Analysis Of FENO And EOS% In AECOPD Patients With Different Acute Exacerbation Frequencies In Assessing The Condition And Guiding Hormone Therapy

[Objectives]To study the correlation between FENO and peripheral blood EOS%in patients with chronic obstructive pulmonary disease with different acute exacerbation frequencies in assessing the degree of acute exacerbation of the disease.And to explore whether FENO and peripheral blood EOS can guide the use of systemic intravenous hormones,as well as their reliability and effectiveness.Therefore,it can provide a more reasonable treatment plan for patients with acute exacerbations of chronic obstructive pulmonary disease,reduce the frequency of acute exacerbations,improve the quality of life of patients and reduce the burden on families and society of the disease.[Methods]A study of 120 inpatients with acute exacerbation of chronic obstructive pulmonary disease in the Second Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Kunming Medical University from October 2018 to December 2020 was conducted.According to the frequency of acute exacerbations:Acute exacerbations≥2 times in the past year are frequent acute exacerbations;other acute exacerbations who have frequent acute exacerbations in exclusion are non-frequent acute exacerbations(ie:frequency of acute exacerbations≤1 time in the past year).Divided into four groups(30 cases in each group)as follows:①Frequent acute exacerbation systemic intravenous hormone therapy group;②Frequent acute exacerbation non-systemic intravenous hormone therapy group;③Infrequent acute exacerbation systemic intravenous hormone therapy group;④Non-frequent acute exacerbation systemic intravenous hormone therapy group Acute exacerbation non-systemic intravenous hormone therapy group.The above group ①and group②,group③and group④are grouped according to the random number table.① Group was given systemic intravenous hormone(methylprednisolone sodium succinate 40mg×5d intravenous infusion)treatment,②④group was given placebo(sodium chloride injection 100ml×5d intravenous infusion)treatment.At the same time ①group according to whether FENO and EOS were elevated or not Divided into four groups as follows(A1 group:patients with elevated FENO and EOS;group A2:patients with elevated FENO;group A3:patients with elevated EOS;group A4:patients with neither FENO nor EOS).Similarly ③ group is divided into two groups as follows(group B1:patients with elevated FENO or EOS;group B2:patients with neither elevated FENO or EOS),and compare the experimental data of each group.The four groups were all supplemented with symptomatic and supportive treatments such as oxygen therapy,antispasmodic,antiasthmatic,expectorant,and anti-infection.After admission,collect the basic data of the patient and determine the patient’s FENO,peripheral blood EOS%,CAT,CRP,PO2,PCO2 level.After the treatment is completed,determine the change level of the patient’s appeal index again,and count the patient’s hospitalization days and hospitalization expenses,and then analyze each index and the correlation between the two,combined with the patient’s treatment effect and outcome,to draw experimental conclusions.[Results]The basic data of the four groups of patients(including:age,BMI,course of disease,smoking index)were not statistically different(P>0.05);FENO,peripheral blood EOS%,CAT,CRP,PO2,and PO2 were measured after admission and after treatment.PCO2 level,it was found that before treatment in the frequent group,FENO(28.00±7.00,24.00±6.00 ppb),EOS(1.70±1.80,1.05±1.00%),CRP(16.32±5.14,14.88±6.01 mg/L)were significantly higher than those of non-Frequent group,P<0.001(significantly statistically significant).Before treatment,the levels of CAT,PO2 and PCO2 were not significantly different(P>0.05).After treatment,the PO2(84.47±4.32,76.27±7.68,76.37±7.93,77.50±15.00 mmhg)was compared between the four groups.PCO2(36.43±3.86,41.23±7.67,44.30±10.16,41.00±8.00 mmhg),CAT score(14.50±2.00,15.50±2.00,15.50±1.00,15.00±2.00 points),CRP(4.59±2.63,8.75±6.36,8.60±7.93,9.35±3.97 mg/L),before and after the difference PO2(14.13±5.26,10.50±9.00,10.87±8.14,11.50±16.00 mmhg),PCO2(14.47±6.81,9.00±14.00,4.50±13.00),3.00±5.00mmhg),CAT score(8.83±1.56,6.77±1.72,6.83±1.93,7.90±2.03 points),CRP(12.30±4.36,6.86±5,13,5.39±10.30,6.12±4.83 mg/L),The number of days of hospitalization(10.07±1.91,12.07±2.36,10.27±3.26,10.00±6.00d)and hospitalization expenses(13622.81±1985.90,16764.49±5367.55,15852.93±4185.34,14784.57±3297.36 yuan),four groups of patients after treatment were found Both have been significantly improved,and the treatment is effective.However,it was found that the overall treatment effect of frequent acute exacerbation hormone therapy group was better than the other 3 groups,P<0.05(statistically significant),and the other three groups were compared with each other P>0.05(not statistically significant),indicating that frequent acute exacerbations The aggravated use of hormones has more advantages in symptom improvement than the other three groups.Intra-group analysis ①Group:Comparing the difference before and after the experimental data of the four groups,it was found that the D-CAT,D-PO2,D-CRP,and D-PCO2 of the A1 group were higher than those of the other three groups,P<0.05(with statistical significance)),indicating that in the frequent group,only patients with elevated FENO and EOS have good benefits from using hormones.Intra-group analysis Group ③:Comparing the difference before and after the experimental data of the two groups found:D-CAT(6.31±1.44,7.24±2.20 points),D-CRP(4.37±11.36,5.56±9.78 mg/L),D-PO2(7.54±7.73,13.41±7.71 mmhg),D-PCO2(4.00±12.00,6.00±15.00 mmhg),P values are all>0.05(not statistically significant),indicating that in the infrequent acute addition and recombination,regardless of The value of FENO and EOS,the use of hormones did not achieve more obvious benefits.Spearman’s test was used to analyze the correlation between FENO and EOS.The difference between FENO and EOS before and after the experiment was P>0.05(not statistically significant),and there was no correlation between the two.At the same time,two-category multi-factor Logistic regression analysis was used to explore the influencing factors of whether AECOPD is frequent:taking whether AECOPD is frequent as an ordered response variable,the appeal factors are individually incorporated into the equation in turn,and the results show:FENO and peripheral blood EOS are both frequent AECOPD Risk factors.(FENO:OR=1.138,95%CI=1.052-1.231;peripheral blood EOS:OR=2.450,95%CI=1.518-3.954.)[Conclusions]1.FENO and EOS%in peripheral blood can identify some patients with frequent acute exacerbations of COPD,and to a certain extent the two can jointly predict the severity of the disease.2.Patients with elevated FENO and EOS in frequent acute addition and recombination have more obvious benefits in symptom improvement,saving hospitalization time and hospitalization costs after using hormone therapy,indicating that the combined detection of FENO and EOS can be achieved to a certain extent Guide the use of hormones.3.In non-frequent acute recombination,whether FENO or peripheral blood EOS is increased or not,the use of hormones has not achieved more obvious benefits.