慢性阻塞性肺疾病急性加重和疾病进展的关系

The attribution of acute exacerbation in the development of chronic obstructive pulmonary disease

目的研究肺功能、血气分析、圣乔治呼吸调查问卷（SGRQ）评分、全身营养状况等临床指标在评价慢性阻塞性肺疾病（COPD）的疾病进展中的作用。方法观察因急性加重而住院的中重度COPD患者的肺功能、血气分析、SGRQ评分、全身营养状况等临床指标与前一次急性加重时的变化趋势。结果中度COPD患者第1秒用力呼气容积占预计值百分比（FEV1％pred）和氧合指数随病情的进展呈现明显下降趋势[住院1、2．3、4次分别为（68．43±3．09）％、（61．27±3．38）％、（42．05±4．16）％、（33．64±3．34）％和435．55±10．23、404．35±11．56、358．38±13．21、321．29±11．78]（P〈0．05），PaCO2则呈现明显上升趋势[住院1、2、3、4次分别为（36．23±3．62）、（45．44±4．67）、（57．82±4．12）、（78．28±5．21）mmHg（1mmHg=0．133kPa）]（P〈0．05），重度COPD患者氧合指数呈明显下降趋势。SGRQ评分在中重度患者中均有明显下降趋势（P〈0．05），血红蛋白、白蛋白、体重指数则无明显变化趋势。结论急性加重对COPD患者的肺功能和生活质量影响甚大，肺功能检查、血气分析指标和SGRQ评分可以反映COPD的疾病进展。

Objective To investigate the role of the pulmonary function, arterial blood gas analysis, the St George respiratory questionnaire （SGRQ） score and nutritional status in evaluating the development of chronic obstructive pulmonary disease （COPD）. Method Changes of the above-mentioned parameters were analyzed in hospitalized patients suffered from moderate to severe COPD and compared with parameters of those who had acute exacerbations when admitted to hospital. Results The forced expiratory volume in one second （FEV1）% pred and oxygenation index of the patients declined significantly with the development of the disease after one, two, three, four times in hospital [（68.43 ± 3.09）%, （61.27± 3.38）%, （42.05 ± 4.16）%, （33.64 ± 3.34）% and 435.55 ± 10.23, 404.35 ±11.56, 358.38 ± 13.21, 321.29 ± 11.78] （P 〈 0.05）, while the level of PaCO2 increased significantly in moderate COPD [ （ 36.23 ± 3.62）, （45.44 ± 4.67 ）, （57.82 ±4.12）,（78.28 ±5.21） mm Hg （1 mm Hg =0.133 kPa）]（P 〈0.05）. The oxygenation index was declined significantly in severe COPD. The Scores of SGRQ score declined significantly in all patients while the level of hemoglobin, albumin and body mass index did not change significantly. Conclusions Acute exacerbation attributes to the deterioration of pulmonary function and life quality of COPD patients. Monitoring the changes of pulmonary function, arterial blood gas analysis and SGRQ score may be useful in the evaluation of the development of COPD.