肺泡膜弥散和肺毛细血管血量特征在不同级别慢性阻塞性肺病患者的表现  

Pulmonary membrane diffusing capacity and pulmonary capillary blood volume in patients with chronic obstructive pulmonary disease at different stages

作　　者：梁斌苗[1] 袁玉如[1] 何太灵[1] 曾继军[1] 杜晶[1] 

机构地区：[1]四川大学华西医院呼吸科,四川省成都市610041

出　　处：《中国组织工程研究与临床康复》2007年第47期9479-9482,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:了解不同级别慢性阻塞性肺病患者肺泡毛细血管膜弥散量和肺泡毛细血管血量的特点。方法:收集2006-07/2007-03就诊于四川大学华西医院呼吸科的慢性阻塞性肺病患者154例,依据慢性阻塞性肺病方案分级,0级64例,Ⅰ级38例,Ⅱ级26例,Ⅲ和Ⅳ级共26例。行肺通气功能、肺容量、一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量测定。结果:154例患者均进入结果分析。①0级与I级慢性阻塞性肺病患者,无论一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量都正常。随着慢性阻塞性肺病程度加重,一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量均有不同程度降低。Ⅱ级慢性阻塞性肺病时一氧化碳弥散量和肺泡毛细血管膜弥散量下降明显,肺泡毛细血管血量改变不明显。其中肺泡毛细血管膜弥散量出现异常明显早于一氧化碳弥散量和肺泡毛细血管血量,而且较严重。Ⅲ和Ⅳ级慢性阻塞性肺病的肺泡毛细血管血量下降明显。②一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量与慢性阻塞性肺病级别、残气量/肺总量成负相关,与第1秒用力呼气容积/用力肺活量和第1秒用力呼气容积占预计值百分比成正相关,而且,肺泡毛细血管膜弥散量与各指标的相关性最好。结论:随着慢性阻塞性肺病程度的加重,一氧化碳弥散量、肺泡毛细血管膜弥散量和肺泡毛细血管血量均有下降。肺泡毛细血管膜弥散量的异常比一氧化碳弥散量和肺泡毛细血管血量较早出现而且较严重。肺泡毛细血管膜弥散量的测定可以监测疾病发展并早期发现慢性阻塞性肺病气体交换的异常。AIM： To assess pulmonary membrane diffusing capacity （Dm） and pulmonary capillary blood volume （Vc） in patients with chronic obstructive pulmonary disease （COPD） at different stages. METHODS： From July 2006 to March 2007, 154 COPD patients were recruited from Department of Respiratory Medicine in West China Hospital of Sichuan University, and were classified into 4 groups according to COPD degree： Stage 0, Ⅰ , Ⅱ, Ⅲ and Ⅳ, with 64, 38, 26, 26 patients respectively. Spirometry, lung capacity, diffusing capacity of carbon monoxide （DLCO）, Dm and Vc were measured. RESULTS： All of 154 patients were involved in the result ananlysis.①DLCO, Dm and Vc were normal in patients of stage 0 and stage Ⅰ, and all declined with the severity of COPD. In stage Ⅱ, DLCO and Dm reduced significantly, but Vc reduced insignificantly. In contrast to DLCO and Vc, the abnormity of Dm occurred more early and severely.②DLCO, Dm and Vc were negatively correlative with stages of COPD and ratio of residual volume to total lung capacity, positively correlative with forced expiratory volume in one second （FEV1）/forced vital capacity and FEV1%. The correlation between Dm and each measurement was the best. CONCLUSION： The severer degree of COPD indicates the decrease of DLCO, Dm and Vc. Compared with DLCO and Vc, the abnormity of Dm occurs more early and severely. The measurement of Dm may monitor the development of the disorder and detect the abnormity of gas exchange in patients with COPD early.

关 键 词：慢性阻塞性肺病 肺泡毛细血管膜弥散量 肺泡毛细血管血量 

分 类 号：R563[医药卫生—呼吸系统]