The assessment of clinical characteristics between different LAA phenotype in patients with acute exacerbation in chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DAI Lu , DUAN Yishan , YUAN Mengxin , OU Xuemei ,  LIANG Binmiao

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIANG Binmiao, Email: liangbinmiao@163.com

Keywords：

Acute exacerbation of chronic obstructive pulmonary disease; High-resolution computed CT; Low attenuation areas scoring system

DOI：

10.7507/1671-6205.202001006

Video：

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Objective To explore the feasibility and clinical application value of low attenuation areas (LAA) scoring system in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods A total of 380 patients with AECOPD were included. Clinical data including general information, laboratory examinations and treatments during hospitalization were collected. According to the high-resolution computed CT (HRCT) imaging performance, the patients were divided into bronchitis phenotype and emphysema phenotype. The clinical data between these two groups were compared to analyze the differences between different phenotypes and the feasibility of LAA scoring system.Results In patients of bronchitis phenotype, the levels of body mass index, C-reactive protein, interleukin-6, procalcitonin, neutrophil-to-lymphocyte ratio, and eosinophil counts on admission were higher than those of emphysema phenotype (P<0.05). Patients with emphysema phenotype had a higher proportion of male, a higher smoking index, higher cystatin C levels and lower bilirubin levels on admission (P<0.05), the rates of using mechanical ventilation and systemic glucocorticoids were higher as also (P<0.05). LAA scores had a positive correlation with the use of mechanical ventilation and systemic glucocorticoids and cystatin C levels, and a negative correlation with interleukin-6 levels (P<0.05).Conclusions For patients with AECOPD, using LAA scoring system to classify different phenotype through HRCT has relevant accuracy and clinical practicability. The LAA scoring system might help to evaluate the patient's condition and prognosis to a certain extent.

Citation： DAI Lu, DUAN Yishan, YUAN Mengxin, OU Xuemei, LIANG Binmiao. The assessment of clinical characteristics between different LAA phenotype in patients with acute exacerbation in chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 430-434. doi: 10.7507/1671-6205.202001006 Copy

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11.	Liang R, Zhang W, Song YM. Levels of leptin and IL-6 in lungs and blood are associated with the severity of chronic obstructive pulmonary disease in patients and rat models. Mol Med Rep, 2013, 7(5): 1470-1476.
12.	梁衛娟, 華鋒. CRP 和 TNF-α 在慢阻肺急性加重期病情嚴重程度判斷中的意義. 中國現代醫生, 2015, 53(9): 12-15.
13.	Borsi H, Nia EP, Mal-Amir MD, et al. Relationship between serum procalcitonin level and chronic obstructive pulmonary disease. J Family Med Prim Care, 2019, 8(2): 738-740.
14.	Günay E, Sar?n? Ula?l? S, Akar O, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation, 2014, 37(2): 374-380.
15.	Rahimi-Rad MH, Asgari B, Hosseinzadeh N, et al. Eosinopenia as a marker of outcome in acute exacerbations of chronic obstructive pulmonary disease. Maedica (Buchar), 2015, 10(1): 10-13.
16.	陸召輝, 楊剛, 金炬, 等. 慢性阻塞性肺疾病急性加重期嗜酸性粒細胞水平與預后關系的分析. 臨床肺科雜志, 2017, 22(3): 407-410.
17.	Zhang M, Li YL, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39(2): 625-631.
18.	Kitaguchi Y, Fujimoto K, Kubo K, et al. Characteristics of COPD phenotypes classified according to the findings of HRCT. Respir Med, 2006, 100(10): 1742-1752.
19.	Tomaro ML, Batlle AM. Bilirubin: its role in cytoprotection against oxidative stress. Int J Biochem Cell Biol, 2002, 34(3): 216-220.
20.	蔚京京, 趙卉, 李建強. 膽紅素在肺氣腫動物模型中發揮保護作用的機制研究. 中華結核和呼吸雜志, 2016, 39(8): 637-641.
21.	Hu GP, Wu YK, Zhou YM, et al. Cystatin C as a predictor of in-hospital mortality after exacerbation of COPD. Respir Care, 2016, 61(7): 950-957.
22.	Zhang Y, Zhu Y, Wu Y, et al. Serum cystatin C as a potential biomarker for the evaluation COPD. Int J Clin Exp Med, 2014, 7(12): 5484-5490.

1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2019 report [EB/OL]. [2018-12-02]. Available at: https://goldcopd.org/gold-reports/.
2. Magnoni MS, Rizzi A, Visconti A, et al. AIMAR survey on COPD phenotypes. Multidiscip Respir Med, 2014, 9(1): 16.
3. Gu SY, Deng XJ, Li QY, et al. Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT. Clin Respir J, 2017, 11(1): 28-35.
4. Bhaskar R, Singh S, Singh P. Characteristics of COPD phenotypes classified according to the findings of HRCT and spirometric indices and its correlation to clinical characteristics. Afr Health Sci, 2018, 18(1): 90-101.
5. Goddard PR, Nicholson EM, Laszlo G, et al. Computed tomography in pulmonary emphysema. Clin Radiol, 1982, 33(4): 379-387.
6. 韓曉彧. 慢性阻塞性肺疾病患者高分辨率 CT 分型與氣道炎癥之間的關系[D]. 遼寧: 大連醫科大學, 2018.
7. Tatsumi K, Kasahara Y, Kurosu K, et al. Clinical phenotypes of COPD: results of a Japanese epidemiological survey. Respirology, 2004, 9(3): 331-336.
8. Celli BR, Locantore N, Tal-Singer R, et al. Emphysema and extrapulmonary tissue loss in COPD: a multi-organ loss of tissue phenotype. Eur Respir J, 2018, 51(2): 1702146.
9. Rutten EP, Grydeland TB, Pillai SG, et al. Quantitative CT: associations between emphysema, airway wall thickness and body composition in COPD. Pulm Med, 2011, 2011: 419328.
10. Casanova C, de Torres JP, Aguirre-Jaíme A, et al. The progression of chronic obstructive pulmonary disease is heterogeneous: the experience of the BODE cohort. Am J Respir Crit Care Med, 2011, 184(9): 1015-1021.
11. Liang R, Zhang W, Song YM. Levels of leptin and IL-6 in lungs and blood are associated with the severity of chronic obstructive pulmonary disease in patients and rat models. Mol Med Rep, 2013, 7(5): 1470-1476.
12. 梁衛娟, 華鋒. CRP 和 TNF-α 在慢阻肺急性加重期病情嚴重程度判斷中的意義. 中國現代醫生, 2015, 53(9): 12-15.
13. Borsi H, Nia EP, Mal-Amir MD, et al. Relationship between serum procalcitonin level and chronic obstructive pulmonary disease. J Family Med Prim Care, 2019, 8(2): 738-740.
14. Günay E, Sar?n? Ula?l? S, Akar O, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation, 2014, 37(2): 374-380.
15. Rahimi-Rad MH, Asgari B, Hosseinzadeh N, et al. Eosinopenia as a marker of outcome in acute exacerbations of chronic obstructive pulmonary disease. Maedica (Buchar), 2015, 10(1): 10-13.
16. 陸召輝, 楊剛, 金炬, 等. 慢性阻塞性肺疾病急性加重期嗜酸性粒細胞水平與預后關系的分析. 臨床肺科雜志, 2017, 22(3): 407-410.
17. Zhang M, Li YL, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39(2): 625-631.
18. Kitaguchi Y, Fujimoto K, Kubo K, et al. Characteristics of COPD phenotypes classified according to the findings of HRCT. Respir Med, 2006, 100(10): 1742-1752.
19. Tomaro ML, Batlle AM. Bilirubin: its role in cytoprotection against oxidative stress. Int J Biochem Cell Biol, 2002, 34(3): 216-220.
20. 蔚京京, 趙卉, 李建強. 膽紅素在肺氣腫動物模型中發揮保護作用的機制研究. 中華結核和呼吸雜志, 2016, 39(8): 637-641.
21. Hu GP, Wu YK, Zhou YM, et al. Cystatin C as a predictor of in-hospital mortality after exacerbation of COPD. Respir Care, 2016, 61(7): 950-957.
22. Zhang Y, Zhu Y, Wu Y, et al. Serum cystatin C as a potential biomarker for the evaluation COPD. Int J Clin Exp Med, 2014, 7(12): 5484-5490.

Chinese Journal of Respiratory and Critical Care Medicine

The assessment of clinical characteristics between different LAA phenotype in patients with acute exacerbation in chronic obstructive pulmonary disease

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