不同严重程度COPD患者吸入支气管舒张剂后的流速和容积反应

Differences of Flow and Volume Responses after Inhalation of Bronchodilator in Patients with Mild to Very Severe COPD

目的比较不同严重程度COPD患者支气管舒张试验中的流速和容积反应的差异。方法回顾性分析217例中度一极重度（Ⅱ～Ⅳ级）COPD患者吸入沙丁胺醇后FEV，和FVC改善的差异。结果Ⅱ～Ⅳ级COPD患者在吸入β2受体激动剂后FEV1、FVC均有显著改善，FEV1和FVC的改善有较大差异。按改变值的大小分段排列，△FEV1和△FVC（流速和容积反应）均大致呈正态分布；其中以△FEV1值在0．00～0．04、0．05～0．09和0．10～0．14L范围，AFVC值在0．00—0．09、0．10～0．19和0．20～0．29L范围的患者最多。△FEV，在Ⅱ-Ⅳ级COPD患者之间有显著差异（P〈0．01），随严重程度增加而降低；△FVC表现出与△FEV1相反的变化趋势，随严重程度增加而增加，但在Ⅱ～Ⅳ级COPD患者之间的差异无统计学意义（P〉0．05）。不同严重程度患者的△FEV1和△FVC变化趋势不同，两者之间仍有显著的相关性，但其相关性随病情严重程度增加而降低。结论COPD患者对支气管舒张剂的流速反应和容积反应有明显差异，表现为流速反应随COPD严重度增加而显著降低，容积反应则随严重度增加而呈增加。

Objective To compare the differences of flow and volume responses in patients with mild to very severe chronic obstructive pulmonary disease（COPD） in bronchodilatation test. Methods The different changes of FEV1 and FVC in 217 patients with mild to very severe COPD（ GOLD stage Ⅱ -Ⅳ ） after inhaling salbutamol were analyzed retrospectively. Results FEV1 and FVC of the patients with COPD at stage Ⅱ-Ⅳ increased remarkably after inhaling 62 agonist, while there were significant differences between the changes of FEV1 and FVC. Increment of FEV1 and FVC （ AFEV1 and FVC ）, representing flow and volume responses respectively, showed a normal distribution. The majority of patients fell in the range of AFEVl from 0. 00 to 0. 04,0.05 to 0. 09 and 0. 10 to 0. 14 liter,and AFVC from 0. 00 to 0. 09,0. 10 to 0. 19 and 0.20 to 0. 29 liter. There was significant difference of △FEV1 among stage Ⅱ-Ⅳ patients with COPD （P 〈 0. 01 ） , namely more severe the disease less △FEV got. In the other hand AFVC increased along with the progression of COPD ,although no significant difference of AFVC among stage Ⅱ-Ⅳ patients with COPD was found. Though different changes of △FEV1 and △FVC were revealed, there was a positive correlation between △FEV1 and △FVC in patients at each GOLD stage and the correlation became more insignificant with the progression of COPD. Conclusions There are significant differences between post-bronchodilator flow and volume responses in patients with COPD. Flow response decreases remarkably along with the progression of COPD, whereas volume response increases along with the progression of COPD.