哮喘-慢阻肺重叠综合征、哮喘及慢阻肺患者的肺功能及临床特征比较  

Asthma, COPD, and asthma-COPD overlap syndrome: pulmonary function and clinical features

作　　者：韩国敬[1] 许菡苡[2] 胡红[1] 白雪[1] 毛丹[1] 马秀清[1] 曹璐[1] HAN Guojing XU Hanyi HU Hong BAI Xue MAO Dan MA Xiuqing CAO Lu(Department of Respiratory, Chinese PLA General Hospital, Beijing 100853, China Department of Respiratory, Guangdong General Hospital, Guangzhou 510080, Guangdong Province, China)

机构地区：[1]解放军总医院呼吸科,北京100853 [2]广东省人民医院呼吸科,广东广州510080

出　　处：《解放军医学院学报》2016年第11期1122-1125,1189,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(11374370);科技部重大仪器开发项目(2012YQ150092)~~

摘　　要：目的分析哮喘-慢阻肺重叠综合征(asthma-COPD overlap syndrome,ACOS)、哮喘及慢性阻塞性肺疾病(简称慢阻肺)患者的肺功能及临床特征,以提高ACOS的早期诊治水平。方法收集解放军总医院呼吸科门诊及住院的ACOS、哮喘及慢阻肺患者资料,ACOS组30例,哮喘组30例,慢阻肺组30例;比较3组患者的性别、年龄、肺功能、呼出气一氧化氮(Fe NO)、外周血嗜酸性细胞百分比、血清总Ig E水平及临床症状评分。结果 ACOS组平均年龄(59.1±12.0)岁,60岁以上占50%。ACOS组FEV_1%预计值(55.01%±21.26%)显著低于哮喘组(71.52%±24.80%)(P<0.05);ACOS组吸入β2受体激动剂前FEV_1/FVC%(51.11%±13.17%)显著低于哮喘组(63.95%±13.54%)(P<0.05);ACOS组小气道功能障碍29例(96.7%),显著多于哮喘组的23例(76.7%)(P<0.05);ACOS组RV/TLC%(46.9%±10.5%)显著高于哮喘组(30.3%±6.5%)(P<0.05)。ACOS组DLco-SB%(60.9%±15.9%)显著低于哮喘组(88.3%±16.6%)(P<0.05),但显著高于慢阻肺组(50.5%±16.0%)(P<0.05)。ACOS组FEV_1%pred、FEV_1/FVC%、小气道功能障碍的比例及RV/TLC%与慢阻肺组差异无统计学意义。ACOS组外周血嗜酸性细胞百分比(4.12%±3.86%)显著低于哮喘组(6.65%±6.17%)(P<0.05)。总Ig E升高者在ACOS中占60%,哮喘中占56.7%,慢阻肺中占10%。ACOS组Fe NO值为(43.75±24.29)ppb,显著低于哮喘组的(63.90±52.97)ppb,但高于慢阻肺组的(32.53±18.33)ppb(P<0.05)。临床症状评分3组间差异无统计学意义。结论与哮喘组比较,ACOS组患病年龄大,肺通气功能下降更明显,小气道功能障碍患者比例更多,肺残气量更高,肺弥散功能更差,Fe NO值更低,外周血嗜酸细胞百分比更低。与慢阻肺组比较,ACOS组肺弥散功能更好,总Ig E升高者更多。Objective To compare the lung function and clinical features of asthma-COPD overlap syndrome（ACOS）, asthma, and COPD for improving the early diagnosis and treatment of ACOS. Methods Selected patients in department of respiratory Chinese PLA General Hospital were classified as ACOS group（n=30）, asthma group（n=30） and COPD group（n=30）. Clinical data were collected and compared between three groups, including gender, age, pulmonary function, fractional exhaled nitric oxide（Fe NO）, peripheral eosinophil count, total level of Ig E and clinical symptom scores. Results The mean age of patients in ACOS group was（59.1±12.0） years with 50% of patients over the age of 60. The predicted level of forced expiratory volume in 1 second（FEV_1%） was significantly lower in ACOS group than asthma group [（55.01%±21.26%） vs（71.52%±24.80%）, P〈0.05]; Before inhalation of short-actingβ2–agonists, the FEV_1/FVC% was significantly lower in ACOS group than asthma group [（51.11%±13.17%） vs（63.95%±13.54%）, P〈0.05]; The number of patients with small airway function obstacle in ACOS group was significantly greater than that in asthma group [29 cases（96.7%） vs 23 cases（76.7%）, P〈0.05]; And RV/TLC% in ACOS group was significantly higher than asthma group [（46.9%±10.5%） vs（30.3%±6.5%）, P〈0.05]. DLco-SB % in ACOS group was significantly lower than asthma group [（60.9%±15.9%） vs（88.3%±16.6%）, P〈0.05], but it was significantly higher than COPD group [（60.9%±15.9%） vs（50.5%±16.0%）, P〈0.05]. While, there was no statistically significant difference in FEV_1% predicted, FEV_1/FVC%, proportion of patients with small airway function obstacle and RV/TLC% between ACOS group and COPD group. The peripheral eosinophil count in ACOS group was significantly lower than asthma group [（4.12%±3.86%） vs（6.65%±6.17%）, P〈0.05]. The proportion of patients with increased total Ig E accounted for 60% in ACOS group, 56.7% in asthma group and 10% in COPD group. F

关 键 词：哮喘-慢阻肺重叠综合征 哮喘 慢性阻塞性肺疾病 肺功能 呼出气一氧化氮 

分 类 号：R562.25[医药卫生—呼吸系统] R563.3[医药卫生—内科学]