| Objective 1.To explore the comprehensive evaluation of clinical conditions of patients with different copd imaging phenotypes based on quantitative CT,such as Pro-BNP,D-D,NLR and other laboratory indicators.2.By following up patients with copd for 1 year after discharge,it can help evaluate the clinical prognosis of patients with different imaging phenotypes.Methods A retrospective study of 98 AECOPD patients admitted to the Department of Respiratory and Critical Care medicine of The Affiliated Hospital of Yan ’an University from January 2018 to July 2019 and a prospective study of 98 AECOPD patients admitted to the Department of Respiratory and Critical care Medicine,confirmed by pulmonary function examination and confirmed by quantitative chest CT with complete data from August 2020 to December 2020 were collected.General data of the patients were collected: Gender,age,BMI and the number of acute exacerbations in the past 1 year;Serological indexes: WBC,NEU%,NEU,LY,hs-CRP,PCT,NLR,D-D,Pro-BNP;Lung function indicators: FEV1% pred,FVC,FEV1/FVC,GOLD grade.All patients were followed up for 1 year,and the frequency of acute exacerbations,hospitalization and death were collected within 1 year.Patients with acute exacerbations≥2 with an interval of more than 4 weeks were considered frequent exacerbations,while acute exacerbations < 2 were considered infrequent exacerbations.Multivariate binary logistic regression analysis was used to determine the severity of disease and ROC curve analysis was used to evaluate the prognosis of patients.Through statistical analysis of Pro-BNP,D-D,NLR and other laboratory indicators,comprehensive evaluation of clinical conditions was made.In addition,the patients with COPD were followed up one year after discharge to provide help for clinical prognosis evaluation of patients with different imaging phenotypes.Results 1.Comparison of general information : There were 37 patients with emphysema phenotype,including 24 males and 13 females,with an average age of 67.56±9.765 years and an average number of acute exacerbations of 2.37±0.758.There were 52 patients with small airway phenotype,including 39 males and 13 females,with an average age of 68.46±9.998 years and an average number of acute exacerbations of0.96 ± 0.277.The emphysema phenotype was smaller and the number of acute exacerbations of airway phenotype was more,and the difference in the number of acute exacerbations between the two groups was statistically significant(P<0.05).There were no significant differences in age,gender and BMI between 2 groups(P>0.05).2.Comparison of serological indicators:The phenotype of emphysema was small,and the airway phenotype of NEU%,Pro-BNP,NLR,hs-CRP and PCT were high,and the difference between the two groups was statistically significant(P<0.05).There were no significant differences in WBC,NEU,LY and D-D between 2 groups(P>0.05).3.Comparison of pulmonary function and pulmonary function grading:The FEV1%pred,FVC and FEV1/FVC of patients with emphysema phenotype were all small and the airway phenotype was low,and there was statistically significant difference in lung function parameters between the two groups(P<0.05).The emphysema phenotype was predominant in patients with severe and very severe obstruction,while the small airway phenotype was predominant in patients with mild and moderate obstruction.4.Emphysema phenotype compared with small airway phenotype Patients with frequent exacerbation of emphysema phenotype had higher Pro-BNP than those with infrequent exacerbation of emphysema phenotype,and the difference in Pro-BNP between the two groups was statistically significant(P<0.05).There was no significant difference in D-D and NLR between 2 groups(P>0.05).Patients with frequent aggravation of small airway phenotype had higher Pro-BNP and NLR than those with infrequent aggravation,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in D-D between 2 groups(P>0.05).5.Correlation analysis: Small airway phenotype,emphysema phenotype,re-hospitalization,Pro-BNP and NLR were positively correlated with the number of acute exacerbations during 1-year follow-up(r=0.734,P=0.001;r=0.852,P=0.001;r=0.414,P=0.022;r=0.613,P=0.035;r=0.742,P=0.001),which was highly correlated with emphysema phenotype,but moderately correlated with Pro-BNP,NLR,small airway phenotype,and re-hospitalization.FEV1% pred,D-D and hs-CRP had no correlation with the number of acute exacerbations(P>0.05)during 1-year follow-up.6.The hospitalization rate of patients with emphysema phenotype was significantly higher than that of patients with small airway phenotype(51.4% and 23.1%,respectively),and the difference between the two groups was statistically significant(P<0.05).After 1 year of follow-up,the survival rate of patients in the two groups was statistically significant(P<0.05).Multi-factor binary logistic regression analysis and ROC curve showed that NLR and Pro-BNP could predict the severity of the disease,and the combined test could more accurately assess the prognosis of patients than a single indicator.Conclusion 1.Patients with frequent exacerbations in the past had a higher frequency of future exacerbations,and the laboratory indicators of NEU%,NLR,hs-CRP,PCT and Pro-BNP were also significantly increased.Patients with severe lung function impairment had a higher risk of future exacerbations.2.Emphysema phenotype has a high risk of acute exacerbation in the future.Increased NLR and Pro-BNP are closely related to the risk of acute exacerbation.3.Patients with emphysema phenotype had a high rate of rehospitalization,and there was a significant difference in mortality between the two groups after 1 year of follow-up.Emphysema phenotype was highly correlated with the number of acute exacerbations during 1 year of follow-up,and the number of rehospitalization indicated that patients had a high risk of death in the future,and early intervention should be conducted to improve the prognosis of patients. |
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