Analysis Of Clinical And Pulmonary Function Of Chronic Obstructive Pulmonary Disease With Frequent Exacerbator Phenotype

Objective: To compare the clinical symptoms,systemic inflammation levels,and pulmonary function of chronic obstructive pulmonary disease with frequent exacerbator phenotype and infrequent exacerbator phenotype,and to analyze the correlation between the number of acute exacerbations of chronic obstructive pulmonary disease with clinical symptoms,systemic inflammation levels,and pulmonary function,in order to provide a basis for better identification of the frequent exacerbator phenotype of COPD,and a better assessment of the risk of future acute exacerbation of COPD patients.Methods:(1)A total of 618 patients with COPD who were treated in the inpatient department of the Second Department of Respiratory and Critical Care Medicine of the First Hospital of Jilin University from June 2018 to December 2019 were selected,501 cases were excluded,and 117 cases were included.There are 100 males and 17 females,the average age is(67.82 ± 6.53).We record general information(age,gender,smoking history,smoking index,BMI)of all patients enrolled,and collect clinical data(leukocytes,C-reactive protein,fibrinogen,calcitonin,FEV1% pre,FEV1/FVC,IC%pre,TLC%pre,RV/TLC)of these patients,clinicians asked the patients about the numbers of acute exacerbations in the past year,and evaluated their clinical symptoms(CAT score and mMRC score).(2)We divided these patients according to the number of acute exacerbations in the past year:frequent exacerbator phenotype group(≥2 acute exacerbations)and infrequent acute exacerbator phenotype group(<2 acute exacerbations).We compared the above indicators of the two phenotypes patients and analyzed the correlation between the number of acute exacerbations in the past year and the above indicators.Results: Our study analysed the clinical data of these 117,74 cases are frequent exacerbator phenotype,43 cases are infrequent exacerbator phenotype.(1)Comparison of clinical symptoms,systemic inflammation levels,and pulmonary function of chronic obstructive pulmonary disease with frequent exacerbator phenotype and infrequent exacerbator phenotype.1)Compared with the infrequent exacerbator phenotype,There were no significant differences in age(P= 0.17),gender(P=0.68),smoking history(P=0.59),smoking index(P= 0.10),and BMI(P= 0.15)between the two phenotypes.2)Compared with the infrequent exacerbator phenotype,CAT score(P = 0.000)and mMRC score(P= 0.000)of frequent exacerbator phenotype cases were significantly increased.3)Compared with the the infrequent exacerbator phenotype,the FIB(P= 0.000)and CRP(P=0.000)of frequent exacerbator phenotype were significantly increased,There were no significant differences in leukins(P=0.07),procalcitonin(P= 0.49)between the two phenotypes.4)Compared with the infrequent exacerbator phenotype,FEV1%pre(P= 0.000)、FEV1 / FVC(P= 0.001)、 IC%pre(P= 0.000)of frequent exacerbator phenotype was significantly reduced,RV / TLC(P= 0.000)significantly increased.TLC%pre(P= 0.146)was not statistically significant between the two phenotypes.(2)Correlation between the numbers of acute exacerbations in the past year and clinical symptoms,levels of systemic inflammation,and pulmonary function.1)The number of acute exacerbations in the previous year was not related to age(P = 0.45),gender(P = 0.28),smoking history(P = 0.46),smoking index(P = 0.55),and BMI(P = 0.47).2)The number of acute exacerbations in the previous year was moderately positively correlated with CAT(r = 0.42,P = 0.000)and weakly positively correlated with mMRC(r = 0.37,P = 0.000).3)The number of acute exacerbations in the past year was weakly positive correlated with C-reactive protein(r = 0.22,P = 0.01).It was not correlated with white blood cells(P= 0.65)、FIB(P= 0.26),and procalcitonin(P = 0.43).4)The number of acute exacerbations in the previous year was moderately negative correlated with FEV1%(r =-0.58,P= 0.000),FEV1 / FVC(r =-0.42,P = 0.000)and IC%(-0.68,P = 0.000).It was moderately positive correlation with RV / TLC(r = 0.62,P = 0.000),and not correlated with TLC%(P = 0.49).Conclusions:(1)There are statistic differences in the clinical symptoms,systemic inflammation level and pulmonary function between the two phenotypes.Frequent exacerbator phenotype have more respiratory symptoms and severe dyspnea,higher levels of systemic inflammation,poorer pulmonary ventilation,and more pronounced lung hyperinflation,which deserved special attention and clinical research.(2)The best indicator to identify the frequent exacerbator phenotype of COPD is the number of acute exacerbations in the past year.Correlation analysis suggested that the number of acute exacerbations in the past year have a medium-intensity correlation with multiple clinical indicators(CAT score,FEV1%pre,FEV1 / FVC,IC%pre,RV / TLC).Therefore,the above indicators have a certain guiding role in identifying this particular phenotype and assessing the risk of acute exacerbation of COPD patients in the future.