气流受限不完全可逆的慢性阻塞性肺疾病患者容量和流速变化与肺通气功能障碍严重程度分级的关系
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摘要
目的探讨气流受限不完全可逆的慢性阻塞性肺疾病(COPD)在支气管舒张试验前后容量和流速变化与肺通气功能障碍严重程度的关系,并对COPD肺通气功能障碍严重程度分级的依据进行初步探索。方法收集2012年1月至2015年6月在中国医科大学附属盛京医院肺功能室登记的COPD患者447例,其中男254例,女193例,平均年龄(65±12)岁。气流受限不完全可逆定义为支气管舒张试验前后FEV1差值<200 m L或FEV1改善率<12%,尽量排除气道高反应性对本研究的影响。结果随着COPD肺通气功能障碍严重程度的增加,FEV1改变值逐渐变小,FVC改变率越来越大,FEV1改变率和FVC改变值没有呈现出具有统计学意义的规律变化。结论气流受限不完全可逆患者肺通气功能障碍严重程度越高,气流受限越来越不可逆;FEV1改变值可以作为评估COPD患者肺通气功能障碍严重程度分级是否合理的依据,分为3组可能是合理的。
Objective To evaluate the difference of FEV1 response and forced vital capacity(FVC)response to bronchodilators in patients with COPD and explore the basis of classification of severity of airflow limitation in COPD. Methods A total of 447 patients with COPD(male 254,female 193),aged 65±12 years were admitted in Shengjing Hospital from Jan 2012 to Jun 2015 were enrolled for the study. We chose the patients with negative response to the bronchodilator in order to minimize the effect of bronchial hyperresponsiveness. Results The absolute change of FEV1 decreased as a function of the severity of COPD. In contrast,the percent change of FVC was increased in those with more severe disease,but the percent change of FEV1 and the absolute change of FVC had no statistical difference with the severity of COPD pulmonary function. Conclusion The absolute change of FEV1 decreased as a function of the severity of COPD,this reflects airflow limitation become more and more irreversible. The absolute change of FEV1 could be used as a basis of classification of severity of airflow limitation in COPD.
Objective To evaluate the difference of FEV1 response and forced vital capacity(FVC)response to bronchodilators in patients with COPD and explore the basis of classification of severity of airflow limitation in COPD. Methods A total of 447 patients with COPD(male 254,female 193),aged 65±12 years were admitted in Shengjing Hospital from Jan 2012 to Jun 2015 were enrolled for the study. We chose the patients with negative response to the bronchodilator in order to minimize the effect of bronchial hyperresponsiveness. Results The absolute change of FEV1 decreased as a function of the severity of COPD. In contrast,the percent change of FVC was increased in those with more severe disease,but the percent change of FEV1 and the absolute change of FVC had no statistical difference with the severity of COPD pulmonary function. Conclusion The absolute change of FEV1 decreased as a function of the severity of COPD,this reflects airflow limitation become more and more irreversible. The absolute change of FEV1 could be used as a basis of classification of severity of airflow limitation in COPD.
引文
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[2]王远征.不同级别慢性阻塞性肺疾病患者对支气管舒张剂的反应[J].江苏大学学报,2014,24(2):157-159.DOI:10.13312/j.issn.1671-7783.y130217.
[3]江汉,张巧,林科雄,等.不同严重程度COPD患者吸人支气管舒张剂后的流速和容积反应[J].中国呼吸与危重监护杂志,2009,8(2):110-113.
[4]Global strategy for the diagnosis,management and prevention of COPD[J],global initiative for chronic obstructive lung disease(GOLD)2015,14.Available from:http://www.goldcopd.org/.
[5]中华医学会呼吸病学分会肺功能专业组.肺功能检查指南(第四部分)—支气管舒张试验[J].中华结核和呼吸杂志,2014,37(9):655-658.DOI:10.3760/cma.j.issn.1001-0939.2014.09.007.
[6]郑劲平,陈荣昌,钟南山.肺功能学—基础与临床[M].广州:广东科学技术出版社,2007:116-122.
[7]SHIMIZU K,HASEGAWA M,MAKITA H,et al.Comparison of airway remodelling assessed by computed tomography in asthma and COPD[J].Respir Med,201l,105(9):1275-1283.DOI:10.1016/j.rmed.2011.04.007.
[8]PELLEGRINO R,VIEGI G et al.Interpretative strategies for lung function tests[J].Eur Respir J,2005,26(5):948-968.DOI:10.1183/09031936.05.00035205.
[9]崔佳,许小毛,孙铁英.肺通气功能障碍指标研究进展[J],中华结核和呼吸杂志,2014,37(9):703-705.DOI:10.3760/cma.j.issn.1001-0939.
[10]郑劲平.肺通气功能障碍严重程度的分级[J].中华结核和呼吸杂志,2009,32(4):317-318.DOI:10.3760/cma j.issn.1001-0939.
[11]MIRAVITLLES M,ANDREU I,ROMERO Y,et al.Difficulties in differential diagnosis of COPD and asthma in primary care[J].Brit J Gen Pract,2012,62(595):e68-75.DOI:10.3399/bjgp12X625111.