脉冲震荡法对慢性阻塞性肺疾病严重程度评估的临床意义

The clinical significance of impulse osciilometry system in the assessment of the severity of chronic obstructive pulmonary disease

目的 通过对慢性阻塞性肺疾病（COPD）稳定期患者进行脉冲震荡（IOS）及常规肺功能FEV1%pre和FEV1/FVC测定，探讨脉冲震荡法对慢性阻塞性肺疾病严重程度评估的临床意义。方法 收集2014年7月至2015年6月于山西大医院确诊为COPD稳定期的患者214例，根据GOLD（2011版）联合评估的方法将其分为A、B、C和D四组。选同期体检人员41例作为健康对照组，分别进行IOS（Z5、R5、R20、R5-R20、X5、Fres）及常规肺功能（FEV1%pre、FEV1/FVC）检测。结果 1. COPD组男性164例，女性50例，平均年龄63.6±9.5岁；其中A组48例、B组68例、C组55例、D组43例。健康对照组男性26例，女性15例，平均年龄54.6±10.4岁。两组性别及平均年龄差异无统计学意义。2. COPD组IOS中Z5、R5、R20和R5-R20分别为（0.70±0.30）、（0.62±0.25）、（0.36±0.12）和（0.26±0.18）kPa/L/s，Fres为（28.71±9.07）Hz 及常规肺功能中FEV1%pre和FEV1/FVC分别为（50.83±21.91）和（51.57 ±11.29）%均较健康对照组显著增高（P均〈0.05）。X5为（-0.31±0.19）kPa/L/s，较健康对照组显著减低（P〈0.05）。3. COPD患者A、B、C和D四组IOS中Z5、R5、R5﹣R20和Fres呈上升趋势，X5呈下降趋势。A、B、C三组间比较差异均有显著性（P均〈0.05）。4.COPD患者IOS中Z5、R5、R5-R20和Fres与FEV1%pre均呈显著负相关（P均〈0.05），其中Fres与FEV1%pre相关性最大（r=﹣0.599）；X5与FEV1%pre呈显著正相关（P〈0.05）。COPD患者A、B、C和D四组IOS中各指标与FEV1%pre相关性逐渐降低。A、B、C三组间比较差异均有显著性（P均〈0.05）。结论 IOS 测定能较好地反映不同组别COPD患者气道阻力的变化，可更好地评估COPD 患者疾病严重程度,尤其适用于老年患者。

Objective By measure Impulse oscillometry system（IOS） and routine pulmonary function FEV1%pre and FEV1/FVC with stable chronic obstructive pulmonary disease（COPD）,discuss Impulse oscillometry system for chronic obstructive pulmonary disease severity evaluation of clinical significance. Methods Collected 214 cases in Shanxi dayi hospital diagnosed with stable COPD in July 2014 to June 2015, according to the GOLD （2011 edition） joint assessment method it can be divided into four groups A, B, C and D. Choose the health examination persons 41 cases for the same period as the healthy control group. IOS （Z5、R5、R20、R5-R20、X5、Fres） measurements and routine pulmonary function （FEV1%pre、FEV1/FVC） were performed for all the healthy subjects and patients. Results 1. In COPD, there were 164 males and 50 females, the mean age was 63.6±9.5 yrs. Among them, 48 cases in group A, 68 cases in group B, 55 cases in group C and 43 cases in group D. In healthy control group, there were 26 males and 15 females, the mean age was 54.6±10.4 yrs. There was no significant difference in gender and mean age between COPD and healthy control group. 2. In COPD group, Z5、R5、R20 and R5-R20 of IOS were （0.70±0.30）、（0.62±0.25）、（0.36±0.12）and（0.26±0.18）kPa/L/s respectively, Fres was （28.71±9.07）Hz;FEV1%pre and FEV1/FVC were （50.83±21.91）and（51.57 ±11.29）%,significantly higher than the control group （P 〈0.05）. X5 was （-0.31±0.19）kPa/L/s, which was significant reduced （P 〈0.05）.3. COPD patients with A, B, C and D four groups Z5, R5, R5-R20 and Fres increased, X5 decreased. Significant differences were detected among A, B and C groups （P 〈0.05）. 4. In COPD patients, Z5, R5, R5-R20 and Fres were significantly negatively correlated with FEV1%pre, which Fres and FEV1%pre correlation is the biggest（r=﹣0.599）; X5 was significantly positively correlated with FEV1%pre. Among A, B, C and D four groups , IOS in each parameter and FEV1%pre correlation gradually decreased. Significant differences were detected among A, B and C groups （P 〈0.05）. Conclusion IOS can better reflect the changes of airway resistance in different groups of patients with COPD, and can better assess the severity of disease in patients with COPD, especially in elderly patients.