| Objective:Chronic obstructive pulmonary disease(COPD)is a group of chronic airway inflammatory diseases which characterized by persistent airflow limitation,At present,there are a lot of clinical researches on inflammatory indexes of chronic exacerbation of chronic obstructive pulmonary disease(AECOPD),However,there is a lack of indicators that can accurately and sensitively to determine the occurrence of AECOPD and to assess the severity of the disease.This study focused on patients with AECOPD,and studied leptin,hs-CRP,PCT,WBC,and NEU%in patients with AECOPD of different severity.To explore the role of leptin and inflammatory indexes in the formation of AECOPD airway inflammation mechanism and the relationship between AECOPD and the severity of the disease.Methods:Forty-seven patients with AECOPD who were admitted to the Department of Respiratory Medicine of the Affiliated Hospital of North Sichuan Medical College from December 2018 to July 2019,including 35 males and 12 females,with an average age of(72.47±7.48)years;According to the severity of the disease,we comprehensive assessment the patients,divided them into three groups,among them,there were 13 cases in the mild group(8 males and 5 females with an average age(72.08±6.09)years),19 cases in the moderate group(15 males and 4 females with an average age(73.79±8.84)years),15 cases in the severe group(12 male and 3 females,mean age(71.13±6.89)years);According to the presence or absence of respiratory failure,there are 22 cases of AECOPD patients with concurrent respiratory failure(16 males and 6 females,mean age(73.36±6.27)years),and 25 cases of AECOPD patients without concurrent respiratory failure(19 males,6 females).Cases,mean age(71.68±8.46)years;According to the presence or absence of cor pulmonale,there are 17 cases of AECOPD patients with cor pulmonale(15 males and 2 females,average age(73.24±8.26)years),and 30 cases of AECOPD patients without cor pulmonale(20 males and 10 females,average age(72.03±7.12)years).For all patients with AECOPD detailed history collection,and physical examination,record all hospitalization information(The parameters of blood routine,blood biochemical parameters,PCT,hs-CRP,hospitalization days,number of exacerbations of last year,etc.),and peripheral venous blood samples,using Elisa method to determine plasma leptin levels.At the same time,Selected 34 healthy subjects as the control group,among them there were 23 males and 11 females with an average age of(69.65±6.18)years.Collected there parameters of blood routine,blood biochemical parameters,hs-CRP,etc,measured their plasma leptin levels,and then compared the levels of leptin and inflammatory indicators in patients with AECOPD of different groups.Result:(1)There were 47 patients in the AECOPD group,including 35 males(74.5%)and 12 females(25.5%),the average age was(72.47±7.48)years old,the average BMI was(21.23±2.94),and the average ALB was(35.21±3.92)g/L.There were 34 cases in the healthy control group,including 23 males(67.6%)and 11 females(32.4%),the average age was(69.65±6.18)years,the average BMI was(21.75±3.60),and the average ALB was(36.52±3.27)g/L.There were differences in age,gender,BMI,and ALB between the two groups.None were statistically significant(P>0.05).(2)The levels of leptin,WBC,NEU%,hs-CRP and PCT in patients with AECOPD before treatment were 3.63±0.84ng/ml,(8.35±3.50)×109/L,(79.79± 9.16)%,9.70(4.62,67.70)mg/L,0.15(0.10,0.74)μg/L;The levels of leptin,WBC,NEU%,hs-CRP,and PCT in patients with AECOPD after treatment were 2.08± 0.74ng/ml,(7.29±2.61)×109/L,(72.91±12.19)%,5.04(3.01,7.09)mg/L,0.05(0.00,0.11)μg/L;The levels of leptin,WBC,NEU%,and hs-CRP levels in the healthy control group were 2.00±0.45ng/ml,(6.01±1.80)×109/L,(55.9±11.34)%,4.37(2.83,6.22)mg/L.The levels of leptin,WBC,NEU%and hs-CRP before treatment in AECOPD patients were higher than those in healthy controls(P<0.05);the levels of NEU%and WBC after AECOPD treatment were higher than those in healthy controls,the differences were Statistical significance(P<0.05),leptin and hs-CRP levels were not significantly different from the healthy control group,the difference was not statistically significant(P>0.05);AECOPD patients compared before and after treatment,the levels of leptin,NEU%,hs-CRP,and PCT decreased after treatment,and the difference was statistically significant(P<0.05).The difference before and after WBC treatment was not statistically significant(P>0.05).(3)The levels of leptin,WBC,NEU%,hs-CRP and PCT in the mild group of AECOPD were 2.76±0.50ng/ml,(8.89±3.61)×109/L,(81.85±7.07)%,6.37(3.39,15.54)mg/L,0.13(0.08,0.20)μg/L;The levels of leptin,WBC,NEU%,hs-CRP and PCT in the moderate group were 3.61±0.66ng/ml,(7.61± 2.52)×109/L,(78.21± 10.21)%,19.72(5.45,93.09)mg/L,0.15(0.11,0.76)μg/L;The levels of leptin,WBC,NEU%,hs-CRP and PCT in severe group were 4.41±0.43ng/ml,(8.83±4.44)×109/L,(80.00±9.56)%,33.14(6.51,121.62)mg/L,0.21(0.09,1.63)μg/L.The level of leptin in the mild group of AECOPD patients was lower than that in the moderate group and severe group,and the level of leptin in the moderate group was lower than that in the severe group(P<0.05);the level of hs-CRP in the mild group of AECOPD patients was lower than that in the moderate and severe groups,the difference was statistically significant(P<0.05),the difference between the hs-CRP level in the moderate group and the hs-CRP level in the severe group was not statistically significant(P>0.05);The differences of WBC,NEU%and PCT in three groups were not statistically significant(P>0.05).(4)The plasma leptin level of AECOPD patients with cor pulmonale was 4.03±0.68ng/ml higher than that of AECOPD patients without cor pulmonale 3.40±0.84ng/ml,the difference was statistically significant(P<0.05);The plasma leptin level in the AECOPD complicated respiratory failure group was 4.01±0.65ng/ml higher than that in the AECOPD uncomplicated respiratory failure group 3.19±0.82ng/ml,the difference was statistically significant(P<0.05).(5)The leptin level in the AECOPD group was positively correlated with the length of hospitalization and the number of acute attacks in the previous year(r=0.462,P<0.001;r=0.585,P<0.001),and the correlation was statistically significant(P<0.05).There was no significant correlation between peripheral blood leptin level and age,BMI,gender,hs-CRP,ALB,PCT,WBC,NEU%(all P>0.05).Conclusion:(1)The levels of leptin,hs-CRP,WBC,and NEU%in AECOPD patients were significantly higher than those in healthy controls,suggesting that all the above inflammatory indicators could reflect the occurrence of AECOPD.(2)The levels of leptin,hs-CRP,NEU%and PCT in AECOPD patients decreased significantly compared with before treatment,and WBC levels may be affected by multiple factors and did not decrease significantly after treatment,suggesting that leptin,hs-CRP,NEU%and PCT are more valuable than WBC in judging the therapeutic effect.(3)With the increase of disease severity,leptin and hs-CRP levels in AECOPD patients gradually increased,while there was no significant difference between WBC,NEU%and PCT,suggesting that leptin and hs-CRP could better reflect the severity of AECOPD than WBC,NEU%and PCT.(4)The levels of leptin in AECOPD patients with cor pulmonale or respiratory failure were higher than those without complications.Leptin can be used as an index to predict whether AECOPD patients will develop pulmonary heart disease or respiratory failure in the future.(5)With the increase of the frequency of acute exacerbation,the level of leptin in AECOPD patients increased,suggesting that leptin could be used as an indicator to predict the risk of future acute exacerbation in patients. |
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