肺功能对稳定期慢性阻塞性肺疾病患者疗效评估的研究

Pulmonary function in evaluating effect of treatment in stable chronic obstructive pulmonary disease patients

目的根据支气管舒张试验结果及气流受限程度分组,比较不同组别的稳定期慢性阻塞性肺疾病(COPD)患者治疗前后主要肺功能指标以及COPD评估测试问卷(CAT)评分的变化,探讨肺功能在稳定期COPD患者疗效评估中的意义。方法选取2013年11月至2014年3月山西大医院呼吸内科就诊的59例稳定期COPD患者,根据舒张试验结果以及气流受限程度分为4组,即舒张试验阳性轻-中度组、舒张试验阳性重-极重度组、舒张试验阴性轻-中度组和舒张试验阴性重-极重度组。根据COPD诊治指南,予以规范治疗1年后,分别比较各组治疗前后主要肺功能指标和CAT评分的变化,利用SPSS 17.0软件进行分析。结果 1舒张试验阳性轻-中度组,用力肺活量(FVC)(3.3±0.7)L、呼气峰值流速(PEF)(5.1±1.1)L/S、CO弥散量(DLCO)(6.4±2.1)mmol·min-1·kPa-1较治疗前[(3.0±0.6)L;(4.5±1.1)L/S;(6.0±1.7)mmol·min-1·kPa-1]增加,差异均有统计学意义(P均<0.05)。2舒张试验阴性重-极重度组中,深吸气量(IC)[(2.2±0.5)L和IC/TLC(44±11)%]较治疗前[(2.0±0.6)L,(39±8)%)]增加,差异均有统计学差异(P均<0.05)。3舒张试验阳性重-极重度和舒张试验阴性轻-中度2组患者上述肺功能指标均无明显变化,差异均无统计学意义(P均>0.05)。4各组患者的CAT评分均有明显下降,差异均有统计学意义(P均<0.05)。结论治疗前后PEF和FVC的变化能够较好地反映气流受限改善的程度,而IC和IC/TLC的变化能够较好地反映肺过度充气改善的程度。

Objective To explore the meaning of pulmonary function indexes in evaluating effect of treatment in on stable COPD patients,through comparing the changes of main pulmonary function indexes and the CAT scores before and after treatment in stable chronic obstructive pulmonary disease（COPD）patients in different groups,which were classified by the results of the bronchial dilation test and airflow limitation degree.MethodsFifty-nine patients with stable COPD from November 2013 to March 2014 were divided into four subgroups：bronchial diastolic positive mild-to-moderate subgroup,bronchial diastolic positive severe-to-very severe subgroup,bronchial diastolic negative mild-to-moderate subgroup and bronchial diastolic negative severe-to-very severe subgroup.We compared changes of the main pulmonary function indexes and CAT scores among patients in these subgroups,who were treated regularly one year according to the guide of COPD diagnosis and treatment.The data was analyzinged using SPSS 17.0software.Results First,in bronchial diastolic positive mild-to-moderate subgroup,FVC（3.3±0.7）L,PEF（5.1±1.1）L/S,DLCO [（6.4±2.1）mmol·min·kPa]increased significantly than pretherapy[（3.0±0.6）L;（4.5±1.0）L/S;（6.0±1.7）mmol·min-1·kPa-1]（all P〈0.05）.Second,in bronchial diastolic negative severe-to-very severe subgroup,IC（2.2±0.5）L and IC/TLC（44±11）%increased significantly than before[（2.0±0.6）L,（39±8）% ]（all P〈0.05）.Third,there were no significant differences in the pulmonary function indexes in bronchial diastolic positive severe-to-very severe subgroup and bronchial diastolic negative mild-to-moderate subgroup（all P〈0.05）.Fourth,the CAT scores were obviously lower than before in the four subgroups（all P〈0.05）.Conclusion The changes of PEF and FVC before and after the treatment can better reflect the improvement of the degree of the airflow limitation,and the improvement of hyperinflation degree could be better reflected by the changes of IC and IC/TLC.