慢性阻塞性肺疾病患者肺容量与弥散能力评估  

Evaluation of lung capacity and diffusing capacity in patients with chronic obstructive pulmonary disease

作　　者：段昊玙 梁斌苗[1] DUAN Haoyu;LIANG Binmiao(Department of Respiratory and Crical Care Medicine,West China Hlospital,Sichuan University,Chengdu,Sichuan 610040,P.R.China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2023年第6期381-386,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省科技厅重点研发项目(2019YFS0033)。

摘　　要：目的观察不同GOLD等级、不同一氧化碳弥散量(diffusing capacity for carbon monoxide,DLCO)慢阻肺患者肺功能的变化及DLCO占预计值百分比(DLCO%pred)与过度充气参数残总比(the ratio of residual volume to total lung capacity,RV/TLC)之间的关系。方法记录患者的年龄、性别、体重指数(body mass index,BMI)及肺功能指标。按GOLD等级进行分组,对各组之间的肺功能进行比较;以DLCO%pred 60%为临界值进行分组,对各组之间的肺功能进行比较。使用秩相关或直线相关对DLCO%pred与年龄、RV/TLC等因素之间的相关性进行分析。结果纳入了431例稳定期慢阻肺患者。随着GOLD等级的增加,患者的肺功能逐渐变差(P<0.05)。相较于DLCO%pred≥60%组,DLCO%pred<60%组患者的BMI更小(t=-5.642,P<0.001),肺功能更差(P<0.001)。相关性分析显示BMI(r=0.352,P<0.001)、用力肺活量占预计值百分比(forced vital capacity in percent predicted value,FVC%pred)(r=0.349,P<0.001)、第1秒用力呼气容积占预计值百分比(forced expiratory volume in one second in percent predicted value,FEV1%pred)(r=0.414,P<0.001)、一秒率(the ratio of forced expiratory volume in one second to forced vital capacity,FEV1/FVC)(r=0.434,P<0.001)、呼气峰流速占预计值百分比(peak expiratory flow in percent predicted value,PEF%pred)(r=0.335,P<0.001)、最大呼气中期流量占预计值百分比(maximal mid expiratory flow in percent predicted value,MMEF%pred)(r=0.405,P<0.001)、深吸气量占预计值百分比(inspiratory capacity in percent predicted value,IC%pred)(r=0.301,P<0.001)与DLCO%pred正相关;RV/TLC(r=-0.328,P<0.001)、GOLD等级(r=-0.430,P<0.001)与DLCO%pred负相关;然而年龄(r=-0.012,P=0.810)、性别(r=0.076,P=0.117)与DLCO%pred之间相关关系无统计学意义。结论随着GOLD等级的增加,DLCO%pred在下降,RV/TLC在增加,RV/TLC与DLCO%pred负相关。相较于常用于评价慢阻肺气流受限的指标FEV1,RV/TLC和DLCO%pred分别从患者的肺容量情况及弥散能力Objective To observe the changes in pulmonary function in chronic obstructive pulmonary disease(COPD)patients with different GOLD grades,diffusing capacity for carbon monoxide in percent predicted value(DLCO%pred),and the relationship between DLCO%pred and hyperinflation parameter,the ratio of residual volume to total lung capacity(RV/TLC).Methods Their age,sex,body mass index(BMI),and lung function parameters were recorded.Group according to GOLD grade,and compare the lung function among different groups;With DLCO%pred 60%as the cut-off value,the lung function of each group was compared.Pearson and Spearman correlation determined the relationship between DLCO%pred and age,RV/TLC,and other factors.Results Four hundred and thirty-one patients were enrolled.With the increase of GOLD grade,the pulmonary function became worse(P<0.05).Compared with DLCO%pred≥60%,the group with DLCO%pred<60%had lower BMI(t=-5.642,P<0.001)and worse pulmonary function(P<0.001).The correlation analysis showed that BMI(r=0.352,P<0.001),forced vital capacity in percent predicted value(FVC%pred)(r=0.349,P<0.001),forced expiratory volume in one second in percent predicted value(FEV1%pred)(r=0.414,P<0.001),the ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC)(r=0.434,P<0.001),peak expiratory flow in percent predicted value(PEF%pred)(r=0.335,P<0.001),maximal mid expiratory flow in percent predicted value(MMEF%pred)(r=0.405,P<0.001),inspiratory capacity in percent predicted value(IC%pred)(r=0.301,P<0.001)were positively correlated with DLCO%pred;while RV/TLC(r=-0.328,P<0.001),GOLD grade(r=-0.430,P<0.001)were negatively correlated with DLCO%pred;However,there was no significant correlation between age(r=-0.012,P=0.810),sex(r=0.076,P=0.117)and DLCO%pred.Conclusions With the increase of GOLD grade,DLCO%pred decreases,and RV/TLC increases.RV/TLC is negatively correlated with DLCO%pred.Attaching importance to the evaluation of hyperinflation and diffusing capacity of COPD patients is helpful in evaluating COPD in al

关 键 词：慢阻肺 过度充气 一氧化碳弥散量 残总比 

分 类 号：R563.9[医药卫生—呼吸系统]