慢性阻塞性肺疾病-哮喘重叠综合征慢性阻塞性肺疾病和支气管哮喘临床特征差异研究  

Differences in clinical features among asthma overlap COPD syndrome,COPD and asthma

作　　者：程璘令[1] 刘雅雅[2] 苏柱泉[1] 刘君[1] 陈荣昌[1] 

机构地区：[1]呼吸疾病国家重点实验室广州医科大学第一附属医院,广州510120 [2]广东食品药品职业学院,广州510520

出　　处：《中国实用内科杂志》2015年第2期143-145,共3页Chinese Journal of Practical Internal Medicine

基　　金：广东省自然基金资助项目(s2013010016665)

摘　　要：目的探讨慢性阻塞性肺疾病-哮喘重叠综合征(ACOS)、慢性阻塞性肺疾病(慢阻肺)和支气管哮喘(哮喘)临床特征的差异。方法收集2011年3月至2014年4月广州医科大学第一附属医院收治的47例ACOS、59例慢阻肺及53例哮喘患者的一般情况、肺功能检查结果、诱导痰细胞嗜酸粒细胞(EOS)百分比、呼出气一氧化氮(FENO)水平、圣乔治呼吸问卷(SGRQ)评定和2年内急性加重和住院次数。结果 ACOS组和慢阻肺组平均年龄分别为(68.0±12.3)岁和(62.0±9.7)岁,均大于哮喘组(43.0±6.2)岁(P<0.05)。ACOS组和慢阻肺组吸烟指数分别为(387±127)年支和(472±91)年支(P<0.05),均大于哮喘组[(72±16)年支](P<0.05)。ACOS和慢阻肺患者儿童时期下呼吸道感染频繁者(每年≥1次)比例分别为21.3%和15.3%,而哮喘患者为7.5%。ACOS组患者2年内第一秒用力呼气容积(FEV1)为(53.7±6.6)m L,下降较慢阻肺(42.8±10.4)m L和哮喘患者(24.2±7.9)m L明显。ACOS和慢阻肺患者一氧化氮肺泡弥散量占预计值(DLCO/VA%)分别为(58.4±9.2)%和(64.7±7.1)%,均低于哮喘患者(91.0±7.3)%(P<0.05)。ACOS和哮喘患者诱导痰EOS百分比分别为(11.3±3.9)%和(14.9±11.7)%,均高于慢阻肺组(1.4±0.8)%(P<0.05)。ACOS和哮喘患者FENO水平分别为(39.2±18.7)×10-9mol/L和(46.6±15.4)×10-9mol/L,均高于慢阻肺组(19.5±5.2)×10-9mol/L(P<0.05)。ACOS患者的SGRQ为69.5±9.2,高于慢阻肺组47.0±11.7和哮喘组(31.3±9.7)(P<0.05)。ACOS患者2年内急性加重次数为(3.1±1.2)次,多于慢阻肺组(1.4±0.6)次(P<0.05);ACOS患者因急性加重住院次数为(2.83±0.96)次,多于慢阻肺组(1.10±0.72)次(P<0.05)。结论 ACOS常见于有特应症特征基础上常年吸烟的老年患者。ACOS临床上肺功能下降更快,健康相关生活质量差,易于反复急性加重。Objective To investigate the clinical differences among asthma overlap chronic obstructive pulmonary disease（ACOS）,chronic obstructive pulmonary disease（COPD）and asthmaaMethods A total of 47 patients with ACOS,59 patients with COPD and 53 patient with asthma were enrolled in this study.The observation period is 24 months.The clinical data were collected and analyzed.Results （1）The mean age in ACOS group and COPD group was 68.0±12.3 and 62.0±9.7,respectively（t=l.93, P〉0.0S）,whereas it was 43.0±6.2 in asthma group（t=14.2,11.8,P〈0.0S）.The smoking index in ACOS group and COPD group was 387±127 pack-year and 472±91 pack-year, respectively（t=7.3,P〈O.OS）,whereas it was 72＋_16 pack-year in asthma group（t=17.6,21.4,P〈0.05）.The incidence of patients with lower tract respiratory infection in childhood in ACOS,COPD and asthma group was 21.3%,15.3% and 7.5%,respectively.（2）Lung function：the patients in ACOS group had a decline of （53.7±6.6）mL in FEVl,while the patients had （42.8±10.4）mL in COPD group（t=13.7,P〈0.05）and （24.2±7.9）mL（t=16.1,P〈0.05） in asthma group. The predicted DLco/VA in value ACOS and COPD group was （58.4±9.2）% and （64.7±7.1）%,respectively, while it was （91.0±7.3）% in asthma group（t= 13.9,9.6,P〈O.OS）.（3）Sputum cells：the percentage of eosinophils in the sputum was higher in ACOS （11.3±3.9）% and asthma group（14.9± 11.7）% respectively than that in COPD group（1.4±0.8）%（t=14.6,19.3,P〈O.OS）.（4）FeNO：The level of FeNO was higher in ACOS group [（39±18.7）xlO9mol/L] and asthma group[（46.6±15.4）×10-9mol/L] respectively than that in COPDgroup[（19.S_＋S.2）xl0-gmol/L] （t=- 11.3,14.1,P〈O.OS）;（S）HRQOL assesssment：the SGRQscore was higher in ACOS group（69.5±9.2） than that in COPD group（47.0＋l 1.7）（t=7.8,P〈0.05）and group（31.3±9.7）（t=12.4,P〈O.O5）;（6）Exacerbation and hospital admission：the frequency of exacerbation was higher that in ACOS gr

关 键 词：重叠综合征 慢性阻塞性肺疾病 支气管哮喘 

分 类 号：R563[医药卫生—呼吸系统]