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| The effect of body mass index on the treatment response and airway mucus hypersecretion in patients with acute exacerbation of chronic obstructive pulmonary disease |
| Nie Xiao-hong, Xiong Shu-guang, Wang Xiao-hong, Luo Li, Yao Meng-die |
| The Second Affiliated Hospital of Chengdu Medical College, Chengdu 610051, China |
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Abstract Objective To investigate the difference in the treatment response and airway mucus hypersecretion before and after treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with different body mass index (BMI). Methods The 132 cases of AECOPD patients with previous pulmonary function GOLD grade Ⅲ-Ⅳ were grouped according to BMI: BMI≤18.5 kg/m2 as A group (36 cases), BMI 18.5-23.9 kg/m2 as B group (60 cases), BMI was≥24.0 kg/m2 as C group (36 cases). All patients were treated with prednisone acetate tablets 30 mg QD for 7 consecutive days on the basis of routine treatment. Chronic obstructive pulmonary assessment test(CAT) score was recorded; sputum mucin MUC5ac and neutrophil elastase (NE) content were detected by enzyme linked immune-sorbent assay on the 1st day and 8th day after admission. 6 minute walk distance (6MWT), pulmonary ventilation function and airway resistance were measured on the 8th day after treatment. Results After treatment, the CAT scores, MUC5ac and NE were significantly better than those at admission (P＜0.01 or P＜0.05). The CAT score［(16.36±1.84) score］in group A was the highest, MUC5ac［(1.33±0.22) μg/mL］ and NE［(4.80±0.67) μg/mL］ were lowest compared with group C and group B (P＜0.01 or P＜0.05). The CAT score ［(14.86±2.14) score］, MUC5ac［(1.47±0.13) μg/mL］ and NE ［(5.67±0.58) μg/mL］ in the C group were higher than those in the B group［(13.62±1.75) score, (1.39±0.15) μg/mL and (5.32±0.72) μg/mL, respectively］(P＜0.05). The change difference of CAT score, MUC5ac and NE ［(6.72±1.42) score, (0.25±0.11) μg/mL and (1.26±0.53) μg/mL, respectively］ in group A before and after treatment were the smallest (P＜0.01 or P＜0.05). The change difference of CAT score in group B and MUC5ac and NE in group C ［(7.25±0.95) score, (0.41±0.15) μg/mL and (2.07±0.52) μg/mL, respectively］ was the largest (P＜0.01 or P＜0.05). The 6MWT of group B ［(408.83±20.98)m］ and group C［(412.69±18.60)m］ was higher than that of group A ［(376.19±17.54)m］ (P＜0.05 and P＜0.01). The first second forced breathing volume (FEV1) was increased, while the residual volume/total lung capacity (RV/TLC) was decreased with the increase of BMI in the three groups (P＜0.01 or P＜0.05). The percent of first second forced expiratory volume compared its predicted value (FEV1%pred) in group A was lower than that in group C, and the first second forced expiratory volume/forced vital capacity (FEV1/FVC) in group A was lower than those of group B and group C (P＜0.01 or P＜0.05). BMI was positively correlated with the MUC5ac at admission, NE before and after treatment, FEV1pre% and FEV1/FVC (r=0.346, 0.361, 0.412, 0.214, 0.190, respectively; P＜0.01 or P＜0.05), and negatively correlated with RV/TLC (r=-0.405, P＜0.01). Conclusion The difference of BMI has influence on the treatment reaction and airway mucus hypersecretion of patients with AECOPD: the response to treatment in patients with low BMI chronic obstructive pulmonary disease is worse relatively at acute stage, and airway mucus hypersecretion is the most significant in the high BMI group of patients with AECOPD. There are positive correlations between BMI and MUC5ac, NE, FEV1%pre and FEV1/FVC, and negative correlation with RV/TLC.
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| About author:: Nie Xiao-hong, E-mail： xhnie1226@sina.com |
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