Clinical Study Of Inflammatory Markers Influence On Treatment In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:The purpose of this study was to observe serum neutrophil/lymphocyte (NLR), C-reactive protein (CRP), eosinophils (EOS) changes and their impact on clinical symptoms, lung function and quality of life, through grouping chronic obstructive pulmonary disease patients with acute exacerbation (AECOPD) according to clinical phenotypes.Methods:1 We selected the patients who met the criteria for the diagnosis of AECOPD in line with "chronic obstructive pulmonary disease treatment guidelines" revised by respiratory diseases branch of Chinese Medical Association in 2014, and accepted medicine treatment in our hospital respiratory from February 2015 to December 2015. We collected a total of 240 cases in which 189 cases were male,51 females, aged 43-90 years old. According to the classification of AECDPD phenotype by Bafadhel, all patients enrolled were grouped into eosinophils phenotype group and bacterial infection phenotype group.2 Eosinophilic phenotype patients received glucocorticoid combined therapy for 7 days, and we summarized serum EOS%>2% (group A) and EOS%<2%(group B) of patients, to assess and compare changes in serum markers, clinical symptoms (CAT questionnaire), pulmonary function and dyspnea index score between the before and after treatment in two groups of patients.3 Bacterial infections phenotype patients were treated with anti-infection combined therapy for 7 days, and we summed CRP>4mg/L and NLR>2.56 (group A),CRP<4mg/L and NLR<2.56 (group B) of patients, to evaluate changes in serum markers and compared changes in clinical symptoms (CAT questionnaire), pulmonary function and dyspnea index score between the before and after treatment in two groups of patients.4 All data was applied to SPSS 17.0 for data analysis.Results:1 Eosinophil phenotype group:the level of serum EOS%in patients of group A had a decrease, and CAT score, FEV1, FEV1(%) and dyspnea index scores were improved significantly (P<0.05) after treatment than those in group B.2 Bacterial infection phenotype group:compared with group B, the level of serum CRP and NLR in patients of group A were decreased, CAT score, FEV1, FEV1(%) and dyspnea index scores were made better(P<0.05) after treatment.Conclusions:1 Patients with EOS%>2%in serum were more sensitive on corticosteroid therapy among AECOPD patients with eosinophil phenotype; 2 Patients with CRP>4mg/L and NLR≥2.56 in serum had a better results on antibiotic therapy among AECOPD patients with bacterial infection phenotype.3 The expression of serum inflammatory markers could guide individual treatment of acute exacerbation of chronic obstructive pulmonary disease patients.