支气管哮喘-慢性阻塞性肺疾病重叠、哮喘、慢性阻塞性肺疾病临床特征的对比研究
|
摘要
目的对比支气管哮喘-慢性阻塞性肺疾病重叠(ACO)、哮喘、慢性阻塞性肺疾病(慢阻肺)的临床特征。方法收集2014年1月-2017年5月青岛市城阳区人民医院收治的符合GINA2014诊断标准的32例ACO患者及同期住院治疗的30例哮喘、32例慢阻肺患者的临床资料。从肺功能指标、临床评分量表、实验室检查指标三个方面对比ACO、哮喘、慢阻肺临床特征的差异。结果 (1)ACO的呼吸系统伴发疾病以肺气肿最常见,共27例(79.4%),其次分别为过敏性鼻炎13例(38.2%)、哮喘家族史11例(32.3%)、支气管扩张4例(11.8%)、睡眠呼吸暂停综合征2例(5.9%)。呼吸系统外伴发疾病以过敏性结膜炎最常见,共13例(38.2%),其次为胃食管反流病9例(26.4%)。症状以咳嗽最常见,共31例(91.2%),其次分别为喘息28例(82.4%)、咳痰25例(73.5%)、胸闷20例(58.8%)、呼吸困难14例(41.2%)。约19例患者(55.9%)听诊可闻及双肺哮鸣音。(2)ACO、哮喘、慢阻肺患者肺功能各项指标,差异均具有统计学意义(均P<0.05)。ACO组的FEV_1%、FEV_1%/FVC、FEF50%、FEF75%、PaO_2均明显低于哮喘组(P<0.05),但与慢阻肺组相比,差异均无统计学意义(P>0.05)。ACO组DLco%明显低于哮喘组,但显著高于慢阻肺组(均P<0.05)。ACO组RV/TLC、PaCO_2均高于哮喘组(P<0.05),但与慢阻肺组差异无统计学意义(P>0.05)。ACO组34例(100%)存在小气道功能障碍,明显高于哮喘组23例(76.7%),但与慢阻肺组29例(90.6%)差异无统计学意义(P>0.05)。(3)ACO组的ACT评分与哮喘组相比,差异无统计学意义(P>0.05)。ACO组的CAT评分、mMRC评分与慢阻肺组相比,差异无统计学意义(P>0.05)。COS、哮喘、慢阻肺患者的HAD评分之间差异无统计学意义(P>0.05)。哮喘组1年内急性发作次数最少,ACO组发作次数最多。(4)COS组的FeNO、嗜酸性粒细胞比例升高者比例明显低于哮喘组(P<0.05),但与慢阻肺组无明显差异(P>0.05)。ACO组总IgE升高患者、过敏原阳性患者显著多于慢阻肺组(P<0.05),但与哮喘组相比无明显差异(P>0.05)。结论 ACO虽然同时具有哮喘、慢阻肺相关的临床表现,但在许多方面有着其独特的临床特征。
Objective To compare the clinical characteristics of ACO,asthma and COPD. Methods The clinical data of 32 patients with ACO,30 patients with asthma and 32 patients with COPD were collected from January 2014 to May 2017 in our hospital. The differences of clinical features of ACO,asthma and COPD were compared from three aspects of pulmonary function indexes,clinical scoring scale and laboratory examination indexes. Results (1)Emphysema was the most common complication of respiratory diseases in ACO patients( 79. 4%),followed by 13 cases of allergic rhinitis( 38. 2%) and 11 cases of family history of asthma( 32. 3%),4 cases of bronchiectasis( 11. 8%),and 2 cases of sleep apnea syndrome( 5. 9%). Allergic conjunctivitis was the most common complication of out-respiratory diseases,including 13 cases( 38. 2%),followed by 9 cases of gastroesophageal reflux disease( 26. 4%). Cough was the most common symptom in 31 cases( 91. 2%),followed by wheezing in 28 cases( 82. 4%),expectoration in 25 cases( 73. 5%),chest tightness in 20 cases( 58. 8%),and dyspnea in 14 cases( 41. 2%). About 19 patients( 55. 9%) received auscultation,audible and double lung wheezing sounds.( 2) The indexes of lung function in ACO,asthma and COPD patients were statistically significant( P < 0. 05). The FEV_1%,FEV_1%/FVC,FEF50%,FEF75% and PaO_2 in the ACO group were significantly lower than those in the asthma group( P < 0. 05),but there was no significant difference between the asthma group and the COPD group( P >0. 05). The DLco% in the ACO group was significantly lower than that in the asthma group,but significantly higher than that in COPD group( P < 0. 05). RV/TLC and PaCO_2 in the ACO group were higher than those in the asthma group( P < 0. 05),but there was no significant difference between the COPD group and the ACO group( P > 0. 05).In the ACO group,34 cases( 100%) had small airway dysfunction,which was significantly higher than that in the asthma group( 76. 7%),but there was no significant difference between the COPD group and the ACO group 29( 90. 6%)( P > 0. 05).( 3) The ACT score of the ACO group was not significantly different with the asthma group( P > 0. 05). The CAT score and m MRC score of the ACO group were not significantly different with the COPD group( P > 0. 05). There was no statistically significant difference in HAD scores among COS,asthma,and COPD patients( P > 0. 05). The asthma group had the least number of attacks in 1 year,and the ACO group had the most frequent attacks.( 4) The proportion of Fe NO and eosinophils in the COS group was significantly lower than that in the asthma group( P < 0. 05),but there was no significant difference between the asthma group and the COPD group( P >0. 05). In the ACO group,the total Ig E increased and the patients with allergen positive were significantly more than those in the COPD group( P < 0. 05),but there was no significant difference with the asthma group( P > 0. 05).Conclusion Although ACO has asthma and COPD related clinical manifestations,it has its unique clinical features in many aspects,such as lung function.
Objective To compare the clinical characteristics of ACO,asthma and COPD. Methods The clinical data of 32 patients with ACO,30 patients with asthma and 32 patients with COPD were collected from January 2014 to May 2017 in our hospital. The differences of clinical features of ACO,asthma and COPD were compared from three aspects of pulmonary function indexes,clinical scoring scale and laboratory examination indexes. Results (1)Emphysema was the most common complication of respiratory diseases in ACO patients( 79. 4%),followed by 13 cases of allergic rhinitis( 38. 2%) and 11 cases of family history of asthma( 32. 3%),4 cases of bronchiectasis( 11. 8%),and 2 cases of sleep apnea syndrome( 5. 9%). Allergic conjunctivitis was the most common complication of out-respiratory diseases,including 13 cases( 38. 2%),followed by 9 cases of gastroesophageal reflux disease( 26. 4%). Cough was the most common symptom in 31 cases( 91. 2%),followed by wheezing in 28 cases( 82. 4%),expectoration in 25 cases( 73. 5%),chest tightness in 20 cases( 58. 8%),and dyspnea in 14 cases( 41. 2%). About 19 patients( 55. 9%) received auscultation,audible and double lung wheezing sounds.( 2) The indexes of lung function in ACO,asthma and COPD patients were statistically significant( P < 0. 05). The FEV_1%,FEV_1%/FVC,FEF50%,FEF75% and PaO_2 in the ACO group were significantly lower than those in the asthma group( P < 0. 05),but there was no significant difference between the asthma group and the COPD group( P >0. 05). The DLco% in the ACO group was significantly lower than that in the asthma group,but significantly higher than that in COPD group( P < 0. 05). RV/TLC and PaCO_2 in the ACO group were higher than those in the asthma group( P < 0. 05),but there was no significant difference between the COPD group and the ACO group( P > 0. 05).In the ACO group,34 cases( 100%) had small airway dysfunction,which was significantly higher than that in the asthma group( 76. 7%),but there was no significant difference between the COPD group and the ACO group 29( 90. 6%)( P > 0. 05).( 3) The ACT score of the ACO group was not significantly different with the asthma group( P > 0. 05). The CAT score and m MRC score of the ACO group were not significantly different with the COPD group( P > 0. 05). There was no statistically significant difference in HAD scores among COS,asthma,and COPD patients( P > 0. 05). The asthma group had the least number of attacks in 1 year,and the ACO group had the most frequent attacks.( 4) The proportion of Fe NO and eosinophils in the COS group was significantly lower than that in the asthma group( P < 0. 05),but there was no significant difference between the asthma group and the COPD group( P >0. 05). In the ACO group,the total Ig E increased and the patients with allergen positive were significantly more than those in the COPD group( P < 0. 05),but there was no significant difference with the asthma group( P > 0. 05).Conclusion Although ACO has asthma and COPD related clinical manifestations,it has its unique clinical features in many aspects,such as lung function.
引文
[1]Bonten TN,Kasteleyn MJ,de Mutsert R,et al.Defining asthmaCOPD overlap syndrome:a population-based study[J].Eur Respir J,2017,49(5):OA2005.
[2]Motamedi-Fakhr S,Wilson RC,Iles R.Tidal breathing patterns derived from structured light plethysmography in COPD patients compared with healthy subjects[J].Med Devices(Auckl),2017,10:1-9.
[3]Boulet LP,Phillips R,O'Byrne P,et al.Evaluation of asthma control by physicians and patients:comparison with current guidelines[J].Can Respir J,2016,9(6):417-423.
[4]Sin DD,Miravitlles M,Mannino DM,et al.What is asthma-COPD overlap syndrome?Towards a consensus definition from a round table discussion[J].Eur Respir J,2016,48(3):664-673.
[5]Gowda I,Genes N,Tignor N,et al.176 The Asthma Mobile Health Study:Wildfires and Asthma Exacerbations,Just Blowing Smoke or is There a Correlation[J].Ann Emerg Med,2016,68(4):S69-S70.
[6]Plaza V,lvarez F,Calle M,et al.Consensus on the Asthma-COPD Overlap Syndrome(ACOS)Between the Spanish COPD Guidelines(Ges EPOC)and the Spanish Guidelines on the Management of Asthma(GEMA)[J].Arch Bronconeumol,2017,53(8):443-449.
[7]Kiljander T,Helin T,Venho K,et al.Prevalence of asthma-COPD overlap syndrome among primary care asthmatics with a smoking history:a cross-sectional study[J].NPJ Prim Care Respir Med,2015,25:15047.
[8]Gelb AF,Yamamoto A,Verbeken EK,et al.Unraveling the Pathophysiology of the Asthma-COPD Overlap Syndrome:Unsuspected Mild Centrilobular Emphysema Is Responsible for Loss of Lung Elastic Recoil in Never Smokers With Asthma With Persistent Expiratory Airflow Limitation[J].Chest,2015,148(2):313-320.
[9]Yalcin AD,Celik B,Yalcin AN.Omalizumab(anti-Ig E)therapy in the asthma-COPD overlap syndrome(ACOS)and its effects on circulating cytokine levels[J].Immunopharmacol Immunotoxicol,2016,38(3):253-256.
[10]Balázs O,István I,Vivien S,et al.Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients[J].Int J Chron Obstruct Pulmon Dis,2015,10(1):2017-2025.
[11]Kitaguchi Y,Yasuo M,Hanaoka M.Comparison of pulmonary function in patients with COPD,asthma-COPD overlap syndrome,and asthma with airflow limitation[J].Int J Chron Obstruct Pulmon Dis,2016,11(1):991-997.
[12]Karampitsakos T,Gourgoulianis KI.Asthma-COPD Overlap Syndrome(ACOS):Single disease entity or not Could exhaled nitric oxide be a useful biomarker for the differentiation of ACOS,asthma and COPD[J].Med Hypotheses,2016,91:20-23.
[2]Motamedi-Fakhr S,Wilson RC,Iles R.Tidal breathing patterns derived from structured light plethysmography in COPD patients compared with healthy subjects[J].Med Devices(Auckl),2017,10:1-9.
[3]Boulet LP,Phillips R,O'Byrne P,et al.Evaluation of asthma control by physicians and patients:comparison with current guidelines[J].Can Respir J,2016,9(6):417-423.
[4]Sin DD,Miravitlles M,Mannino DM,et al.What is asthma-COPD overlap syndrome?Towards a consensus definition from a round table discussion[J].Eur Respir J,2016,48(3):664-673.
[5]Gowda I,Genes N,Tignor N,et al.176 The Asthma Mobile Health Study:Wildfires and Asthma Exacerbations,Just Blowing Smoke or is There a Correlation[J].Ann Emerg Med,2016,68(4):S69-S70.
[6]Plaza V,lvarez F,Calle M,et al.Consensus on the Asthma-COPD Overlap Syndrome(ACOS)Between the Spanish COPD Guidelines(Ges EPOC)and the Spanish Guidelines on the Management of Asthma(GEMA)[J].Arch Bronconeumol,2017,53(8):443-449.
[7]Kiljander T,Helin T,Venho K,et al.Prevalence of asthma-COPD overlap syndrome among primary care asthmatics with a smoking history:a cross-sectional study[J].NPJ Prim Care Respir Med,2015,25:15047.
[8]Gelb AF,Yamamoto A,Verbeken EK,et al.Unraveling the Pathophysiology of the Asthma-COPD Overlap Syndrome:Unsuspected Mild Centrilobular Emphysema Is Responsible for Loss of Lung Elastic Recoil in Never Smokers With Asthma With Persistent Expiratory Airflow Limitation[J].Chest,2015,148(2):313-320.
[9]Yalcin AD,Celik B,Yalcin AN.Omalizumab(anti-Ig E)therapy in the asthma-COPD overlap syndrome(ACOS)and its effects on circulating cytokine levels[J].Immunopharmacol Immunotoxicol,2016,38(3):253-256.
[10]Balázs O,István I,Vivien S,et al.Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients[J].Int J Chron Obstruct Pulmon Dis,2015,10(1):2017-2025.
[11]Kitaguchi Y,Yasuo M,Hanaoka M.Comparison of pulmonary function in patients with COPD,asthma-COPD overlap syndrome,and asthma with airflow limitation[J].Int J Chron Obstruct Pulmon Dis,2016,11(1):991-997.
[12]Karampitsakos T,Gourgoulianis KI.Asthma-COPD Overlap Syndrome(ACOS):Single disease entity or not Could exhaled nitric oxide be a useful biomarker for the differentiation of ACOS,asthma and COPD[J].Med Hypotheses,2016,91:20-23.