不同HRCT表型的COPD患者对长效β_2受体激动剂/吸入型糖皮质激素的治疗应答性比较

Comparison of therapeutic response of different HRCT phenotypes of COPD patients to long-term 2 receptor agonists/inhaled corticosteroids

目的:探讨不同高分辨CT(HRCT)表型的慢性阻塞性肺疾病(COPD)患者对长效β_2受体激动剂/吸入型糖皮质激素治疗的应答性。方法:选取217例COPD患者,根据HRCT表现分为A型72例、E型80例和M型65例,观察3组治疗前、后肺功能情况[第1秒用力呼气容积占预计值百分比(FEV_1%预计值)、残气量占预计值百分比(RV%预计值)、深吸气量占预计值百分比(IC%预计值)、FEV_1/FVC、肺总量百分比(TLC%预计值)、第1秒用力呼气容积(FEV_1)、肺总量(TLC)、深吸气量(IC)、残气量(RV)]。结果:M型体重指数(BMI)为(20.12±3.22)kg/m^2,明显低于A型和E型组(P<0.05);M型组FEV_1%预计值和RV%预计值分别为(47.52±9.80)%和(138.89±52.29)%,明显低于A型和E型组(均P<0.05),IC%预计值为(87.71±13.26)%,明显高于A型和E型组(P<0.05)。治疗后A型组FEV_1、TLC、IC和RV改善值分别为(0.35±0.09)L、(-0.53±0.12)L、(0.17±0.06)L和(-0.60±0.11)L,明显优于E型和M型组(均P<0.05)。结论:不同HRCT表型的COPD患者对长效β_2受体激动剂/吸入型糖皮质激素的治疗存在差异,其中A型COPD的疗效较好,肺功能改善明显。

Objective： To investigate the therapeutic responses of different high-resolution CT（ HRCT） phenotypes of chronic obstructive pulmonary disease（ COPD） patients to long-term 2 receptor agonist/inhaled glucocorticoids. Methods：217 patients with COPD were selected. According to the HRCT findings,there were 72 cases of type A,80 cases of type E,and 65 cases of type M. The pulmonary function（ FEV1% forecast value,RV% forecast value,IC% forecast value,FEV1/FVC,TLC% forecast value,FEV1,TLC,IC,RV） was observed before and after treatment. Results： The body mass index（ BMI） in type M group [（ 20. 12 ± 3. 22） kg/m^2]was significantly lower than that in type A group and type E group（ P〈0. 05）. FEV1 percent predicted（ FEV1% predicted） and residual volume percent predicted（ RV% predicted） in type M group were（ 47. 52 ± 9. 80） % and（ 138. 89 ± 52. 29） % respectively,significantly lower than in the type A group and type E group（ P〈0. 05）; inspiratory capacity percent predicted（ IC% predicted） was（ 87. 71 ± 13. 26） % in the type M group,significantly higher than that in the type A group and type E group（ P〈0. 05）. The improved values of forced expiratory volume in one second（ FEV1）,total lung capacity（ TLC）,inspiratory capacity（ IC） and residual volume（ RV） in the type A group after treatment were（ 0. 35 ± 0. 09） L,（-0. 53 ± 0. 12） L,（ 0. 17 ± 0. 06） L and（-0. 60 ± 0. 11） L respectively,significantly superior to those in the type E group and type M group（ P〈0. 05）. Conclusion： There are differences in the curative effectiveness of long-term 2 receptor agonist/inhaled corticosteroid in patients with different HRCT phenotypes of COPD,among which the treatment effect of type A COPD is better,and the lung function is improved obviously.