大肠湿热型和脾气虚弱型溃疡性结肠炎患者肺功能损伤的研究

Study on Pulmonary Function Abnormalities in Syndromes of Colorectal Damp-heat and Deficiency of Spleen Qi of Patients with Ulcerative Colitis

目的：基于传统中医学＂肺与大肠相表里＂的理论,研究大肠湿热型和脾气虚弱型溃疡性结肠炎（UC）患者合并肺功能损伤的临床表现及其特征。方法：纳入91例UC患者,其中大肠湿热组46例,脾气虚弱组45例。调查性别、年龄、吸烟史、病程、用药史等人口学指标,肺部症状评分,疾病活动度指数,检查肠镜,胸部X摄片,检测肺功能指标包括肺活量（VC）、第1秒用力呼气容积（FEV1）、第1秒的用力呼气量占用力肺活量的百分率（FEV1/FVC）,50%用力肺活量时的呼气流速（FEF50）、75%用力肺活量时呼气流速（FEF75）,残气容积（RV）、肺总量（TLC）、残气容积与肺总量的比（RV/TLC）,一氧化碳弥散量（DLCO）,肺一氧化碳弥散量/肺泡通气量（DLCO/VA）。结果：91例患者中,有咳嗽、气短、胸闷、咳痰等症状中1项或1项以上者68例（74.7%）;其中大肠湿热组比脾气虚弱组更多出现咳嗽、气短、胸闷肺部症状病例。77例出现通气、换气肺功能指标1项或多项异常（84.6%）。大肠湿热组大气道功能指标FEV1和FEV1/VC值低于脾气虚弱组（分别P〈0.05,P〈0.01）;大肠湿热组小气道功能指标FEF50和FEF75明显低于脾气虚弱组（均P〈0.01）;脾气虚弱组残气功能指标RV、TLC和RV/TLC显著高于大肠湿热组（分别P〈0.01、P〈0.01和P〈0.05）。结论：UC具有较高的并发肺部症状、胸部影像学异常和肺功能指标异常发生率,大多数病例存在通气、换气肺功能指标异常。大肠湿热组比脾气虚弱组更多出现肺部症状。大肠湿热组倾向于出现大气道和小气道功能损伤,而脾气虚弱组易于表现为残气功能损伤。

Objectives： To study the pulmonary function injury in syndromes of colorectal damp-heat and deficiency of spleen qi of patients with ulcerative colitis（ UC） based on the theory of the interior-exterior relationship between lung and large intestine. Methods： Ninety-one UC patients were enrolled,including 46 patients with syndrome of colorectal damp-heat and 45 patients with syndrome of deficiency of spleen qi. The demography indexes such as gender,age,the disease course,smoking and medication histories were surveyed. The scores of the TCM syndrome and the symptom of the lung,the disease activity index（ DAI）,the colonoscopy,the chest radiograph and the pulmonary function test（ PFT）were also examined. The PFT parameters included ventilation capacity（ VC）, forced expiratory volume at 1 st s（ FEV1）,forced expiratory volume at 1 st s/forced volume capacity（ FEV1/FVC）,maximal expiratory flow in 50% vital capacity（ FEF50）,maximal expiratory flow in 75%（ FEF75）,residual volume（ RV）,total lung capacity（ TLC）,re-sidual volume/total lung capacity（ RV/TLC）,diffusion capacity for carbon monoxide of lung（ DLCO）,diffusion capacity for carbon monoxide of lung/alveolar ventilation（ DLCO/VA）. Results： There were 68 cases with one or more symptoms like cough,shortness of breath,chest tightness,sputum and other pulmonary symptoms,accounting for 74. 7%.The cases of symptoms like cough,shortness of breath and chest tightness in syndrome of colorectal damp-heat group were more than those of deficiency of spleen qi group. A pulmonary function abnormality was present in 77 cases（ 84. 6%）. The large airways function parameters FEV1 and FEV1/VC values were significantly lower in the syndrome of colorectal damp-heat than those in the syndrome of deficiency of spleen qi（ P 0. 05,P 0. 01,respectively）. The small airways function parameters FEF50 and FEF75 values were significantly lower in the syndrome of colorectal damp-heat than those in the syndrome of deficiency of spleen qi（ all P 0. 05）,while the residual gas functional indicators RV,TLC and RV/TLC values were significantly higher in the syndrome of deficiency of spleen qi than those in the syndrome of colorectal damp-heat（ P 0. 01,P 0. 01,and P 0. 05 respectively）. Conclusion： The incidence of the concurrent pulmonary symptoms and abnormalities in chest radiography and PFT were higher in UC. The majority of patients presented abnormal ventilation PFT parameters. The more pulmonary symptoms occurred in the syndrome of colorectal damp-heat than that in the syndrome of deficiency of spleen qi. The patients with the syndrome of colorectal damp-heat tended to appear the injury of large and small airway function,while the patients with the syndrome of deficiency of spleen qi were more prone to the injury of the residual gas function.