深吸气量在鉴别慢性阻塞性肺疾病和支气管哮喘-慢性阻塞性肺疾病重叠中的应用价值研究  

Application Value of Inspiratory Capacity in Differentiating Chronic Obstructive Pulmonary Disease from Asthma-chronic Obstructive Pulmonary Disease Overlap

作　　者：王芳 姜晨宇 罗旭平 陈芳[2] WANG Fang;JIANG Chenyu;LUO Xuping;CHEN Fang(The First Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Pulmonary Function Test Room,the First Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000,China)

机构地区：[1]浙江中医药大学第一临床医学院,浙江省杭州市310053 [2]浙江中医药大学附属第一医院肺功能室,浙江省杭州市310000

出　　处：《中国全科医学》2019年第33期4053-4057,共5页Chinese General Practice

基　　金：国家自然科学基金青年项目(81302934);浙江省中医药科学研究基金项目(2018ZA039)

摘　　要：背景 临床上大多将支气管舒张试验作为鉴别慢性阻塞性肺疾病(COPD)和支气管哮喘-慢性阻塞性肺疾病重叠(ACO)的一个重要步骤,但其并不能鉴别所有的COPD和ACO.研究显示,深吸气量(IC)在反映严重COPD患者肺过度充气及呼吸困难程度中具有良好的灵敏度,因此IC能否作为一个鉴别COPD和ACO患者肺功能的指标尚有待研究.目的 探究IC在鉴别COPD和ACO中的应用价值.方法 选取2018年3-9月在浙江中医药大学附属第一医院呼吸科门诊就诊的符合研究标准的COPD患者20例(COPD组)、ACO患者21例(ACO组).患者均进行肺通气功能检查及支气管舒张试验检查,初次肺通气功能检查结果 记为舒张前.行支气管舒张试验后再行肺通气功能检查记为舒张后.比较两组患者一般资料(包括身高、体质量、BMI、性别、年龄),肺通气相关指标〔第1秒用力呼气末容积(FEV1)、用力肺活量(FVC)、IC、最大呼气流量(PEF)、用力呼出25%肺活量位气体的瞬间流量(FEF25)、用力呼出50%肺活量位气体的瞬间流量(FEF50)、用力呼出75%肺活量位气体的瞬间流量(FEF75)、最大呼气中期流量(MMEF)〕舒张前、舒张后、舒张前后的绝对值变化(Δ)及改善率;分析ACO组患者及COPD组患者IC改善率与ΔFEV1、FEV1改善率、ΔFVC、FVC改善率、ΔPEF、PEF改善率的相关性,IC改善率诊断ACO的价值.结果ACO组患者年龄小于COPD组(P<0.05).ACO组患者ΔFEV1、FEV1改善率、ΔFVC、FVC改善率、IC改善率、ΔPEF、PEF改善率高于COPD组(P<0.05).ACO组患者IC改善率与ΔFEV1、FEV1改善率、ΔFVC、FVC改善率、ΔPEF、PEF改善率均无相关关系(P>0.05).COPD组患者IC改善率与FVC改善率呈正相关(rs=0.501,P=0.021),与ΔFEV1、FEV1改善率、ΔFVC、ΔPEF、PEF改善率无相关关系(P>0.05).IC改善率诊断ACO的ROC曲线下面积为0.714(P=0.019),最佳截断值为13.11%,灵敏度为61.90%,特异度为85.00%.结论 IC在评价COPD患者对支气管舒张剂的Background Bronchial dilation test is mostly used as an important step in differentiating chronic obstructive pulmonary disease(COPD) from bronchial asthma-chronic obstructive pulmonary disease overlap(ACO),but it does not identify all COPD and ACO.Studies have shown that inspiratory capacity(IC) has a good sensitivity to reflect the degree of pulmonary hyperinflation and respiratory difficulty in patients with severe COPD,so we aim to study whether IC can be used as an indicator to distinguish patients with COPD from patients with ACO.Objective To evaluate the diagnostic value of IC in identifying COPD and ACO.Methods Twenty patients with COPD(COPD group) and 21 patients with ACO(ACO group) who were admitted to the respiratory department of the First Hospital Affiliated to Zhejiang Chinese Medical University and met the study criteria were enrolled from March to September in 2018.All patients underwent pulmonary ventilation function test, whose data were recorded as pre bronchial dilation test data,and then bronchial dilation test.After the bronchial dilation test,the pulmonary ventilation function test was performed again,whose data were recorded as post bronchial dilation test data.The general information(including height,mass,BMI,gender and age),indicators of pulmonary ventilation function [forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),IC,peak expiratory flow(PEF),forced expiratory flow after 25% of FVC(FEF25),forced expiratory flow after 50% of FVC(FEF50),forced expiratory flow after 75% of FVC(FEF75), maximum mid-expiratory flow(MMEF)],the pre and post bronchial dilation test data and their absolute value changes (Δ),and improvement rate between patients in two groups were compared.The correlation between IC improvement rate and Δ FEV1,improvement rate of FEV1,Δ FVC,improvement rate of FVC,Δ PEF,improvement rate of PEF among patients with ACO and COPD was analyzed.The improvement rate of IC was analyzed to show its diagnostic value of ACO.Results The age of patients in the ACO gr

关 键 词：肺疾病 慢性阻塞性 哮喘-慢性阻塞性肺疾病重叠 深吸气量 支气管舒张试验 鉴别诊断 

分 类 号：R563.9[医药卫生—呼吸系统]