Correlation Of Blood Homocysteine With Disease Progression And Prognosis In Patients With AECOPD

Objective:To explore the correlation between blood homocysteine（Hcy）and disease progression and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods:AECOPD patients admitted to Lanzhou University First Hospital from January 2018 to June 2021 were retrospectively included according to the inclusion and exclusion criteria.Searching the hospital information management system to record the basic characteristics of patients,such as Hcy level,neutrophil count（NUE）,lymphocyte count（LYM）,D-dimer（D-D）,fibrinogen（FIB）,blood gas analysis results,pulmonary function,complications such as respiratory failure,length of hospital stay,and readmission within one year.The patients were divided into HHcy group（Hcy>15μmol/L）and NHcy group（Hcy≤15μmol/L）according to the blood Hcy level measured at admission in AECOPD patients.According to the data type,the corresponding statistical methods were used to describe and compare the basic characteristics and the above-mentioned outcome indicators between these two groups;Spearman correlation analysis or Pearson correlation analysis was used to analyze the correlation between Hcy level and the outcome indicators such as lung function;Binary Logistic regression model was used to evaluate whether Hcy was a risk factor for comorbidities in AECOPD patients.P<0.05 was considered statistically significant.Results:A total of 383 patients were included in this study,including 199AECOPD patients in the HHcy group,involving 148 male patients（74.37%）and 51female patients（25.62%）;a total of 184 AECOPD patients in the NHCY group,including male patients 129 patients（70.10%）and 55 female patients（29.89%）.There was no significant statistical difference in the basic characteristic between the two groups of patients,that is,they were comparable.（1）D-D and FIB in HHcy group were significantly higher than those in NHcy group（P<0.05）,and Hcy level was positively correlated with D-D and FIB（D-D:r=0.124,FIB:r=0.215,P<0.05）.（2）The NLR in the HHcy group was significantly higher than that in the NHcy group（P<0.05）,and the Hcy level was positively correlated with the NLR（r=0.243,P<0.05）.（3）The status of pulmonary function in HHcy group was worse than that in NHcy group,and Hcy level was negatively correlated with FEV₁,FEV₁%,FVC,FEV₁/FVC in AECOPD patients（FEV₁:r=-0.315,FEV₁%:r=-0.373,FVC:r=-0.247,FEV₁/FVC:r=-0.306,P<0.05）.（4）Comparison of the blood gas analysis results of the two groups showed that,compared with the patients in the NHcy group,the Pa CO₂ in the HHcy group was significantly increased,the Pa O₂ and Sa O₂ were significantly decreased（P<0.05）.And Hcy level was positively correlated with Pa CO₂（r=0.256,P<0.05）and negatively correlated with Pa O₂ and Sa O₂（Pa O₂:r=-0.146,Sa O₂:r=-0.157,P<0.05）.（5）The results of risk assessment of Hcy level and the occurrence of comorbidities in AECOPD patients showed that the HHcy group had a higher risk of chronic pulmonary heart disease（OR 1.095,95%CI 1.063-1.127,P<0.05）and respiratory failure.（OR 1.030,95%CI 1.008-1.054,P<0.05）.（6）There was no significant difference in the length of hospital stay（P<0.05）and the readmission rate within one year（15.15%VS 11.96%,P>0.05）between the two groups.Conclusion:（1）Hcy was related to the occurrence of airway inflammation,hypercoagulable state,decreased lung function,hypoxemia and CO2 retention in patients with AECOPD.It indicated that Hcy was related to the severity and progression of AECOPD patients.（2）AECOPD patients in the HHcy group had a higher risk of chronic pulmonary heart disease and respiratory failure,which suggested that the Hcy level could guide the clinical management of AECOPD patients.（3）The level of Hcy was not significantly related to the length of hospital stay and the number of readmissions in one year in patients with AECOPD,which suggested that Hcy was not related to the treatment effect of patients with AECOPD and the risk of future exacerbations.