慢性阻塞性肺疾病的长期肺功能变化及影响因素  

Change of long-term lung function and its influencing factors in patients with chronic obstructive pulmonary disease

作　　者：谢梅[1] 骆艳妮[2] 李娜[1] 景粉茸 石志红[3] XIE Mei;LUO Yan-ni;LI Na;JING Fen-rong;SHI Zhi-hong(Department of Respiratory Medicine,Second Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院呼吸内科,陕西西安710004 [2]西安交通大学第二附属医院重症医学科,陕西西安710004 [3]西安交通大学第一附属医院呼吸内科,陕西西安710061

出　　处：《中国临床研究》2018年第11期1449-1452,共4页Chinese Journal of Clinical Research

基　　金：国家自然科学基金(81270094)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者肺功能的长期变化及其影响因素。方法选取2010年1月至2014年3月收治的89例COPD患者为研究对象,对其进行至少3年的随访,分析其肺功能变化,根据每年第一秒用力呼气容积(FEV1)的平均变化率进行分组,分为肺功能不稳组(下降或上升≥5%,n=41)和肺功能稳定组(下降或上升<5%,n=48),比较两组的临床资料,采用多因素Logistic回归分析影响患者肺功能稳定性的因素。结果89例COPD患者出现FEV1下降68例(76. 4%),每年下降(29. 8±42. 6)ml,年变化率为下降(3. 63±5. 47)%,下降<40 ml者28例,下降40～80 ml者23例,下降81～120 ml者17例;FEV1上升21例(23. 6%),上升<40 ml者8例,上升40～80 ml者5例,上升81～120 ml者8例。随访第2、3年的FEV1、FEV1/预计值均显著低于基线值,差异有统计学意义(P <0. 05)。肺功能不稳组的糖皮质激素应用比例显著低于稳定组,基线FEV1、基线FEV1/预计值、基线用力肺活量(FVC)、基线FVC/预计值、支气管舒张试验(BDT)阳性率、急性加重次数均显著高于稳定组,差异有统计学意义(P <0. 05,P <0. 01)。多因素Logistic回归分析结果表明,基线FEV1、BDT阳性、急性加重次数是患者出现肺功能不稳定的独立危险因素(P <0. 05)。结论 COPD患者的肺功能长期变化存在一定的差异性,约3/4的患者出现下降,且基线FEV1越高,BDT阳性、急性加重次数越多,患者更易出现肺功能不稳定。Objective To investigate the changes of long-term lung functions and its influencing factors in patients with chronic obstructive pulmonary disease（COPD）. Methods Eighty-nine patients with COPD from January 2010 to March2014 followed up for at least 3 years were selected as research objects. The lung function changes were analyzed. According to the annual average change rate of forced expiratory volume in the first second（FEV1）,the patients were divided into pulmonary function unstable group（decreased or increased by more than 5%,n = 41） and pulmonary function stable group（decreased or increased by less than 5%,n = 48）. The clinical data were compared between two groups. The factors affecting the stability of pulmonary function were analyzed by multivariate Logistic regression analysis. Results In 89 cases of COPD,FEV1 decreased in 68 cases（76. 4%）,and the average annual decline was（29. 8 ± 42. 6） ml with the annual change rate of（3. 63 ± 5. 47） %,in whom annual declining less than 40 ml,40 to 80 ml and 81 to 120 ml were 28 cases,23 cases and 17 cases,respectively;FEV1 increased in 21 cases（23. 6%）,in whom annual ascending less than 40 ml,40 to 80 ml and 81 to 120 ml were 8 cases,5 cases and 8 cases,respectively. FEV1 and FEV1/predicted volume（%） followed up for2-and 3-years were significantly lower than their baseline values（all P〈0. 05）. The ratio of glucocorticoid use in pulmonary function unstable group was significantly lower than that in pulmonary function stable group,and baseline FEV1,baseline FEV1/predicted volume（%）,baseline forced vital capacity（FVC）,baseline FVC/predicted volume（%）,the positive rate of bronchial dilation test（BDT） and the frequency of acute exacerbation in pulmonary function unstable group were significantly higher than those in pulmonary function stable group（P〈0. 05,P〈0. 01）. Multivariate Logistic regression analysis showed that baseline FEV1,positive BDT and frequency of acute exacerbation were the independent risk

关 键 词：慢性阻塞性肺疾病 肺功能 支气管舒张试验 多因素分析 糖皮质激素 

分 类 号：R563.9[医药卫生—呼吸系统]