The Correlation Between HRCT Classification,Serum ICAM-1 Level And Clinical Features In Patients With Chronic Obstructive Pulmonary Disease

Objective:To explore the relationship and its clinical significance between high-resolution CT（HRCT）typing,serum intercellular adhesion molecule-1（ICAM-1）levels and clinical features in patients with chronic obstructive pulmonary disease（COPD）.Methods:The study included 80 patients with COPD admitted to the Second Affiliated Hospital of Dalian Medical University from November 2017 to November2018,including 50 patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and 30 patients with stable COPD,among which were divided into AECOPD group and stable COPD group.The average age of patients in the AECOPD group was（69.47±9.33）years old,43 males and 7 females.The average age of patients in the COPD stable phase group was（72.09±7.94）years old,26 males and 4 females.All patients were tested lung function.The levels of serum high-sensitivity C-reactive protein（hs-CRP）and intercellular adhesion molecule-1（ICAM-1）were measured by ELISA and pre-albumin levels were measured by immunoturbidimetry.At the same time,the patient’s clinical data were collected,including the patient’s smoking index,body mass index,and the number of acute exacerbations in the past 1 year.Patients in the AECOPD group were typed through high-resolution CT（HRCT）examination.According to the bronchial wall thickness/adjacent pulmonary artery diameter grading in the chest HRCT image and the density reduction area（LAA）score of CT value<-950HU,they were divided into3 types that:type A:no or slight emphysema,with or without bronchial wall thickening;type E:emphysema,but no bronchial wall thickening;type M:emphysema with bronchial wall thickening.This study used SPSS24.0 statistical software for statistical analysis.In the measurement data,the t test was used for comparison between the two groups;the variance analysis was used for comparison between groups;the?² test was used for the count data,P<0.05 was statistically significant in statistics.Results:（1）.There were 50 patients with AECOPD,including 21 cases of type A,16cases of type E,and 13 cases of type M.（2）The smoking index of patients with HRCT type A was（24.36±18.97）package years,which was significantly lower than that of type E（36.31±18.68）and type M（44.46±20.64）package years.The difference was statistically significant（P<0.05）.The pre-albumin levels between type A,type E and type M were（259±83）,（185±53）,and（226±72）mg/L,of which type A was higher than type E,and the difference was statistically significant（P<0.05）.Patients with type A who were in acute exacerbation≥2 times in the past 1 year were 19%,which was significantly lower than 56.3%in type E and 69.2%in type M（P<0.05）.The partial pressure of carbon dioxide（PaCO2）of type A patients was（38.32±3.75）mmHg,which was significantly lower than that of type E（41.96±4.53）mmHg and M type（43.81±4.08）mmHg.The difference was statistically significant（P<0.05）.The body mass index did not differ significantly between the three groups.（3）The FEV₁%pre of patients with type A,type E and type M were（60.64±17.00）%,（48.10±18.68）%and（43.89±19.87）%,and type A was higher than E and M,the difference was statistically significant（P<0.05）.The FEV₁/FVC%of patients with type A,type E and type M were（57.97±8.03）%,（49.71±7.13）%and（44.53±5.84）%,and type A was significantly better than type E and type M,（P<0.05）.The RV/TLC of patients with type A,type E and type M were（66.68±16.64）%,（77.86±11.60）%and（79.39±12.1）%,and type A was significantly lower than type E and type M.Academic significance（P value<0.05）.The levels of serum ICAM-1 expression in patients with type A,type E,and type M were not significantly different between the three types.The levels of serum hs-CRP in patients with type A,type E,and type M were not significantly different between the three types.（4）The smoking index of patients with LAA score≤1 was（24.36±18.97）package years,which was lower than LAA score≥2（39.97±19.66）package years,the difference was statistically significant（P<0.05）.The FEV₁%pre of patients with LAA≤1 was（60.65±17.00）%,which was significantly higher than that of patients with LAA≥2（47.81±22.04）%（P<0.05）;the FEV₁/FVC of patients with LAA≤1 was（57.97）.±8.03)%,higher than（47.98±7.78）%of patients with LAA≥2,the difference was statistically significant（P<0.05）.The RV/TLC of patients with LAA≤1 was（66.68±16.64）%,which was significantly lower than that of patients with LAA≥2（78.52±11.63）%（P<0.05）.The PaCO2 of patients with LAA≤1 was（38.32±3.7）mmHg,which was lower than that of patients with LAA≥2（42.74±4.36）mmHg,the difference was statistically significant（P<0.05）.Patients with a LAA score of≤1 who had an acute exacerbation of≥2 in the past year was 19%,which was significantly less than 62.1%of patients with a LAA score of≥2（P<0.05）.（5）The smoking index of patients with bronchial wall thickening≥2 in HRCT was（44.46±20.64）package years which was higher than that of patients with bronchial wall thickening≤1（29.53±19.52）package years.The difference was statistically significant.（P<0.05）.The FEV₁/FVC of patients with bronchial wall thickening≥2was（45.69±8.32）%,which was lower than that of bronchial wall thickening≤1（54.39±8.61）%,the difference was statistically significant（P<0.05）.Patients with bronchial wall thickening≥2 who had an acute exacerbation of≥2 in the past year was 69.2%,which was significantly higher than 35.1%of patients with a LAA score of≥2（P<0.05）.（6）The levels of serum ICAM-1 was（195.20±35.42）ng/mL in patients with stable COPD,which was significantly lower than that in acute exacerbation group（232.58±52.91）ng/mL（P<0.05）.The levels of serum hs-CRP was（3.01±5.61）mg/L in patients with stable COPD,which was significantly lower than that in acute exacerbation group（33.79±52.04）mg/L（P<0.05）.The FEV₁/FVC of patients in the COPD stable phase group was（69.25±10.40）%better than that in the acute exacerbation group（52.27±9.26）%,and the difference was statistically significant（P<0.05）.Conclusion:The clinical features of different types of HRCT in COPD are different and can be used as reference indicators for disease prediction and individualized treatment.Among them,E type and M type are associated with higher smoking index,worse lung function level and frequent acute exacerbation.The levels of serum ICAM-1 and hs-CRP are significantly elevated in AECOPD and can be used as markers for AECOPD diagnosis.