长期吸烟者的肺气肿和肺功能损害特征

Characteristics of pulmonary emphysema and pulmonary function damage in long-term smokers

目的:分析长期吸烟者肺气肿和肺功能损害特性,总结其规律性,寻求可能的干预方法。方法:2001-05/2003-10商丘市第一人民医院门诊健康体检者288例。本研究提出的纳入标准:年龄≥45岁;自愿接受各种量表调查。排除标准:确诊为肺心病和其他器质性心脏病患者;有胸部创伤、手术史及患有其他限制呼吸运动疾病者。符合上述标准吸烟者84例(吸烟组),根据吸烟指数的不同,分为轻度吸烟组(n=28),中度吸烟组(n=35),重度吸烟组(n=21)。按相同性别、年龄、身高、体质量、职业配对为不吸烟组。比较肺气肿患病率、平均视觉评分值(meanvisualscoring,MVS)和各项肺功能检测值。结果:84例吸烟者的肺部高分辨率CT扫描中,共检出肺气肿患者41例,其肺气肿患病率(49%)和MVS犤(14.55±2.38)分犦明显高于不吸烟组犤21%,(5.81±0.45)分犦(χ2=16.556,P<0.001;t=2.384,P<0.05)。在按不同吸烟程度分组后,重度(吸烟指数≥100)、中度吸烟患者(吸烟指数51～99)的肺气肿患病率明显高于轻度吸烟组(吸烟指数<50)(χ2=13.819,P<0.001),同时重度吸烟患者的MVS犤(16.41±5.09)分犦也分别明显高于中度和轻度吸烟组,后者MVS也明显低于中度吸烟组(t=2.254～3.380,P<0.05～0.01)。吸烟和不吸烟者之间的全部肺功能指标均无明显区别(P均>0.05),但重度吸?

AIM:To analyze the characteristics of pulmonary emphysema and pulmonary function damage in long-term smokers,summarize its regularity and seek possible interventional methods. METHODS:Totally 288 healthy examiners in the First People's Hospital in Shangqiu City from May 2001 to October 2003 were selected.Inclusive criteria: age≥45 years old;voluntarily accepted scale investigation.Exclusive criteria:diagnosed to have pulmonary heart disease and other cardiac disease;chest injury,operation history and other restricted breathing exercise. Totally 84 smokers in accordance with the above criteria(smoking group) were divided into mild smoking group(n=28),moderate smoking group (n=35),heavy smoking group(n=21) on the basis of smoking indexes. They were matched with nonsmoking group by the same sex, age,height, body mass,occupation and housing conditions.The incidence of pulmonary emphysema(IPE), mean visual scoring(MVS) and all examining values of pulmonary function were measured. RESULTS:After high resolution computerized tomography(HRCT) scanning, pulmonary emphysema were diagnosed in 41 among 84 smokers.The IPE and MVS was 49%and 14.55±2.38 respectively,which was significantly higher than that in the nonsmoking group(21%,5.81±0.45)(χ2=16.556,P< 0.001;t=2.384,P< 0.05).After division on different smoking degree,the IPE in the moderate smoking group(smoking index ≥100) and heavy smoking group(smoking index 51 to 99) was significantly higher than that in the mild smoking group(smoking index < 50)(χ2=13.819,P< 0.001),and meanwhile, the value of MVS(16.41±5.09) in heavy smoking group was significantly higher than that in the moderate smoking and mild smoking groups,the value of MVS in the latter was also significantly lower than that in the moderate smoking group(t =2.254 to 3.380;P< 0.05 to 0.01).There was no obvious differences in the total index of pulmonary function between smokers and nonsmokers(all P >0.05),but the forced expiratory volume(FEV) at the first second, FEV and the percentage of FEV in predictive value in severe smoking group had significantly lower than those in the nonsmokers(t=2.162 to 2.351;P< 0.05). CONCLUSION:HRCT is a reliable facility for identifying pulmonary emphysema and estimating the extent of pathological changes.The IPE and MVS are significantly higher in smokers.The IPE and MVS are closely correlated to the smoking index.Severe smokers often partially have changes in pulmonary function index.