The Spatial Distribution Of Pulmonary Emphysema In Stable Patients With Chronic Obstructive Pulmonary Disease And The Response To Inhalation Therapy

Part One Correlation between spatial distribution of emphysema and clinical characteristics in patients with stable COPDobjectiveTo investigate the clinical characteristics of patients with stable chronic obstructive pulmonary disease(COPD)with different spatial distribution of emphysema.MethodPatients with stable COPD(COPD group)were recruited at Zhujiang hospital of Southern Medical University from December 2015 to December 2016.All of the subjects were using the German MasterScreen children's pulmonary function of lung ventilation function examination,and use Philips Brilliance of the 256 layer iCT HRCT was performed on all subjects within a week,and whole lung and lobar emphysema each index by Philips pulmonary quantitative software(LAA%,i.e.-950HU threshold,low attenuation area percentage of pulmonary lung volume),right upper lung bronchus in fifth branches of the tip section of the tube wall the total cross-sectional area percentage(WA%)and the inner perimeter of 10mm tracheal wall thickness(Pi 10).Result1.Compared with the healthy control group,COPD group in smoking index,small airway resistance and RV/TLC%increased significantly(P<0.01),FEV1%pred,FEV1/FVC,DLCO and SB decreased significantly,the differences between groups was statistically significant(P<0.01).The more severe the degree of pulmonary obstruction,the higher the score,the higher the SGRQ score and the number of acute exacerbation in the previous year,the difference was statistically significant(P<0.01).2.The higher the degree of airflow limitation,the higher the grade of grouping,the higher the LAA%of whole lung and pulmonary lobe,the greater the Pi10 and WA%(P<0.05).3.Mild airflow limitation(GOLD1,GOLD2)and acute exacerbation of low risk(A group,B group)of the patients with COPD were main by above lobar emphysema distribution,the degree of airflow heavier(GOLD3 and above),the high risk of acute exacerbation(C group,D group)of chronic obstructive pulmonary disease patients by the contrary.Emphysema distribution was statistically significant because of the severe airflow limitation and difference acute risk(P=0.02,P=0.04)4.There was significant difference in the number of acute exacerbation,FEV1/FVC and FEV1 between the upper lobe emphysema and lower lobe emphysema(P<0.05).5,LAA%have correlation with smoking index,a year before the times of acute exacerbation,FEV1/FVC,FEV1%predicted,DLCO SB,RV/TLC%,Z5,R5 and Fres(P<0.01),no correlation with R20(P=0.71);upper lobe emphysema is associated with smoking index,FEV1/FVC,FEV1%predicted SB,RV/TLC,DLCO%,Fres(P<0.01),no correlation with the previous year of acute exacerbation,Z5,R5,R20(P>0.10);lower lobar emphysema have correlation with one year before the times of acute exacerbation,FEV1/FVC,FEV1%predicted,DLCO SB,RV/TLC,Z5 R5,and Fres(P<0.01),no correlation with smoking index,R20(P=0.19).conclusion1.The degree of emphysema in COPD group was higher than that of the control group,and the higher the degree of airflow limitation,the higher the LAA%of the whole lung and each lobe of lung and the thicker the wall,the same to the higher grade of the evaluation group.2.Upper lobe emphysema mainly distributed in mild airflow limitation and A group,B group COPD patients,the severe airflow limitation and C group,D group by the contrary.3.In patients with lower lobar emphysema,acute exacerbation was more frequent and pulmonary ventilation function was worse4.Emphysema index is related to pulmonary ventilation and IOS findings,which can be used to evaluate the structure and function of small airwayPart Two The response to inhalation evaluation in stable COPD patients with different imaging phenotype.ObjectTo explore the different imaging phenotypes of budesonide/formoterol inhalation treatment response.Method55 patients with stable COPD enrolled from May 2016 to January 2017,all the subjects were evaluated with symptom scores,pulmonary function test and HRCT the same as the first part,according to the results of HRCT scan is divided into A type,E type,M type.Three groups were treated for 3 months with budesonide/formoterol inhalation therapy,observing the improvement of three groups of patients in symptom scores,pulmonary function test and small airway after treatment,to find out the difference in imaging phenotype.Result1.Pulmonary function index:F V C%pred,FEV1%pred,FEV1/FVC,DLCO%pred:A>E>M,the difference was statistically significant(P<0.05);RV/TLC%:A type<E type<M type,the difference was statistically significant(P=0.01).2.Symptom score:before treatment,the scores of the three groups were statistically significant(P<0.05).The use of budesonide/formoterol inhalation therapy after three month,the symptoms scores such as mMRC score,CAT score,St Georges questionnaire scores were significantly lower than that before treatment,there is significant difference in each index before and after treatment(P<0.05).3.The evaluation of pulmonary function:patients with type A and type E for a period of 3 months after inhalation in the treatment of pulmonary function indexes of FVC,FVC%pred,FEV1,FEV1%pred,FEV1/FVC than before treatment increased,compared with before treatment,no significant change in the index of patients with type M,type A with ventilation function index before and after treatment statistical difference(P=0.00),E type had no significant difference with M type(P>0.05).Three groups of patients with lower airway resistance index of Z5,R5 and R20 were compared with those before treatment,the difference was statistically significant(P<0.05),Fres after treatment were significantly lower than those before treatment(P<0.01),the absolute value of X5 decreased than before treatment(P<0.01).There was no significant difference between the three groups before and after treatment with FVC and FEV1 index(P>0.05).Before and after A treatment,the IOS index was more obvious than that of E and M,but there was no significant difference between the groups(P>0.05).DLCO%pred in three groups after treatment than before treatment increased(P<0.01),residual capacity of RV/TLC%decreased,but there was no significant difference between the three groups(P=0.61,P=0.26).Conclusion1.ICS/LABA inhalation therapy can reduce the small airway resistance and improve the clinical symptoms in patients with COPD.2.IOS airway resistance index is more sensitive than the lung ventilation function index,and can better evaluate the effect of inhalation therapy in COPD patients.3.A type patients with mild emphysema,mild airflow limitation,partially reversible airflow limitation occurred after budesonide/formoterol.4.The effect of inhaled budesonide/formoterol in E type,M type patientsis not obvious in pulmonary ventilation function.5.the effect of budesonide/formoterol on treatment of type A is not better than that of E type and M type.