| BackgroundFor most countries in the world,the impact of chronic obstructive pulmonary disease(COPD)can not be ignored.It is found clinically because of the typical airway symptoms inherent in the disease,and because the airway symptoms are often characterized by repetition,persistent attacks,irreversible airflow obstruction and so on,the disease can not be completely cured and has been paid attention to by the clinic.These symptoms are more obvious in the period of sudden adverse changes in the condition of COPD,which is specifically referred to by a proper term in medicine:AECOPD.The one-second rate in the pulmonary function test,that is,the value of FEV1/FVC,less than 70%(after inhaling bronchodilators),was used as the clinical basis for the diagnosis of COPD.At present,with the development of economy and society,the level of global medical technology is advancing by leaps and bounds.Compared with the past,a considerable number of COPD patients have received timely and standardized diagnosis and treatment,and have made progress in controlling the progress of the disease,improving the ability of living.However,in modern society,the problems of high morbidity and mortality of COPD still need to be solved urgently[1].According to the statistics of China Lung Health Research,the total number of people with COPD in China from 2012 to 2015 is as high as 99.9 million,of which the proportion of men and women is 2.2%.The prevalence rate of people aged 20 or older is 8.6%,while that of people over 40 years old is as high as 13.7%.But these clinical data only come from patients who improve lung function tests[2].Moreover,the latest Global Initiative for chronic obstructive Pulmonary Disease 2020(GOLD2020)also puts forward a negative view that the incidence of COPD may continue to rise in the next 40 years,GOLD2020 estimated that more than 5.4 million people will die as a result of COPD each year by 2060.The current situation of COPD diagnosis in China is not optimistic,the proportion of patients with clear diagnosis is 35.1%,those who take the initiative to receive treatment is less than 25%,and the understanding of the name of the disease is less than 10%[3-4].It is mentioned in GOLD2020 that about 60%of COPD patients are asymptomatic,lack of awareness of their own condition,and to some extent are more likely to cause adverse consequences.We must pay close attention to it.In fact,COPD is often complicated with respiratory diseases such as pulmonary heart disease and lung cancer,but also closely related to cardiovascular disease,nutrition and metabolism,psychosis and mental health.These diseases bring many tests to the treatment and prognosis of patients.Therefore,it is still one of the hotspots in current research to use simple,effective,convenient and cost-effective biological indicators to assist the early diagnosis of COPD,evaluate the severity,prevent complications or prevent the progression of the disease as soon as possible,thereby improving the patients’prognosis and survival.ObjectiveThis article discusses the changes of plasma D-dimer(D-D)and hematocrit(HCT)in patients with COPD.At first,the patients with COPD in stable stage and acute stage were compared with healthy people,and then the patients with COPD in different stages of pulmonary function were compared to observe the relationship between the changes and different stages of disease and different stages of pulmonary function.Finally,the correlation between D-D,HCT and procalcitonin(procalcitonin,PCT),interleukin-6(interleukin-6,IL-6)and C-reactive protein(C-reactive protein,CRP),and arterial blood gas(PO2,PCO2)in inflammatory markers was analyzed.The purpose of this study is to discuss the changes of blood viscosity and blood coagulation in patients with COPD,to analyze the pathophysiological mechanism leading to this change,and to evaluate the value of the changes of plasma D-D and HCT in the evaluation and treatment of COPD.Materials and methodsA total of 149 patients with COPD diagnosed by pulmonary function in the second affiliated Hospital of Zhengzhou University from March 2017 to March 2019 were selected(male 120,female 29)and compared with 100 healthy subjects(72 males and 28 females)who underwent physical examination in the outpatient clinic in the same period.Routine and biochemical tests such as mobile pulse blood gas test,pulmonary function,blood routine test,blood coagulation function,infection markers,etc.,were performed in all patients with COPD.According to the condition,the observation group was divided into COPD stable group(n=58,male 44,female 14)and AECOPD group(n=91,male 76,female 15).It is then divided into four groups according to the FEV1%value of lung function:mild airflow limitation group(n=36)(FEV1%≥80%),moderate airflow limitation group(n=34)(50%≤FEV1%<80%),severe airflow limitation group(n=48)and extremely severe airflow limitation group(n=31)(FEV1%<30%).The general conditions of the subjects were counted,including recent medication history,past diseases,sex and age,and the results of blood sampling test in the observation group were collected:HCT,D-D,CRP,PCT,IL-6,arterial partial pressure of oxygen(PO2),arterial partial pressure of carbon dioxide(PCO2),pulmonary function(FEV1%,FEV1/FVC).Collect D-D and HCT in the control group.The changes of HCT,D-D and other observation indexes in each group were compared,and the correlation between HCT,D-D and infection index,arterial blood gas and pulmonary function was analyzed.Results(1)HCT:①The data of the observation group was higher than that of the control group(41.75±4.16),the data of AECOPD group(54.95±3.88)was higher than that of COPD group(51.17±3.96)(P<0.05).②COPD was re-divided into two groups according to lung function:extremely severe airflow restriction group(56.29±3.98)and severe group(54.75±3.15),higher than moderate group(51.92±4.25)and mild group(50.83±4.01)(P<0.05),moderate group was higher than mild group,extremely severe group was higher than severe group,the difference was meaningless(P>0.05).(2)D-D:①The data of the observation group was higher than that of the control group(0.30±0.16),the data of AECOPD group(3.15±1.12)was higher than that of COPD group(2.23±1.03)(P<0.05).②COPD was re-divided into for groups according to lung function:extremely severe airflow restriction group(3.43±0.85)and severe group(3.28±1.01),higher than moderate group(2.22±0.78)and mild group(2.12±1.35)(P<0.05),moderate group was higher than mild group,extremely severe group was higher thanthe severe group,there differences were meaningless(P>0.05).(3)COPD was divided into four groups according to pulmonary function,①CRP comparison in each group:the extremely severe airflow limitation group(3 9.79±9.74)was significantly higher than the severe group(30.67±7.38),the moderate group(23.19 ±7.32)and the mild group(22.35 ±8.21)(P<0.05).The severe airflow limitation group was higher than the mild group and the moderate group(P<0.05),and the mild group was lower than the moderate group,but the difference was meaningless(P>0.05).② PCT comparison in each group:in extremely severe airflow limitation group(3.30±1.21),severe group(2.86±0.86)and moderate group(2.44±1.22)were higher than those in mild group(1.76 ±0.78),and the extremely severe group were higher than those in moderate group(P<0.05),the data in the severe group was higher than that in the moderate group,and that in the extremely severe group was higher than that in the severe group(P>0.05),the difference was not obviously significant.③IL-6 comparison in each group:the extremely severe airflow limitation group(36.03±10.24)was significantly higher than that in severe group(26.57±7.27),moderate group(21.41±6.84)and mild group(18.37±7.94)(P<0.05),he data of severe group was higher than that of mild group and moderate group(P<0.05),and that of moderate group was higher than that of mild group(P<0.05),a and that of moderate group was higher than that of mild group(P>0.05),the difference was not obviously significant.(4)D-D and HCT were negatively correlated with PO2 respectively(r=-0.422,p<0.001,r=-0.453,p<0.001).D-D and HCT were positively correlated with PCO2 respectively(r=0.329,p<0.001,r=0.387,p<0.001).D-D was positively correlated with CRP,PCT and IL-6(r=0.767,p<0.001,r=0.282,p<0.001,r=0.676,p<0.001).HCT was positively correlated with CRP,PCT and IL-6(r=0.735,p<0.001,r=0.319,p<0.001,r=0.544,p<0.001).Conclusions(1)The levels of D-D and HCT in patients with COPD were increased,especially in acute exacerbation,which suggested that there were changes of high blood coagulation and high viscosity.(2)D-D and HCT in COPD patients were significantly different in different pulmonary function groups,and increased in turn with the increase of airflow limitation.(3)The changes of D-D and HCT in patients with COPD were significantly correlated with PO2,PCO2,CRP,PCT and IL-6,which were suggested that the content of oxygen and carbon dioxide in blood,indicated the degree of inflammatory reaction.(4)D-D and HCT are closely related to the progression of COPD,and their dynamic changes play an important role in the diagnosis and treatment of diseases. |
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