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中老年慢性阻塞性肺疾病临床特征与病情进展的相关性

Correlation between clinical features and disease progression of chronic obstructive pulmonary disease in middle-aged and elderly patients

    摘要
  • 摘要:
      目的  探讨中老年慢性阻塞性肺疾病(COPD)患者的临床特征与病情进展的相关性。
      方法  采用双盲法选取136例COPD患者作为研究对象，按病情的不同分为COPD稳定期组(n=52)、COPD急性加重期(AECOPD)组(n=44)和哮喘慢阻肺重叠综合征(ACOS)组(n=40)。分析3组患者的基线资料年龄、性别、体质量指数(BMI)、吸烟情况、饮酒情况、高血压史、糖尿病史、过敏史、COPD病程、临床表现、症状和体征、肺部听诊及CT检查结果、肺功能指标第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、呼出气一氧化氮(FeNO), 并比较3组白细胞计数(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、总免疫球蛋白E(IgE)、动脉血氧分压pa(O2)、动脉血二氧化碳分压pa(CO2)、pH值等实验室指标。
      结果  ACOS组年龄高于COPD稳定期组、AECOPD组，差异有统计学意义(P < 0.05)。ACOS组首发症状为气促者、肺部干湿啰音者比率高于COPD稳定期组、AECOPD组，肺部仅有湿啰音者和肺部CT见肺气肿、肺大疱者比率低于COPD稳定期组、AECOPD组，差异有统计学意义(P < 0.05); AECOPD组肺部CT见肺气肿、肺大疱者比率高于COPD稳定期组，差异有统计学意义(P < 0.05)。ACOS组FEV1、FVC、FEV1/FVC、pa(O2)低于COPD稳定期组、AECOPD组, FeNO、WBC、IL-6、TNF-α、CRP、总IgE、pa(CO2)高于COPD稳定期组、AECOPD组，差异有统计学意义(P < 0.05); AECOPD组FEV1、FVC、FEV1/FVC、pa(O2)低于COPD稳定期组, WBC、IL-6、TNF-α、CRP、总IgE、pa(CO2)高于COPD稳定期组，差异有统计学意义(P < 0.05)。年龄、FEV1、FVC、FEV1/FVC、总IgE是ACOS的独立相关因素(P < 0.05或P < 0.01)。
      结论  COPD进展性疾病AECOPD、ACOS的临床特征与COPD稳定期具有一定差异，临床应重点关注COPD稳定期患者的年龄、肺功能情况，有效防控COPD病情进展。

     

    Abstract:
      Objective  To investigate the correlation between clinical features and disease progression of chronic obstructive pulmonary disease (COPD) in middle-aged and elderly people.
      Methods  A total of 136 COPD patients were selected by double-blind method, and were divided into stable phase of COPD group (n=52) and acute exacerbation phase of COPD (AECOPD) group(n=44), and asthma COPD overlap syndrome (ACOS) group(n=40). Baseline data age, gender, body mass index(BMI), smoking status, alcohol history, history of hypertension, diabetes mellitus, history of allergies, COPD course, clinical manifestations, signs and symptoms, lung auscultation and CT test results, pulmonary function indexes forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, fractional exhaled nitric oxide (FeNO)were analyzed, and laboratory indexes such as white blood cell count (WBC), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), total immunoglobulin E (IgE), partial arterial oxygen pressure pa(O2), partial arterial carbon dioxide pressurepa(CO2), pH value and other laboratory indicators were compared.
      Results  The age of ACOS group was higher than that of the stable phase of COPD group and AECOPD group, and the difference was statistically significant (P < 0.05). The proportions of first symptoms of breath shortness and dry as well as dry and wet rales in lungs in the ACOS group were higher, and the proportions of moist rales in lungs and lung emphysema as well as pulmonary bulla in CT findings were higher than those of the stable phase of COPD group and AECOPD group (P < 0.05). The proportions of lung emphysema as well as pulmonary bulla in CT findings of AECOPD group were significantly higher than those of the stable phase of COPD group (P < 0.05). FEV1, FVC, FEV1/FVC and pa(O2) of the ACOS group were significantly lower than those of the stable phase of COPD group and AECOPD group (P < 0.05), and FeNO, WBC, IL-6, TNF-α, CRP, total IgE andpa(CO2) were significantly higher than those of the stable phase of COPD group and AECOPD group (P < 0.05). FEV1, FVC, FEV1/FVC and pa(O2) of the AECOPD group were significantly lower than those of the stable phase of COPD group, and WBC, IL-6, TNF-α, CRP, total IgE and pa(CO2) of the AECOPD group were significantly higher than those of the stable phase of COPD group(P < 0.05). Age, FEV1, FVC, FEV1/FVC and total IgE were independent risk factors of ACOS (P < 0.05).
      Conclusion  COPD the clinical characteristics of AECOPD and ACOS differ from COPD at stable phase. Therefore, age and lung function should be attached great importance in clinic to prevent and treat progression of COPD.

     

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