The Effect Of Metabolic Syndrome And Its Components On Prognosis Of COPD Patients In China By Real World Research

Background:In China,the prevalence of chronic obstructive pulmonary disease(COPD)is high both in urban and rural area.In recent decade,the prevalence of COPD in China has risen from 8.2% to 13.7%.The population of Chinese COPD patients is occupied with 25% of the global COPD population,up to one hundred million.COPD is not only a low cure rate,high disability rate and high mortality disease,but also a disease with high prevalence of comorbidity.It is a phenomenon that should pay more attention by researchers on treatment and prevention,especially in the multi-disciplinary field which study the prognosis of COPD with comorbidity.With the development of economy and materials,prevalence of obesity,diabetes,hypertension and dyslipidemia has risen from year to year,at the same time,these diseases bring much burden on progression and prognosis.Metabolic syndrome(MS)is a series of diseases including obesity,diabetes,hypertension,dyslipidemia and hyperinsulinemia.They are all the risk factors which contribute to vascular lesions.The prevalence of MS in China is 24%,the MS comorbidity prevalence in COPD is 40%,but the prevalence of the comorbidity with its components in COPD is uncertain.There is no large-scale investigation on prevalence of the comorbidity,and the effect of Metabolic syndrome and its components on progression and prognosis in COPD.We aim to investigate the prevalence and study the effect in this research.Methods:We set up a platform by Shandong Provincial Medical Doctor Association Respiratory Chapter COPD Collaborative Group and Shandong Province Chronic Respiratory Diseases Management Network Platform,and randomly sampled 5 hospitals: Shandong Provincial Hospital,Taishan Medial College affiliated Hospital,Zhongshan Hospital affiliated to Fudan University,Dezhou People’s Hospital,Liaocheng People’s Hospital.Our retrospective real world research included 948 patients with COPD diagnosed by spirometry and hospitalized from January 1st,2014 to December 31 st,2017.The indicators were gathered from hospital records database.We observed the prevalence of COPD with MS.We analyzed the association between Metabolic syndrome or its components and pulmonary function,inflammation levels and exacerbation etc.by Spearman bivariate correlations,the difference analysis by Kruskal-Wallis test,Mann-Whitney U test and logistic regression.Results:The clinical data of 948 COPD patients were analyzed by using a multicenter,retrospective real world study.The results showed that the prevalence of COPD patients with metabolic syndrome was 39.3%.By further research,we found that the prevalence of type 2 diabetes mellitus,dyslipidemia,essential hypertension,hyperuricemia,overweight and obesity were 29.96%,35.3%,54.32%,11.63%,28.43%,28.06%-28.80% and 35.3%,respectively.About 19.6%(15.52%-23.7%)and 48.03%(44.31%-51.75%)of patients with chronic obstructive pulmonary disease complicated with overweight and/or obesity.Patients with COPD complicated with metabolic syndrome and type 2 diabetes mellitus,dyslipidemia,hypertension and hyperuricemia had higher levels of inflammation(β2-microglobulin,PCT,CRP,total white blood cells,etc.)than patients with COPD alone;in terms of pulmonary function,metabolic syndrome mainly affected residual air volume,residual ratio and inspiratory fraction,which also predicted that This population has more severe obstructive disease and worse prognosis,and their high incidence of coronary heart disease may also affect their long-term prognosis,survival and quality of life.It is worth noting that properly high BMI(grade 1 overweight and obesity)is a protective factor for the prognosis of COPD patients.BMI is positively correlated with pulmonary function and negatively correlated with inflammation level and acute exacerbation.Conclusion:1.The prevalence of COPD with metabolic syndrome and its con diseases is higher,the overall prevalence is 39.3%.This high incidence of complications needs to be paid attention to by clinicians in diagnosis and treatment.2.Chronic obstructive pulmonary disease(COPD)patients with metabolic syndrome and its components have higher degree of systemic inflammation than those with COPD,and higher degree of pulmonary obstruction,which may be the cause of poor prognosis in this group.3.BMI as a measure of body weight and nutritional status of COPD patients,BMI was positively correlated with pulmonary function,negatively correlated with inflammation level and acute exacerbation,and did not increase the use of glucocorticoid.Because COPD is often accompanied by sarcopenia and other reasons,it is considered that appropriate high BMI is a protective factor for the prognosis of COPD patients and an important indicator for long-term management and prognosis evaluation of COPD.