pg/ml,136.34±12.26 pg/ml) has significant difference (f=20.761, P < 0.001), the concentrations of MMP-9 (380.04 ± 50.04ng/ml,550.67 ± 66.05ng/ml, 498.35 ± 42.68ng/ml) has significant difference (F=51.858, P< 0.001); blood eosinophil cell count (0.23 ± 0.04x109/L,0.16 ± 0.11xl09/L,0.37 ± 0.04x109/L) has difference (F= 3.901, P= 0.027).The concentration of CRP in induced sputum (127.36 ±14.20 ug/L,93.16 ± 22.16 ug/L,154.82 ± 51.20 ug/L) has significant difference (F=20.922, P<0.001), the concentration of IL-8 (103.24 ± 10.32pg/ml, 86.44 ± 9.19pg/ml,112.95 ± 12.30 pg/ml) has significant difference (F=10.734, P<0.001), the concentration of MMP-9 (231.12 ± 48.44ng/ml,343.17 ± 63.60ng/ml, 296.31 ± 37.12ng/ml) with significant difference (F=31.331, P<0.001); sputum neutrophil count (59.44±10.94%,52.59± 11.34%,62.28±11.58%) has significant difference (F=10.003, P<0.001), sputum eosinophil count (2.44±0.40%,1.72±0.61%, 2.77±0.26%) also has difference (F=3.303, P=0.031).3 The correlation between HRCT index and other indexes in ACOS group:PI-950 is positively correlated with acute exacerbation frequency-. smoking index, mMRC classification、RV/TLC (P<0.05).PI-950 is negatively correlated with FEV1、 FEVl%Pre (P<0.05).Bronchial wall thickness/adjacent pulmonary artery diameter is positively correlated with the frequency of acute exacerbation、smoke index、 mMRC classification、IL-8、blood neutrophilic granulocyte count、blood eosinophile cell count( P<0.05), bronchial wall thickness/adjacent pulmonary artery diameter is negatively correlated with FEV1 (r=-0.541, P=0.002), and no correlation with FEV1%Pre and RV/TLC.4 The comparison of clinical data between COPD-ACOS type 36 cases (60%) and asthma-ACOS type 24 cases (40%) of ACOS patients.-age of COPD-ACOS type and asthma-ACOS type (70.22 ±7.83,57.79±12.31) has a significant difference (t=4.786, P< 0.001), gender (2=6.033, P= 0.014), and allergy history (2=12.319, of P< 0.001) there are significant differences, smoking index 531.94±71.69156.25±56.41 of also has significant difference (t=35.4, P< 0.001), acute exacerbation (1.72 ± 0.14,1.04 ± 0.20) differences exist statistical significance (t=2.894, P= 0.005).The difference of FEV1(1.18±0.40,1.62±0.16) between the two types exist statistical significance (t=-2.867, P= 0.006), and FEV1%Pre (48.24±17.21,61.84±20.44) also has statistical significance (t=-2.781, P= 0.006).The concentration of MMP-9 (336.71±35.57ng/ml, 20.397±43.89ng/ml) in induced sputum has statistical significant difference (t=2.353, P= 0.022) and MMP-9 in peripheral serum (532.25±38.77ng/ml,377.79±44.15ng/ml) has statistical significant difference (P= 0.012 t=2.59); sputum eosinophil cell count (1.12±0.20%,3.82± 0.40%) exist significant difference (t=-6.626, P< 0.001), blood eosinophil cell count (0.14±0.02x109/L,0.42±0.07 x109/L)also exist significant difference (t=-3.764, P= 0.001).5 The curative effect analysis of asthma, ACOS and COPD:the comparation of all patients’ pulmonary function and CAT score between befor and after 3 months of treatment show significantly improved than befor. ΔFEV1 ΔFEV1%Pre without significant difference. ARV/TLC (1.80±0.76,12.56±3.14,5.00±0.23) exist significant difference (F=60.838, P< 0.001), and the difference of ΔCAT score (1.87±0.16,2.43 ±0.13,2.30 ±0.21) has statistical significance (F=3.205, P= 0.044).Phenotype A、E、 M ΔFEV1 exist significant difference (group B:F=5.263, P=0.001; group C: F=3.239, P=0.035). ΔFEV1%pre exist obvious difference (group B:F=10.337, P <0.001; groupC:F=11.176, P<0.001), ΔRV/TLC has no statistically significant difference. The difference of ΔCAT score was statistically significant (group B: F=3.951,p=0.026; group C:F=16.376, P<0.001).Conclusions:1 ACOS patients have the clinical features both asthma and COPD. In some aspects, showed similar characteristics to COPD, and in other aspects characteristics similar to asthma.2 The clinical index exist difference among phenotypes A、E、M of ACOS and COPD-ACOS phenotype and asthma-ACOS phenotype. The HRCT index of ACOS is correlated with other indexes, which means HRCT can contribute to the classification of ACOS into different phenotypes, HRCT in ACOS condition assessment, efficacy assessment, follow-up, prognosis and prediction of efficacy has important significance.3 After 3 months’treatment, the CAT score and pulmonary function of asthma、 ACOS、COPD patients got obvious improvement, especially ACOS. The response to ICS of each phenotype of ACOS patients is different, phenotype A is better than other two phenotypes. |
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