老年人肺通气功能非特异性表现的演变初探

The preliminary exploration of evolution of nonspecifie manifestations of pulmonary function in elderly people

目的探讨老年人肺通气功能非特异性表现的演变。方法选取2004年1月至2012年12月我院临床资料保留完整的老年体检者中同一台肺功能机中符合肺通气功能非特异性表现（NSPF）、且截至2013年12月31日至少复查过1次肺功能者进行回顾性研究，根据肺功能随访转归，将人组者分为阻塞组、限制组、NSPF组和正常组，各组间进行对照分析，采用Kaplan-Meier方法对老年NSPF患者转归进行分析，并进行Log—rank检验比较不同转归的差异，应用Cox回归进行不同转归的单因素和多因素分析。结果符合条件的老年人共59例，男女比例52：7，平均年龄（71．8±8．8）岁，中位随访时间4年。各组年龄、性别、体质指数（BMI）、吸烟状况、初诊临床表现、胸部CT表现差异均无统计学意义，且随访中患者的临床表现和胸部CT演变情况各组间差异均无统计学意义（均P〉0．05）。NSPF患者肺功能转归为阻塞性、限制性和正常的4年累及发生率分别为19．6％、7．6％和8．8％，且差异有统计学意义（X2=7．411，P=0．024）。肺功能类型维持NSPF不变的占最多数（64．0％），其他最常见转归的类型为阻塞性通气功能障碍。Cox单因素和多因素回归分析结果显示，NSPF转归为阻塞性通气功能障碍与初诊CT发现肺气肿和肺大泡相关（HR=4．325，P=0．045），转归为限制性通气功能障碍与年龄相关（HR=1．143，P=0．020），转归为正常肺功能与胸膜增厚和胸腔积液消失相关（HR=8．889，P=0．018）。结论在老年人群中多数NSPF可以长期存在，其最常见转归的类型为阻塞性通气功能障碍，其演变与初诊CT发现肺大泡和肺气肿可能相关。

Objective To investigate the evolution of nonspecific manifestations of pulmonary function in elderly people. Methods Retrospective analysis of the data of nonspecific pulmonary function（NSPF） on the initial PF testing in elderly people from the same PFT apparatus in Beijing Hospital were collected from January 2004 to December 2012. All the patients with complete clinical data and reexamination at least one time were enrolled into this analysis. NSPF was defined as normal FEV1/FVC and TLC combined with a decreased FEV1 or FVC or both. All the patients with complete clinical data were divided into blocking group, restricted group, NFSP group and normal group according to their PF. The comparison was performed among these groups. Kaplan-Meier was used for analysis of the turnover and outcome of elderly NSPF patients,log-rank test was used for comparing the difference of turnover and outcome and COX regression was used for analyzing single and multiple factors of different turnover and outcome. Results Overall 59 patients were diagnosed as NSPF, with male ： female ratio of 52 ： 7,the average age of（71.8 ± 8.8）years and at a median follow-up of 4 years. The statistically significant differences in age,sex, body mass index（BMI）, smoking status, both the clinical manifestations and chest CT performance at first visit and during the following-up were not found among the groups（all P 〈0. 05）. The pulmonary functions of NSPF patients were transformed into an obstructive pattern（ 19.6 % ）, into a restrictive pattern（7.6%）and into a normal pattern（8.8 % ） in 4 years cumulative incidence rate, with statistically significant in differences（X2 = 7. 411, P = 0. 024）.An invariant pulmonary function in NSPF patients accounted for 64.0% in the most, and the second was obstructive ventilation function disability. Monomial and multinomial Cox regression analysis showed that emphysema and bulla in the initial CT scan was the predictor of the change to the obstructive pattern from NSPF during follow-up（HR=4. 325 ,P=0. 045） ,age was the predictor of the change to the restrictive pattern（HR= 1. 143, P = 0. 020）. And pleural thickening and disappearing of pleural effusion were the predictor of change to the normal pattern （FIR = 8. 889, P = 0. 018） respectively. Conclusions Most NSPF in elderly people could exist consistently. Obstructive pattern is the maximal likelihood of NSPF changing to the other pattern. Emphysema and bulla in the initial CT scan is the predictor of the obstructive pattern. The change is related with emphysema and bulla in the initial CT scan.