哮喘慢阻肺重叠综合征与单纯慢性阻塞性肺疾病的病例对照研究

Case-control Study on Asthma-COPD Overlap Syndrome and Chronic Obstructive Pulmonary Disease

目的探讨哮喘慢阻肺重叠综合征(ACOS)与单纯慢性阻塞性肺疾病(简称慢阻肺)临床特点的不同之处,以提高临床医师关于两种疾病的认识及诊疗水平。方法收集2013年3月至2014年9月在福建省立医院呼吸科住院确诊为慢阻肺的患者,将其分为ACOS组及单纯慢阻肺组,比较分析两组患者的临床表现、实验室检查结果、治疗方案及治疗反应等临床资料。结果 139例纳入患者中,ACOS组46例(33.1%),单纯慢阻肺组93例(66.9%)。ACOS组较单纯慢阻肺组吸烟史比例低(80.4%比93.5%),大多数患者有既往哮喘史(89.1%比4.3%)、过敏史(60.9%比9.6%)以及明显的气道高反应性(80.4%比6.5%),差异均有统计学意义(P<0.05)。ACOS组以气促症状首发的比例高于单纯慢阻肺组(26.1%比8.6%),肺部体征方面更易闻及干湿性啰音并存(67.4%比31.2%),实验室检查结果提示血嗜酸粒细胞比例增高(21.7%比5.4%),Ig E水平升高(18.3%比4.3%),差异均有统计学意义(P<0.05)。治疗方面,ACOS组更倾向于使用糖皮质激素(58.7%比24.7%),且用量大(80 mg),差异均有统计学意义(P<0.05)。结论单纯慢阻肺和ACOS为慢阻肺的两种亚型,ACOS患者较单纯慢阻肺患者更易表现为喘息,双肺更易闻及干湿性啰音并存,血嗜酸粒细胞比例、Ig E水平明显升高,对糖皮质激素治疗反应较好。

Objective To investigate and compare the clinical characteristics of chronic obstructive pulmonary disease（ COPD） and asthma-COPD overlap syndrome（ ACOS）. Methods A case-control study was conducted in 139 patients with COPD who admitted between March 2013 and September 2013. The patients were divided into a COPD-only group and an ACOS group. Clinical data were collected and compared between two groups. Results Of all 139 patients,93 patients were diagnosed with COPD only（ 66. 9%） and 46 patients were diagnosed with ACOS（ 33. 1%）. Compared with the COPD-only group,the ACOS group had a lower ratio of exposure to cigarette smoking（ 80. 4% vs. 93. 5%）,but high possibility of a history of asthma（ 89. 1% vs. 4. 3%）,allergies（ 60. 9% vs. 9. 6%） and airway hyperreactivity（ 80. 4%vs. 6. 5%）（ P 0. 05）. In clinical symptoms,the ACOS group had a higher ratio of breathless as the first complaint of symptom（ 26. 1% vs. 8. 6%） and dry and moist rales in lung by auscultation（ 67. 4% vs.31. 2%）（ P 0. 05）. In laboratory examination,the ACOS group had increased levels of peripheral blood eosinophils and Ig E than those of the COPD-only group（ 21. 7% vs. 5. 4%,18. 3% vs. 4. 3%,P 0. 05）.In treatment,the ACOS group was more likely to use systemic glucocorticoid（ 58. 7% vs. 24. 7%） and be treated with higher dosage of glucocorticoid（ 80 mg,P 0. 05）. Conclusions ACOS and COPD-only are two subtypes of COPD. Compared with COPD-only patients,ACOS patients might be more likely to be breathless and have dry and moist rales in clinical symptoms,more likely to have increased levels of peripheral blood eosinophils and Ig E in blood test,and more inclined to receive systemic glucocorticoid treatment.