慢性阻塞性肺疾病支气管舒张试验47例临床分析

Clinical analysis of COPD with bronchodilator reversibility in 47 patients

目的探讨支气管舒张试验不同结果的慢性阻塞性肺疾病(COPD)患者的临床特点。方法对2007年4月至2008年1月上海交通大学医学院附属新华医院呼吸内科住院的47例COPD患者进行肺功能及支气管舒张试验的检查,并收集患者相关临床资料,对于不同的支气管舒张试验结果进行比较分析。结果舒张试验阳性组的COPD患者吸烟史明显少于阴性组(P<0.05),而血清IgE则明显高于阴性组(P<0.05)。阳性组用力肺活量(FVC)改善率、第一秒钟用力呼气容积(FEV1)改善率、功能残气量(FRC)、75%肺活量时的最大呼气流量(MEF75%)改善率、50%肺活量时的最大呼气流量(MEF50%)改善率均高于阴性组(P<0.05),其中尤以FEV1改善率、MEF75%改善率、MEF50%改善率明显(P<0.01)。不同分级的COPD患者舒张试验的结果差异有统计学意义(P<0.05)。结论吸烟是影响COPD患者支气管舒张试验结果的一个因素。支气管舒张试验阳性的COPD患者具有更高的血清IgE水平,可能存在气道高反应性。舒张试验阳性的COPD患者气流受限的小气道的改善不明显,可能是以大中气道的改善为主。轻-中度的COPD患者更具有的气流受限的可逆性。

Objective To analyze the clinical features of chronic obstructive pulmanory disease（COPD） with different results of bronchodilator reversibility test. Methods A total of 47 cases of COPD were selected and given bronchodilator reversibility test and lung ruction who were divided into two groups according to the bronchodilator reversibility test. We compared these two groups with sex, age, smoke history, body mass index, levels of IgE, eosinophil and lung function. Results The positive group had a shorter history of smoking and a higher level of IgE. The amelioration of FVC, FEV1, FRC,MEF 75% and MEF 50% was higher in the positive group than the negative（ P 〈 0. 05 ） , especially FEV1, MEF 75% and MEF 50%. Patients of mild to midrange had a higher positive rate of bronchodilator reversibility test. Those who have good reaction for bronchodilator may have airway hyperreactivity（AHR） with high level of IgE and the relaxation of the bronch focus on the majoy hronch, and the mesobronchus. The reversibility of airway may be better in mild or midrange than the severe patients of COPD （ P 〈 0. 05 ）. Conclusion Smoking is an influencing factor of the hronchodilator reversibility test in COPD patients.