支气管哮喘、慢性阻塞性肺疾病及哮喘-慢性阻塞性肺疾病重叠患者的气道阻力比较

Compare the airway resistance of bronchial asthma, chronic obstructive pulmonary disease and asthma-COPD overlap

目的利用肺功能及脉冲震荡比较支气管哮喘（简称哮喘）、慢性阻塞性肺疾病（cOPD）及哮喘-慢性阻塞性肺疾病重叠（ACO）患者的气道阻力。方法2015年10月至2016年11月就诊于首都医科大学宣武医院呼吸内科的稳定期哮喘患者42例（哮喘组），COPD患者57例（COPD组），AC0患者45例（ACO组），比较3组患者的肺功能及脉冲震荡检查结果。结果哮喘组用力肺活量占预计值百分比（FVC%pred）、第1秒用力呼气容积占预计值百分比（FEV1％pred）、FEV1／FVC、呼气峰流速占预计值百分比（PEF％pred）及最大呼气中段流速均高于COPD组及ACO组，差异均有统计学意义（F值分别为5．840、29．760、18．770、2．024，P值均〈0．05）。COPD组FEV1％pred、PEF％pred均高于ACO组，差异均有统计学意义（F值分别为9．814、2．793，P值均〈0．05）。哮喘组残总比（RV／TLC）低于cOPD组、ACO组，差异均有统计学意义（F值分别为2．000、2．030，P〈0．05），COPD组RV／TLC与AC0组间比较，差异无统计学意义（F=1．830，P〉0.05）。哮喘组CO弥散量占预计值百分比（DL CO％pred）高于ACO组，ACO组高于COPD组，差异有统计学意义（F=3．215，P〈0.05）。哮喘组响应频率（Fres）、周边阻力（Rp）、总气道阻力（R5）、周边气道总阻力（R5-R20）均低于COPD组，COPD组均低于ACO组，差异均有统计学意义（F值分别为3．769、5．321、3．768、5．289，P值均〈0.05）。结论哮喘患者、COPD患者及ACO患者临床上虽有许多相似之处，但是与单纯哮喘患者及COPD患者相比，ACO患者有更严重的气流受限。肺功能中通气功能指标FEV1、PEF及肺弥散功能指标DL CO，脉冲震荡中Rp、Fres、R5、R5-R20都有助于鉴别3组病症，两者方法结合使用更具意义。

Objective To compare the airway resistance of bronchial asthma （asthma）, chronic obstructive pulmonary disease （COPD） and asthma-COPD overlap （ACO）. Methods Patients admitted to pneumology department of Xuanwu Hospital from October 2015 to November 2016 were recruited as study subiects, including 42 patients with asthma, 57 patients with COPD and 45 patients with ACO. Three groupsr respiratory obstruction indexes were compared. Results The indexes, including forced vital capacity as percentage of predicted volume （FVC% pred）, forced expiratory volume in one second as percentage of predicted volume （FEV1% pred）, the ratio of FEV,/FVC, peak expiratory flow as percentage of predicted volume （PEF% pred）, the ratio of residual volume/total lung capacity （RV/TLC） in asthma patients were significantly higher than those in COPY） patients and ACO patients （ F = 5. 840, 29. 760,18. 770,2. 024, all P 〈 0.05）. The indexes, including FEV1% pred, PEF% pred in COPD were significantly higher than those in ACO patients （ F =9. 814, 2. 793, all P 〈 0.05）. The CO diffusing capacity values as percentage of predicted volume （DLCO% pred） in asthma patients was significantly higher than that in ACO patients, in ACO patients was higher than that in COPD patients （ F = 3. 215, P % 0.05）. The lOS parameters, including peripheral resistance （Rp）, resonant frequency （Fres）, resistance at 5Hz（R5）, R5-R20 in asthma patients were significantly lower than those in COPD patients, and in COPD patients were significantly lower than those in ACO patients （ F = 3. 769,5. 321,3. 768,5. 289, all P 〈0.05）. Conclusions The airway limitation was severer in ACO patients than that in asthma and COPD patients. The indexes of pulmonary function test, including FEV1, PEF, DLCO and the IOS parameters, including Rp, Fres, R5, RS-R20 are helpful to identify three diseases.