STANDARD AND INTEGRAL HEMATOLOGICAL MARKERS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ASSOCIATED WITH OVERWEIGHT AND OBESITY

Abstract

The attention of the scientific community is devoted to the study of new markers of the disease course, among which the indices calculated according to the standard hemogram take the leading place, which makes their use in medical practice available. Since all blood cells play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD) and its complications, we decided to calculate separate hematological indices that take into account the content of various cellular elements and their ratio. The purpose of the research was to analyze hemogram and integral hematological indices in patients with exacerbation of COPD combined with overweight and obesity. 145 patients with exacerbation of COPD were examined (96 men and 49 women), median age – 51 years old. According to body mass indeх (BMI), we divided patients into 3 groups: with normal weight (n = 42; group 1), overweight (n = 41; group 2) and obesity (n = 62; group 3). In addition to standard and integral hematological indicators (the ratio of granulocytes and monocytes to lymphocytes (GM/Li), the ratio of leukocytes to ESR (L/ESR); the red cell index (RCI)) C-reactive protein (qualitative test) and the external respiration function (ERF) by computer spirometry were determined. The results were processed statistically, the level of significance is p < 0.05. It was established that the number of red blood cells (5.6 vs. 5.3 х 1012/l; p = 0.005) and the red cell distribution width (RDW) (14.8 vs. 14.4%; p = 0.02) were significantly higher in patients with COPD and obesity, but the mean corpuscular hemoglobin (MCH; 34.0 vs. 34.4 pg; p = 0.03) and the mean corpuscular volume (MCV; 81.5 vs. 84.4 fl; p = 0.001) were significantly lower than in patients with normal body weight. Under conditions of obesity, the number of white blood cells at the expense of granulocytes was significantly higher than under conditions of normal body weight (8.6 vs. 7.9 x 109/l; 6.1 vs. 5.2 x 109/l; both p < 0.05), and growth of RDW was associated with the severity of COPD (τ = 0.2; p = 0.03). The ratios of GM/Li and L/ESR significantly increased under conditions of obesity (3.9 vs 2.5 a.u. under conditions of normal body weight; 1.0 vs 0.7 a.u.; all p < 0.05), which correlated with a decrease in forced expiratory volume in 1st second (FEV1), vital capacity of the lungs (VC) (according to GM/Li; τ1,2 = –0.1; р1 = 0.004; р2 = 0.02), forced VC (FVC) (according to GM/Li and L/ESR: τ1,2 = –0.1; р1.2 < 0.005) and peak expiratory flow (PEF) (according to L/ESR: τ = –0.1; р = 0.02), more pronounced bronchial inflammation with an increase in the content of leukocytes, bronchial epithelium and alveolar macrophages in sputum (according to GM/Li: τ1.,3 = 0.3; p1,3 < 0.0001; τ2 = 0.2; p2 = 0.0001; according to L/ESR: τ1,2,3 = 0.2; р1 = 0.001; р2 = 0.002; р3 = 0.0003) and severe respiratory failure (RF) (according to GM/Li: τ = 0.2; р = 0.005). An increase in RCI in obese patients is associated with smoking, the presence of pulmonary emphysema, an increase in the severity of bronchial obstruction (τ1,2,3 = 0.3; р1 = 0.01; р2 = 0.003; р3 = 0.02) and the fasting glucose level (τ = 0.2; p = 0.04). So, GM/Li and L/ESR ratios significantly increase under conditions of obesity, which is accompanied by deterioration of ERF indicators, a more pronounced bronchial inflammation and RF. An increase in RCI in obese patients is associated with smoking, the development of pulmonary emphysema, an increase in the severity of bronchial obstruction and a violation of carbohydrate metabolism.