吸烟对慢性阻塞性肺疾病患者及健康人肺纤毛运动及肺功能的影响

Effects of smoking on lung mucociliary movement and pulmonary function in patients with chronic obstructive pulmonary disease and healthy people

目的 探讨在慢性阻塞性肺疾病（COPD）患者及健康人中，吸烟对肺纤毛运动及肺功能的影响。方法 选取92例COPD患者（COPD组），其中吸烟48例（COPD吸烟组），不吸烟44例（COPD非吸烟组）；再选取76例健康体检者（对照组），其中吸烟37例（对照吸烟组），不吸烟39例（对照非吸烟组）。均进行糖精试验及肺功能检查，测定黏膜纤毛清除时间（MCT）、用力肺活量（FVC）、第1秒用力呼气容积（FEV1），计算FEV1与FVC比值（FEV1/FVC）和FEV1占预计值百分比（FEV1%pre）。结果 COPD组MCT明显高于对照组[（26.17 ± 19.23）min比（15.28 ± 11.34）min]，FEV1/FVC和FEV1%pre明显低于对照组[（54.25 ± 12.76）%比（83.04 ± 5.98）%和（53.26 ± 9.84）%比（85.38 ± 5.72）%]，差异有统计学意义（P〈0.05）。COPD吸烟组MCT明显高于COPD非吸烟组和对照吸烟组[（30.72 ± 27.37）min比（18.25 ± 8.19）和（18.31 ± 8.17）min]，FEV1/FVC和FEV1%pre明显低于COPD非吸烟组和对照吸烟组[（49.98 ± 11.38）%比（58.00 ± 6.85）%和（80.15 ± 4.67）%、（50.24 ± 8.77）%比（61.31 ± 4.62）%和（82.13 ± 4.58）%]，差异有统计学意义（P〈0.05）。COPD非吸烟组MCT明显高于对照非吸烟组，FEV1/FVC和FEV1%pre明显低于对照非吸烟组，差异有统计学意义（P〈0.05）。对照吸烟组MCT明显高于对照非吸烟组[（18.31 ± 8.17）min比（11.26 ± 7.53）min]，差异有统计学意义（P〈0.05）；对照吸烟组和对照非吸烟组FEV1/FVC和FEV1%pre比较差异无统计学意义（P〉0.05）。Pearson相关性分析结果显示，MCT与吸烟强度、年龄呈正相关（r= 0.346和0.256，P〈0.05），与FEV1/FVC和FEV1%pre呈负相关（r=-0.327和-0.414，P〈0.05）。结论 吸烟明显影响肺纤毛运动功能，并且可使COPD患者的肺功能恶化。

Objective To observe the effects of smoking on lung mucociliary movement and pulmonary function in patients with chronic obstructive pulmonary disease （COPD） and healthy people.Methods Ninety-two patients with COPD （COPD group） were selected, including 48 smoking patients （COPD smoking group） and 44 non-smoking patients （COPD non-smoking group）. Another 76 healthy people （control group） were selected, including 37 smokers （control smoking group） and 39 non-smokers （control non-smoking group）. The saccharin test and pulmonary function were carried out respectively, including mucociliary clearance time （MCT）, forced vital capacity （FVC） and forced expired volume in 1 s （FEV1）, and the ratio of FEV1 and FVC （FEV1/FVC） and FEV1 percentage of predicted （FEV1%pre） were calculated.Results The MCT in COPD group was significantly higher than that in control group： （26.17 ± 19.23） min vs. （15.28 ± 11.34） min, the FEV1/FVC and FEV1%pre were significantly lower than those in control group： （54.25 ± 12.76）% vs. （83.04 ± 5.98）% and （53.26±9.84）% vs. （85.38 ± 5.72）%, and there were statistical differences （P〈0.05）. The MCT in COPD smoking group was significantly higher than that in COPD non-smoking group and control smoking group： （30.72 ± 27.37） min vs. （18.25 ± 8.19） and （18.31 ± 8.17） min, the FEV1/FVC and FEV1%pre were significantly lower than those in COPD non-smoking and control smoking group： （49.98 ± 11.38）% vs. （58.00 ± 6.85）% and （80.15 ± 4.67）%, （50.24 ± 8.77）% vs. （61.31 ± 4.62）% and （82.13 ± 4.58）%, and there were statistical differences （P〈0.05）. The MCT in COPD non-smoking group was significantly higher than that in control non-smoking group, the FEV1/FVC and FEV1%pre were significantly lower than those in control non-smoking group, and there were statistical differences （P〈0.05）. The MCT in control smoking group was significantly higher than that in control non-smoking group： （18.31 ± 8.17） min vs. （11.26 ± 7.53） min, and there were statistical differences （P〈0.05）. There were no statistical differences in FEV1/FVC and FEV1%pre between control smoking group and control non-smoking group （P〉0.05）. The Pearson correlation analysis result showed that there was positive correlation between MCT and smoking intensity, age （r= 0.346 and 0.256, P〈0.05）, and there was negative correlation between MCT and FEV1/FVC, FEV1%pre （r=-0.327 and-0.414, P〈0.05）.Conclusions Smoking can destroy the mucociliary function and aggravate the deterioration of lung function in patients with COPD.