结核性胸膜炎患者化疗时是否加用糖皮质激素对肺功能动态变化的对比研究  

Dynamic changes of lung function and hormone-assisted therapy in patients with tuberculous pleurisy

作　　者：阮洪云[1] 李琦[2] 陈效友 段鸿飞[4] 郭超[4] 操敏[2] 梁清涛[4] 王志茹[2] 杨扬[4] 孙桂新[2] 李华[4] 邓玲[2] 绍玲玲 邢维祥 张芸 杨新婷[4] RUAN Hong-yun;LI Qi;CHEN Xiao-you;DUAN Hong-fei;GUO Chao;CAO Min;LIANG Qing-tao;WANG Zhi-ru;YANG Yang;SUN Gui-xin;LI Hua;DENG Ling;SHAO Ling-ling;XING Wei-xiang;ZHANG Yun;YANG Xin-ting(Department of Cellular and Molecular Biology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;不详)

机构地区：[1]首都医科大学附属北京胸科医院细胞和分子生物室,101149 [2]首都医科大学附属北京胸科医院心肺功能室,101149 [3]首都医科大学附属北京地坛医院,101149 [4]首都医科大学附属北京胸科医院结核科

出　　处：《中国防痨杂志》2021年第1期58-65,共8页Chinese Journal of Antituberculosis

基　　金：北京市医院管理局“登峰”计划(DFL20151501,DFL20181601);北京市科学技术委员会重点项目(D141107005214003,D181100000418003,Z191100006619078)。

摘　　要：目的探讨结核性胸膜炎患者化疗时是否加用糖皮质激素对肺功能的动态变化。方法回顾性分析首都医科大学附属北京胸科医院2015年5月至2018年5月收治的结核性胸膜炎患者172例,对患者的肺通气、容积、弥散功能和呼吸肌力学指标在化疗前,以及化疗第1、6、12个月末进行4次检测;根据在抗结核药品化疗方案的基础上是否加用糖皮质激素分为两组,即加用组60例(醋酸泼尼松+2H-R-Z-E/10H-R-E)和未加用组112例(2H-R-Z-E/10H-R-E)。肺通气功能的检测指标为患者用力肺活量检测值占正常预计值的百分比(FVC)、第1秒用力呼气容积检测值占正常预计值的百分比(FEV1%pred)、第1秒钟用力呼气容积/用力肺活量比值占正常预计值的百分比(FEV1/FVC%pred)、用力呼出75%肺总量时瞬间呼气流量检测值占正常预计值的百分比(FEF75)、最大分钟通气量检测值占正常预计值的百分比(MVV%pred);肺容积功能的检测指标为残气量检测值占正常预计值的百分比(RV%pred)、肺总量检测值占正常预计值的百分比(TLC%pred)、残气量/肺总量比值占正常预计值的百分比(RV/TLC%pred);弥散功能的检测指标为肺弥散量检测值占正常预计值的百分比(D_(L)CO)和肺泡容量校正的肺弥散率检测值占正常预计值的百分比(D_(L)CO/VA%pred);呼吸肌力学的检测指标为气道阻力检测值占正常预计值的百分比(Rtot%pred、呼气峰流量检测值占正常预计值的百分比(PEF%pred)、吸气峰值流量实测值(PIF),通过对检测指标的观察,了解肺功能的变化。肺功能测定结果按"测定值/正常预计值×100%"表示(除PIF为实测值),符合正态分布的计量资料采用"x±s"进行统计描述,统计学处理采用t检验;不符合正态分布的计量资料采用中位数(四分位数)[M(Q_(1),Q_(3))]表示,统计学处理采用Z检验,P<0.05为差异有统计学意义。结果 (1)结核性胸膜炎患者化疗前,以限制性通气功能障Objective To investigate the dynamic changes of pulmonary function in patients with tuberculous pleurisy after chemotherapy with glucocorticoid. Methods All of 172 patients with tuberculous pleurisy admitted to Beijing Chest Hospital affiliated to Capital Medical University from May 2015 to May 2018 were retrospectively analyzed.The pulmonary ventilation,volume,diffusion function and respiratory muscle mechanics indexes of patients were tested for 4 times:before treatment,at the end of the 1 st,6 th and 12 th months of treatment.On the basis of anti-tuberculosis drug treatment regimen,patients were divided into two groups:60 patients in the plus group(prednisone acetate+2 H-R-Z-E/10 H-R-E)and 112 patients in the non-plus group(2 H-R-Z-E/10 H-R-E).Pulmonary ventilation function of patients were tested with percentage of forced vital capacity values over the expected value(expected value of pulmonary function factory default value formula),percentage of forced expiratory volume in 1 second readings over the expected value,percentage of forced expiratory volume in 1 second readings versus a forced vital capacity values,percentage of forcibly exhale 75% total lung moment expiratory flow values over the expected value(FEF_(75)% pred),percentage of the maximum values of the expected minute ventilation(MVV% pred);The measurement index of lung volume function were percentage of residual volume detected value over the estimated value,percentage of total lung detected value over the estimated value,and percentage of residual volume/total lung ratio over the estimated value.The measurement index of dispersion function were percentage of the detected lung dispersion amount over the predicted value and percentage of the detected lung dispersion rate in the corrected alveolar volume over the predicted value.The measurement indexes of respiratory muscle mechanics were percentage of airway resistance detected,percentage of peak expiratory flow detected and the measured value of peak inspiratory flow. Results(1)Before chemotherap

关 键 词：结核 胸膜 抗结核药 糖皮质激素类 药物疗法 联合 呼吸功能试验 疗效比较研究 

分 类 号：R521.7[医药卫生—内科学]