Based On The Clinical Study Of Dual-phase Quantitative CT To Explore The Differences Of Imaging Phenotypes In Chronic Obstructive Pulmonary Disease

Objective1.Image classification of COPD patients was conducted by post-processing the data parameters of dual-phase QCT.2.To explore the differences between general data,clinical characteristics,serological indicators and pulmonary function parameters of COPD patients with different imaging phenotypes,so as to provide help for guiding clinical diagnosis,making treatment plans and follow-up observation in the future.Methods Collected in December 2018-December 2019 Yu Yanan university hospital respiratory medicine in the hospital,and confirmed by lung function examination of met inclusion and exclusion criteria,63 patients with AECOPD,measurement and data post-processing of double gas phase QCT gain parameters,fSAD%Emph%and Normal%,the clustering analysis,divided into two groups after clustering emphysema phenotype and small airway phenotypic group.Comparison between the two groups of general information?gender,age,smoking index,BMI?,clinical characteristics?duration,hospitalization days,hospitalization expenses,the number of exacerbations,CAT scores,mMRC score?,serology indexes?WBC,NEU%,EOS%,L%,hs-CRP and PCT,D-Dimer,PaO₂,PaCO₂?,and pulmonary function parameters?FEV1%Pred,FEV1/FVC,FEF25-75%Pred,MEF50%Pred,MEF25%Pred?.The differences between the two groups of phenotypic patients were compared by statistical methods,and the correlation between QCT measurement parameters and lung function parameters was analyzed by means of Person correlation coefficient and scatter plot.Results1.Imaging phenotypic features:The cluster analysis clustering,Emph%,fSAD%Normal%parameters for two kinds,the first kind of patients with emphysema is given priority to,the second category of patients with small airway is given priority to,and two kinds of parameters of the Normal%,Emph%,fSAD%difference had statistical significance?P=0.00?,therefore,the first named emphysema phenotypic group,the second category of patients named small airway phenotypic groups.2.General data comparison:There were 45 patients in the emphysema phenotype group,31 males and 14 females,with an average age of 69.33±8.512 years;there were 18patients in the small-airway phenotype group,10 males and 8 females,with an average age of 67.06±9.365 years;there was a statistically significant difference in gender ratio between the two groups?P=0.004?and a statistically significant difference in smoking index?P=0.042?.There was no statistically significant difference in age and BMI between the two groups?P>0.05?.3.Comparison of clinical characteristics:there were statistically significant differences between patients with emphysema phenotype group and patients with small airway phenotype group in disease course,length of stay,hospitalization cost,number of acute exacerbations in the past year,and CAT score?P<0.05?.There was no significant difference in mMRT score and GOLD grade between the two groups?P>0.05?.4.Comparison of serological indicators:The difference of EOS%between patients with emphysema phenotype group and patients with small airway phenotype group was statistically significant?P=0.000?.The average PaCO₂ of patients in the emphysema phenotype group was 56.31±12.484mmHg,and the smaller airway phenotype group was higher,with statistically significant differences between the two groups?P=0.000?.There was no significant difference in WBC,NEU%,L%,CRP,PCT,D-Dimer and PaO₂between the two groups?P<0.05?.5.Comparison of lung function:In the emphysema phenotype group,FEV1%pred and FEV1/FVC were both small and low in the airway phenotype group,with statistically significant differences between the two groups?P<0.05?.FEF25-75%pred,MEF50%pred and MEF25%pred in the small-airway phenotype group were significantly lower than those in the emphysema phenotype group,and the differences between the groups were statistically significant?P<0.05?.6.Correlation analysis:Emph%in emphysema phenotype group was negatively correlated with FEV1%pred and FEV1/FVC?r=-0.704,P=0.00;r=-0.765,P=0.000?,FEV1/FVC was significantly correlated with Emph%,but not with FEF25-75%pred,MEF50%pred,and MEF25%pred?P>0.05?.In the small-airway phenotype group,fSAD%was negatively correlated with FEF25-75%pred,MEF50%pred,and MEF25%pred?r=-0.764,P=0.000;r=0.850,P=0.000;r=-0.760,P=0.000?,in which MEF50%pred was significantly correlated with fSAD%,but not with fev1%pred and FEV1/FVC?P>0.05?.Conclusion1.Emphysema phenotype COPD patients are mainly male smokers,and small-airway phenotype COPD patients are mostly female.2.Patients with emphysema phenotype COPD have higher airway phenotype with smaller EOS%and PaCO2,and greater risk of acute exacerbation.3.Patients with emphysema phenotype COPD with small airway phenotype have more severe clinical symptoms,worse quality of life,more obvious decline in lung function,and more expensive hospitalization.Therefore,individualized assessment and follow-up should be conducted for patients with this phenotype to improve their quality of life.4.The measurement parameters of dual-phase QCT in COPD patients have a good correlation with lung function,and dual-phase QCT is helpful for the diagnosis,treatment and prognosis assessment of COPD.