慢性阻塞性肺疾病患者、哮喘-慢性阻塞性肺疾病重叠综合征患者和气流受限的哮喘患者之间肺功能的比较
2016/07/27
摘要
背景：开展这项研究是为了探讨慢性阻塞性肺疾病（COPD）患者、哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）患者和气流受限的哮喘（哮喘FL（+））患者之间呼吸生理的差异。
方法：对所有具有因COPD, ACOS 或者哮喘所引起的持续气流受限的稳定期患者的一系列医疗记录进行回顾性分析，并将他们分成COPD组（n = 118），ACOS组（n = 32），和哮喘FL（+）组（n = 27）。所有患者均进行胸部高分辨CT（HRCT）和肺功能测试包括呼吸阻抗。
结果：胸部HRCT的低衰减区评分在COPD组中显著高于ACOS组（9.52±0.76 vs 5.09±1.16，P＜0.01）。胸部HRCT显示的支气管壁增厚的患病率在哮喘FL（+）组明显高于COPD组（55.6% vs 25%，P＜0.01）。肺功能方面，1秒钟用力呼气容积（FEV1）和最大呼气流速在哮喘FL（+）组明显高于ACOS组（分别为：占预计值76.28% ±2.54%vs 占预计值63.43%±3.22%，P＜0.05和占预计值74.40%±3.16%vs 占预计值61.08%±3.54%，P＜0.05）。虽然在哮喘FL（+）组残气量显著降低于COPD组（占预计值112.05%±4.34%vs 占预计值137.38%±3.43%，P＜0.01）和ACOS组（占预计值112.05%±4.34%vs占预计值148.46 %±6.25%，P＜0.01），但功能残气量或肺总量无显著差异。对短效β2-受体激动剂的FEV1反应性增加在ACOS组显著高于COPD组（229±29毫升vs 72±10毫升，P＜0.01）和哮喘FL（+）组（22 9±29毫升vs 153±21毫升，P＜0.05）。对于呼吸阻抗，脉冲频率为5 Hz和20 Hz时的呼吸阻抗（呼吸阻力振荡参数），在整个呼吸相（分别为：4.29±0.30 cmH2O/L/s vs 3.41±0.14 cmH2O/L/s, P<0.01 and 3.50±0.24 cmH2O/L/s vs 2.68±0.10 cmH2O/L/s, P<0.01, respectively）、呼气相和吸气相上，哮喘FL（+）组均显着高于COPD组。
结论：虽然持续气流受限在COPD患者、ACOS患者和气流受限哮喘患者中均有发生，但是他们可能有显著不同的呼吸生理学特征，对支气管扩张剂的反应性也不同。
（苏欣 审校）
Int J Chron Obstruct Pulmon Dis. 2016 May 9;11:991-7. doi: 10.2147/COPD.S105988. eCollection 2016.
Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation.
Kitaguchi Y1, Yasuo M1, Hanaoka M1.
Author information
Abstract
BACKGROUND:This study was conducted in order to investigate the differences in the respiratory physiology of patients with chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome (ACOS), and asthma with airflow limitation (asthma FL(+)).
METHODS:The medical records for a series of all stable patients with persistent airflow limitation due to COPD, ACOS, or asthma were retrospectively reviewed and divided into the COPD group (n=118), the ACOS group (n=32), and the asthma FL(+) group (n=27). All the patients underwent chest high-resolution computed tomography (HRCT) and pulmonary function tests, including respiratory impedance.
RESULTS:The low attenuation area score on chest HRCT was significantly higher in the COPD group than in the ACOS group (9.52±0.76 vs 5.09±1.16, P<0.01). The prevalence of bronchial wall thickening on chest HRCT was significantly higher in the asthma FL(+) group than in the COPD group (55.6% vs 25.0%, P<0.01). In pulmonary function, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate were significantly higher in the asthma FL(+) group than in the ACOS group (76.28%±2.54% predicted vs 63.43%±3.22% predicted, P<0.05 and 74.40%±3.16% predicted vs 61.08%±3.54% predicted, P<0.05, respectively). Although residual volume was significantly lower in the asthma FL(+) group than in the COPD group (112.05%±4.34% predicted vs 137.38%±3.43% predicted, P<0.01) and the ACOS group (112.05%±4.34% predicted vs148.46%±6.25% predicted, P<0.01), there were no significant differences in functional residual capacity or total lung capacity. The increase in FEV1 in response to short-acting β2-agonists was significantly greater in the ACOS group than in the COPD group (229±29 mL vs 72±10 mL, P<0.01) and the asthma FL(+) group (229±29 mL vs 153±21 mL, P<0.05). Regarding respiratory impedance, resistance at 5 Hz and resistance at 20 Hz, which are oscillatory parameters of respiratory resistance, were significantly higher in the asthma FL(+) group than in the COPD group at the whole-breath (4.29±0.30 cmH2O/L/s vs 3.41±0.14 cmH2O/L/s, P<0.01 and 3.50±0.24 cmH2O/L/s vs 2.68±0.10 cmH2O/L/s, P<0.01, respectively), expiratory, and inspiratory phases.
CONCLUSION:Although persistent airflow limitation occurs in patients with COPD, ACOS, and asthma FL(+), they may have distinct characteristics of the respiratory physiology and different responsiveness to bronchodilators.
KEYWORDS:ACOS; FOT; MostGraph; respiratory impedance
Int J Chron Obstruct Pulmon Dis. 2016 May 9;11:991-7. doi: 10.2147/COPD.S105988. eCollection 2016.
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尿中金属浓度与成人哮喘的相关性研究——中国武汉市的病例对照研究
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