The Comparative Analysis Of Pathogens And Inflammation Feature In AECOPD Patients With Heat-phlegm Syndrome And Cold-phlegm Syndrome

Objective:To observe the difference of pathogens and inflammation index between heat-phlegm syndrome(S1)and cold-phlegm syndrome(S2)with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to analyze the relationship between the two syndromes and the inflammation index,and to provide new ideas for the treatment of AECOPD.Methods:?I gathered the patients of S1 and S2 with AECOPD that lived at Respiratory department of the hospital from January 2016 to January 2017,and recorded the age?sex?smoking history?course of disease?acute exacerbation time and FEV1%pred,and so on,then compare the difference of the two groups.?Comparing the difference of the Pathogens between S1 and S2 on the sputum smear,sputum culture and respiratory pathogens(anti-respiratory syncytial virus IgM antibody,anti-adenovirus IgM antibody,anti-influenza virus type A IgM antibody,anti-influenza virus type B IgM antibody,anti-influenza virus IgM antibody,Mycoplasma pneumoniae IgM antibody,anti-Chlamydia pneumoniae IgM antibody,anti-Legionella IgM antibody).?Comparing the percentage of sputum neutrophils?sputum eosinophils and blood neutrophils between S1 and S2 according to Sputum routine and blood.?Patients were examined for FeNO?hsCRP?PCT,and the levels of inflammatory markers between the two groups were compared.?According to?2012 the diagnosis and treatment of traditional Chinese medicine guidelines of the chronic obstructive pulmonary disease?and?quantitative diagnosis of Chinese medicine?,to draw up syndrome score form between S1 and S2 and fill out,then analysis the relationship between syndrome and inflammation index.Results:?60 cases with AECOPD were differentiated into 2 groups equally according to heat-phlegm syndrome and cold-phlegm syndrome,and the age?sex?smoking history?course of disease?acute exacerbation and the first second forced expiratory volume in percent predicted(FEV1%pred)between them were not statistically significant(P>0.05).?The detection rate of bacteria in heat-phlegm group was higher than that in cold-phlegm group significantly(P<0.05).Gram-negative bacteria were mainly detected in heat-phlegm group.The distribution between Gram-negative bacteria and Gram-positive bacteria were not significant(P<0.05).The positive rate of influenza virus B IgM antibody in heat-phlegm group was higher than that in cold-phlegm group(P<0.05),and the difference was statistically significant(P<0.05).There was no significant difference in the positive rate of serum IgM antibody among respiratory syncytial virus,adenovirus,influenza virus A,parainfluenza virus,mycoplasma pnenmoniae,Chlamydia pneumoniae and Legionella pneumophila(P>0.05)?There was no significant difference in the percentage of eosinophils between the two groups(P>0.05),While the percentage of neutrophils in the sputum and blood of the AECOPD heat-phlegm group was significantly higher than that in the cold-phlegm group(P<0.05).?The values of FeNO?hsCRP and PCT in patients with heat-phlegm were higher than those in cold sputum group(P<0.05).?There was a positive correlation between syndrome score and hsCRP and PCT in AECOPD heat-phlegm group(P<0.05),and the difference was statistically significant(P<0.05),but there was no linear correlation between syndrome score and FeNO(P>0.05).The syndrome score of patients in the cold-phlegm group was no linear correlation with hsCRP?PCT and FeNO(P>0.05).Conclusion:?The detection rate of bacteria in AECOPD patients with heat-phlegm is high,and Gram-negative bacteria are the main ones.The positive rate of influenza virus B in respiratory pathogen list is high;the detection rate of bacterial and respiratory pathogens in patients with cold-phlegm syndrome is low.?AECOPD heat-phlegm syndrome in patients with high levels of inflammation than cold-phlegm syndrome,so we can select sputum neutrophils?blood neutrophils?hsCRP?PCT and FeNO as a reference index when we distinguish the heat-phlegm syndrom and cold-phlegm syndrome??The severity of syndromes in patients with AECOPD heat-phlegm syndrome has a certain correlation with hsCRP and PCT,which can be used as an objective basis for judging the severity of syndrome of AECOPD patients with heat-phlegm syndrome.