КЛИНИКО-ЛАБОРАТОРНЫЕ ОСОБЕННОСТИ ФЕНОТИПОВ БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЁГКИХ ПРОФЕССИОНАЛЬНОЙ ЭТИОЛОГИИ

Abstract

Introduction. The pathogenetic differences between the phenotypes of occupational chronic obstructive pulmonary disease which develop after silica-containing dust exposure are still unclear. The research aims to study the relationship of occupational chronic obstructive pulmonary disease clinical phenotypes with inflammation. Material and methods. 123 patients were included in the study. Basing on the forced expiratory volume in 1 second, clinical symptoms and the history of exacerbations, the patients were divided into 4 groups (group 1 - 30 people (24%) phenotype «B1», group 2 - 16 people phenotype «B2» (13%), group 3 - 32 people (26%) phenotype «D», group 4 - 45 people (36%) phenotype «A»). The groups of patients were comparable in age, body mass index, duration of working period in hazardous conditions, the number of cardiovascular comorbidities (p>0.05), but differed in spirometry, the number of exacerbations and the number of eosinophils in the blood (p = 0.02, p = 0.0001 and p=0.006) and therapy. Results and discussion. The concentration of hyaluronic acid in the blood serum was increased in all groups of the patients, but most of all in the «D» phenotype, 204.5 ng/ml, p=0.0024. Immunoglobulin A was above the normal level in the patients with phenotypes «B2» and «D»6,32 and 9.84 mg/l, p=0.0059. Endothelial synthase in phenotypes «B2» and «D» was more than 2 times higher than in other groups (57.9 and 64.5 pg/ml, р=0.013). The groups did not differ in terms of endothelin-1. Correlation analysis revealed statistically significant (p<0.05) correlations between exacerbations, eosinophils, comorbidities, forced expiratory volume in 1 second. Immunoglobulin A had a direct relationship with endothelial synthase and an inverse relationship with forced expiratory volume in 1 second. Hyaluronic acid directly correlated with the number of exacerbations and eosinophils and inversely with forced expiratory volume in 1 second. Endothelial synthase had a direct relationship with eosinophils and cardiovascular comorbidities and an inverse relationship with forced expiratory volume in 1 second. Conclusion. The concentration of hyaluronic acid, immunoglobulin A and endothelial synthase in the blood serum reflects the activity of remodelling bronchi, the risk of exacerbations and connections to cardiovascular comorbidities.