肺音可以作为首诊慢阻肺严重程度的判断指标  

Lung sounds can be used as an indicator for assessing severity of chronic obstructive pulmonary disease at the initial diagnosis

作　　者：陈仕锋 黄敏於 彭显如 袁亚飞 黄淑榆 叶艳梅[1] 赵文驱 李博厚 韩慧姗 杨淑銮 蔡绍曦[1] 赵海金[1] CHEN Shifeng;HUANG Minyu;PENG Xianru;YUAN Yafei;HUANG Shuyu;YE Yanmei;ZHAO Wenqu;LI Bohou;HAN Huishan;YANG Shuluan;CAI Shaoxi;ZHAO Haijin(Laboratory of Chronic Airway Diseases,Department of Respiratory and Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科慢性气道疾病实验室

出　　处：《南方医科大学学报》2020年第2期177-182,共6页Journal of Southern Medical University

基　　金：国家自然科学基金(81770033,81900027);广东省科技计划项目(2017B020226006);广州市科技计划项目(201804010069)~~

摘　　要：目的探讨肺部听诊肺音对首诊慢性阻塞性肺疾病(慢阻肺)严重程度的判断价值。方法入选我院2016年5月~2019年5月临床首次确诊慢阻肺患者,根据肺部听诊情况把肺音区分为5组:呼吸音正常、呼吸音减弱、呼吸音减弱并喘鸣、呼吸音明显减弱、呼吸音明显减弱并喘鸣。基于GOLD指南和欧洲标准,区分慢阻肺和哮喘慢阻肺重叠(ACO)诊断,并进行肺功能分级。结果入组慢阻肺患者1046例,男性949例,女性97例,年龄62.6±8.71岁;根据GOLD标准,诊断为慢阻肺中度及以上占比88.1%,重度及以上占比为50.0%,进一步诊断ACO为347例,占33.2%。ANOVA分析肺音5组间在病程、用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%),FEV1/FVC、用力肺活量(FVC)、FVC占预计值百分比(FVC%)、mMRC均存在显著差别(P<0.001),FENO未见显著差异(P=0.097)。ACO较单纯慢阻肺组表现更高比例的喘鸣(P<0.001)。Spearman相关分析示:肺音与疾病严重程度、FEV1、FEV1%及FVC%显著相关(P<0.001)。多元线性回归分析显示:病程、吸烟指数及肺音与疾病严重程度相关。结论肺音可以作为首诊慢阻肺严重程度判断指标,临床需加强识别。Objective To assess the value of pulmonary auscultation for evaluating the severity of chronic obstructive pulmonary disease(COPD)at the initial diagnosis.Methods The patients with newly diagnosed COPD in our hospital between May,2016 and May,2019 were enrolled in this study.According to the findings of pulmonary auscultation,the lung sounds were classified into 5 groups:normal breathing sounds,weakened breathing sounds,weakened breathing sounds with wheezing,obviously weakened breathing sounds,and obviously weakened breathing sounds with wheezing.The pulmonary function of the patients was graded according to GOLD guidelines,and the differential diagnosis of COPD from asthmatic asthma COPD overlap(ACO)was made based on the GOLD guidelines and the European Respiratory Criteria.Results A total of 1046 newly diagnosed COPD patients were enrolled,including 949 male and 97 female patients with a mean age of 62.6±8.71.According to the GOLD criteria,88.1%of the patients were identified to have moderate or above COPD,50.0%to have severe or above COPD;a further diagnosis of ACO was made in 347(33.2%)of the patients.ANOVA analysis showed significant differences in disease course,FEV1,FEV1%,FEV1/FVC,FVC,FVC%and mMRC among the 5 auscultation groups(P<0.001),but FENO did not differ significantly among them(P=0.097).The percentage of patients with wheezing in auscultation was significantly greater in ACO group than in COPD group(P<0.001).Spearman correlation analysis showed that lung sounds was significantly correlated with disease severity,FEV1,FEV1%,FVC and FVC%of the patients(P<0.001);Multiple linear regression analysis showed that a longer disease course,a history of smoking and lung sounds were all associated with poorer lung functions and a greater disease severity.Conclusion Lung sounds can be used as an indicator for assessing the severity of COPD at the initial diagnosis.

关 键 词：慢阻肺 肺部听诊 肺音 严重程度 哮喘慢阻肺重叠 

分 类 号：R563.9[医药卫生—呼吸系统]