支气管哮喘慢性阻塞性肺病重叠综合征的患病人群特征调查及应对治疗策略

Investigation on the characteristics of patients with overlap syndrome of bronchial asthma and chronic obstructive pulmonary disease and the corresponding treatment strategy

目的调查支气管哮喘-慢性阻塞性肺病重叠综合征(ACOS)的患病人群特征,旨在为ACOS患者的治疗作出最佳的选择。方法选取2015年12月~2016年8月广州市南沙区第六人民医院收治的82例ACOS患者(ACOS组),均给予孟鲁司特治疗,1次/d,10 mg/次,于睡前服用,疗程为12周。另选择我院同期收治的100例慢性阻塞性肺病患者(COPD组)及85例哮喘患者(哮喘组)的临床资料进行回顾性分析,并对三组患者的一般情况、肺功能、诱导痰细胞嗜酸粒细胞(EOS)百分比、呼出气一氧化氮(FENO)水平、圣乔治呼吸问卷(SGRQ)评定和2年内急性加重次数进行调查分析。结果三组患者的性别、民族、教育程度、医疗保障指标比较差异均无统计学意义(P>0.05);ACOS组的平均年龄、儿童时期下呼吸道感染频繁者比例,2年内FEV1每年下降水平、SGRQ评分、2年内急性加重次数指标均明显高于COPD组和哮喘组,差异有统计学意义(P<0.05);ACOS组患者的体重指数、弥散功能DLCO/VA(%)等指标均明显低于COPD组和哮喘组,差异有统计学意义(P<0.05);ACOS患者治疗后的FEV1、FEV1%、PEF和PEF%水平明显高于治疗前,差异均有统计学意义(P<0.05)。结论 ACOS在临床上肺功能下降更快,健康相关生活质量差,易于反复急性加重。孟鲁司特治疗能有效改善ACOS患者的肺功能,为临床研究提供有力的依据。

Objective To investigate the characteristics of the patients with overlap syndrome of bronchial asthma and chronic obstructive pulmonary disease （ACOS） in order to make the best choice for the treatment of ACOS patients. Methods A total of 82 patients with ACOS （ACOS group） treated in the Sixth People＇s Hospital of Nansha District in Guangzhou City from December 2015 to August 2016 were selected.they were treated by Montelukast lO mg each time, once per day.The drug should be taken before sleep and course of treatment was lasted for 12 weeks.The clinical data from the other two groups of 100 patients with chronic obstructive pulmonary disease （COPD group） and 85 asthmatic patients （asthma group）in the same period were retrospectively analyzed.The general condition,pulmonary function,pro- portion of induced sputum cell eosinophil granulocyte （EOS）,fraetional exhaled nitric oxide （FENO）,St. George respira- tory questionnaire （SGRQ） assessment,and frequency of acute exacerbations within 2 years were investigated and ana- lyzed among three groups.Results There were no statistical differences in gender, ethnics,educational background,and health care （P〉0.05）.In the ACOS group,average age,proportion of frequent lower respiratory tract infection in children, yearly decreasing level of forced expiratory volume in one second （FEVj） within 2 years,SGRQ score,and frequency ofacute exacerbations within 2 years were much higher than those in the COPD group and asthma group,which were displayed statistical differences （P〈0.05）.In the ACOSgroup,the indexes of body mass index and diffusion function DLCO/VA （%） were both greatly lower in comparison with those in the COPD group and asthma group with statistical differences （P〈0.05）.For ACOS patients,the levels of FEV1, FEVl%,peak expiratory flow （PEF）,and PEF% were all much higher compared with those before treatment with statisti- cal differences （P〈0.05）.Conclusion In clinic,pulmonary function decreases fast in ACOS patients,quality of life-related with health is poor,and is inclined to repeated acute exacerbations.Montelukast therapy can effectively enhance pul- monary function in ACOS patients and provide a strong basis for clinical research.