无创通气和慢性阻塞性肺疾病急性加重次数和持续时间关系的初步研究

A preliminary study on the relationship between noninvasive ventilation and the number and duration of acute exacerbation of chronic obstructive pulmonary disease

目的评估无创正压通气(noninvasive positive pressure ventilation,NPPV)对慢性阻塞性肺疾病(COPD)急性加重次数和持续时间的影响,及对C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)表达的影响。方法选择河南科技大学第一附属医院收治的98例65岁以上稳定期COPD合并高碳酸血症患者,简单随机分组随机分为NPPV组和无NPPV组。NPPV组在常规治疗基础上,接受双水平气道正压通气,2组均检测B-型脑钠肽(brain natriuretic peptide,BNP)、CRP和IL-6水平,检查肺功能、动脉血气、6 min步行距离(6MWD),记录圣乔治呼吸调查问卷(SGRQ)。所有病例跟踪随访12个月。结果 12个月后,NPPV组吸药前后第1秒用力肺活量(FEV_1)占预计值百分比(FEV_1%pred)、动脉氧分压(Pa O_2)、SGRQ、6MWD较无NPPV组升高,差异有统计学意义(均P<0.05);NPPV组动脉二氧化碳分压(Pa CO_2)、COPD急性加重次数、加重持续时间、BNP较无NPPV组降低,差异有统计学意义(均P<0.05)。NPPV组CRP、IL-6分别低于无NPPV组,差异有统计学意义(均P<0.05)。COPD急性加重次数分别与CRP、IL-6、COPD严重程度分级呈正相关(均P<0.05)。与吸药前、后FEV_1%pred呈负相关(均P<0.05)。多元线性逐步回归分析显示,COPD急性加重次数和未应用无创通气及COPD严重程度有关。结论 NPPV耐受性较好,降低了COPD加重次数和持续时间,其原因可能和CRP、IL-6表达有关。

Objective To assess the efficacy of noninvasive positive pressure ventilation （NPPV） on the number and duration of acute exacerbation of chronic obstructive pulmonary disease （COPD） and on the expressions of C-reactive protein （CRP） and interleukin-6 （IL-6）. Methods This study included 98 stable hypercapnic COPD patients whose age were over 65 years old. The 98 patients who met the study criteria were randomized into the no NPPV group maintained on standard treatment and the NPPV group received hi-level positive pressure ventilation added to their standard treat- ment. Serum Brain Natriuretic Peptide （ BNP）, CRP and IL-6 levels were detected, to check lung function, arterial blood gases, 6-minute walking distance and record Saint George respiratory questionnaire （SGRQ） , all patients were fol- lowed-up 12 months. Results After 12 months of NPPV, forced expiratory volume in one second （FEV1% pred） , arte- rial partial pressure of oxygen （ PaO2 ） , SGRQ, 6MWD were significantly higher in patients with NPPV than those in patients without NPPV, with statistically significant difference （ P 〈 0.05 ）. Decrease in partial pressure of arterial carbondioxide （PaCO2）, number of acute exacerbation of COPD, mean duration of each exacerbation, BNP in patients with NPPV, and there was a statistically significant difference （ P 〈 0.05 ）. The expressions of CRP and IL-6 in patients with no NPPV were significantly higher than those in patients with NPPV （ P 〈 0.05 ）. There were significant positive correla- tions between the number of acute exacerbation of COPD and the level of CRP, and of IL-6 in the whole study groups （ P 〈 O. 05 ）. The frequency of acute exacerbation was significantly associated with COPD classification, which was nega- tively correlated with drugs before and after the FEVj （ % ） , P 〈 0.05. Multiple linear stepwise regression analysis showed that the number of acute exacerbation of COPD was associated with no NPPV, and the severity of COPD. Conclu- sion NPPV bears well tolerance. It can reduce the frequency of acute exacerbation of COPD and mean duration of each exacerbation, because of its relevance to the express of CRP, IL-6.