| objective: In order to understand the acute-exacerbations of patients with COPD in different degree of airflow limited after one year of follow-up in this region,investigate the relationship between the levels of oxidative stress makers,nutritional status and the risk of acute-exacerbation in patients with COPD,analyze the independent risk factors of high-risk acuteexacerbation.Methods :(1)200 patients of stable COPD in Lu zhou City Community Hospital(Jiang nan Community Hospital,Red Cross Hospital of shi dong)and Luzhou Medical College Affiliated Hospital(now: Affiliated Hospital of Southwest Medical University)from June 2014 to August 2014 as COPD group were collected,100 cases of healthy people in the same period as the control group also were collected.(2)Collected general information ?measured lung function?detected the levels of PC,MDA,8-OHdG and A-TOC in the serum for each object of this study at baseline;assessed the nutritional status by calculating the BMI and using mini-nutritional assessment(MNA)for each COPD patients at baseline.(3)Then acute-exacerbations of patients with COPD was followed up every six months and were followed for one year.The follow-up form was that telephone call to inform the patients to arrive at the local community hospital for face-to-face history collection,or go to the patient's home.During the follow-up period,no intervention and a truthful assessment about the exacerbations of the patients with COPD after one year of followed-up in this regions was taken.(4)According to the frequency and severity of acute-exacerbations within one year of follow-up,the patients with COPD were divided into high-risk acute-exacerbation subgroup(exacerbations ?2 times or exacerbation ?1 time and hospitalized for exacerbation within one year)and low-risk acute-exacerbation subgroup(exacerbation ?1 time within one year and no hospitalized for exacerbation).the levels of oxidative stress markers(PC,MDA,8-OHdG,A-TOC)and nutritional status were compared between the two subgroups,the relevant factors of acute-exacerbation were explored,further the independent risk factors of high-risk acute-exacerbation were analyzed.Results:(1)There were 162 patients of COPD after one year of follow-up,38 patients were lost,The follow-up rate is 81%.(2)162 patients were graded by the extent of airflow limitation(GOLD grade): grade I(mild)were 36 patients(22.2%),grade II(moderate)were 50 patients(30.9%),grade III(severe)were 58 patients(35.8%),grade IV(extremely severe)were 18 patients(11.1%).2 patients(5.6%)had frequent acute-exacerbations and 1 patient(2.8%)hospitalized for acute-exacerbation in grade I(mild subgroup);14 patients(28.0%)had frequent acute-exacerbations and 7 patients(14.0%)were hospitalized for acute-exacerbation in grade II(moderate subgroup);27 patients(46.5%)had frequent acute-exacerbations and 15 patients(25.9%)were hospitalized for acute-exacerbation in grade III(severe subgroup);12 patients(66.6%)had frequent acute-exacerbations and 8 patients(44.4%)were hospitalized for acute-exacerbation in grade IV(extremely severe subgroup).The average number of acute-exacerbation per person per year was 0.31 in grade I(mild subgroup),0.96 in grade II(moderate subgroup),1.47 in grade III(severe subgroup)and 2.17 in grade IV(extremely severe subgroup).There are 64 cases of COPD in the high-risk acuteexacerbation subgroup accounted for 39.5% and were 98 cases of COPD in the low-risk acute-exacerbation subgroup accounted for 60.5%.(3)The levels of serum PC,MDA and 8-OHdG in the COPD group(162 cases)were higher than those in the healthy control group(100 cases),while the serum T-AOC concentration was lower than that of the healthy control group,the differences were all statistically significant.The serum PC concentration in the high-risk subgroup was 6.87 [5.40,10.30](ng / ml),which was obviously higher than that in the low-risk subgroup was 2.68 [1.34,3.88](ng / ml)),the difference was significant(P <0.001).The serum MDA concentration in the high-risk subgroup was 5.18 [3.10,7.62](nmol / ml),which was obviously higher than that in the low-risk subgroup was 3.60[2.64,4.84](nmol / ml),the difference was statistically significant(P <0.001).The serum 8-OHdG concentration in the high-risk subgroup was 390.73 [261.88,608.76](pg / ml),which was higher than that in the low-risk subgroup was 363.14 [267.33,595.46](pg / ml),the difference was not statistically significant(P = 0.797).The serum T-AOC concentration in the high-risk subgroup was 9.56 [3.17,17.45](U / ml),which was lower than that in the low-risk subgroup was 12.71 [5.95,22.23](U / ml),the difference was statistically significant(P = 0.047).(4)According to MNA,the morbidity of malnutrition and nutritional risk was up to 47.5%(77 cases)of the 162 stable COPD patients in this study,there were 20 cases(12.3%)in low body mass index of the 162 stable COPD patients.The body mass index(BMI)was 21.28 ± 3.52 in the high-risk subgroup,which was obviously lower than that in the low-risk subgroup was 23.96 ± 3.34,the difference was statistically significant(P <0.001);there were 15 cases(23.4%)with low body mass index(BMI)in the high-risk subgroup,and the proportion was obviously higher than that in the low-risk group were 5 cases(5.1%),the difference was statistically significant(P <0.001).The MNA score in the high-risk subgroup was 20.91 ± 3.96,which was obviously lower than that in the low-risk subgroup was(24.06 ± 3.26),the difference was statistically significant(P <0.001);about non-nutritious,there were 44 patients(68.8%)of COPD in the high-risk subgroup,and the proportion was significantly higher than that in the low-risk group were 33 patients(33.7%),the difference was statistically significant(P <0.001).(5)In univariate logistic regression analysis,the factors related to the high-risk acute-exacerbation were BMI,MNA score,serum PC concentration,serum MDA concentration,serum A-TOC concentration,FEV1%,FEV1 / FVC,the extent of airflow limitation,Whether it belongs to low body mass index or whether it is combined with malnutrition(risk)(6)Multivariate logistic regression analysis showed that the independent risk factors of high-risk acuteexacerbation were MNA score <24 points(OR=3.655,95% CI 1.211-11.036),FEV1% <50%(OR=2.935,95% CI 1.052-8.189),the serum PC level(OR=2.013,95% CI 1.546-2.620)and the serum MDA level(OR=1.677,95% CI 1.298-2.166)in patients with stable COPD.Conclusions:(1)The worsening lung function in patients with stable COPD,the more frequent and serious acute-exacerbations were occurred.(2)There is oxidative / anti-oxidative imbalance in COPD,and this imbalance was more serious in high-risk acuteexacerbation subgroup.(3)According to MNA,the morbidity of malnutrition and nutritional risk was up to 47.5%(77 cases)of the 162 patients with COPD in this study.(4)The FEV1% <50%,MNA scores<24 points and the high level of PC and MDA concentration were the independent risk factors for high-risk acute-exacerbation in stable COPD;The increased of PC and MDA concentration may be candidate serum markers for high-risk acute-exacerbation of patients with stable COPD,and may become a new intervention point for antioxidant therapy. |
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