Analysis of clinical features and inflammatory factors in induced sputum in common phenotypes of COPD with frequent exacerbations / 中国综合临床

ABSTRACT

Objective To compare the clinical characteristics of chronic bronchitis ( CB),emphysema (EM ), asthma - chronic obstructive pulmonary disease overlapping syndrome ( ACOS ) with frequent exacerbations ( FE ) or infrequent exacerbations ( iFE ) and induced sputum inflammatory cells and the heterogeneity of the transmitter. Methods Ninety-one cases of chronic obstructive pulmonary disease( COPD) with acute exacerbation were divided into CB,EM or ACOS phenotype,among which 44 were frequent,and 47 were non frequent. The clinical data,induced sputum inflammatory cells,interferon-γ(IFN-γ),tumor necrosis factor-α ( TNF-α ), interleukin ( IL )-4, IL-13 were analyzed. Results The FEV1% was ( 47 ± 13. 1 )%, significantly lower than that of non frequent episodes (( 56. 2 ± 10. 2)%),and the difference was statistically significant(P＝0.049).The FEV1/FVC% was (54.3±9.3)%,significantly lower than that of non frequent episodes (60. 1±7. 3)%,and there was a significant difference between them ( P＝0. 001) . The proportion of patients with GOLD III and IV,the percentage of neutrophils in induced sputum,tumor necrosis factor -α(TNF-α) and interferon-γin the patients with frequent episodes were significantly higher than those with non frequent episodes (P＜0. 05). Among them,FEV1/FVC% and TNF-αwere independent risk factors for COPD patients (P＝0. 032, 0. 021) . The FEV1% of patients with CB phenotypic frequent episodes were ( 47. 9 ± 14. 9 )%, significantly lower than that of non frequent episodes ((57. 2±10. 9)%)(P＝0. 000),and FEV1/FVC% was (53. 4± 9. 5)% in patients with CB frequent episodes,significantly lower than that of non frequent episodes ((60. 3±6. 9)%),and the difference was statistically significant (P＝0. 022),while the level of N%,TNF-α in induced sputum were significantly higher in CB phenotype subjects with FE than those in subjects with iFE(P＜0. 01). Patients with frequent episodes of emphysema had longer duration of disease (P＜0. 05),lower FEV1%and FEV1/FVC%(P＜0. 05),the proportion of GOLD III patients and the induced sputum TNF-αwere higher, but there was no significant difference in the number and proportion of phlegm inflammatory cells,interferon-γ, interleukin 4 and interleukin 3. The level of GOLD III and the IL-13 level of induced sputum in patients with frequent ACOS phenotype were significantly higher than those in patients with non frequent episodes (P＜0. 05) . Conclusion The lung function,the severity of the disease,the course of the disease,and the percentage of sputum neutrophils,tumor necrosis factor-α,or interleukin 13 are helpful in diagnosing patients with high risk of frequent episodes.