哮喘慢阻肺重叠综合征的临床特点分析

Clinical Features of Athma-COPD Overlap Syndrome

目的探讨哮喘慢性阻塞性肺疾病重叠综合征(ACOS)与慢性阻塞性肺疾病(COPD)患者临床表现及相关检验指标的差异性。方法收集2015年7月~2016年12月某大学附属医院呼吸内科收治的48例ACOS患者及60例COPD患者的临床资料,比较两者临床特点及实验室指标的差异。结果 ACOS组年龄高于COPD组,吸烟史所占比例、肺部湿啰音所占比例、肺部CT见肺气肿、肺大疱所占比例低于COPD组,过敏史所占比例、首发症状为气促所占比例、肺部体征伴干湿啰音所占比例高于COPD组(P<0.05);ACOS组1秒用力呼吸容积(FEV1)、FEV1/FVC、氧分压(PaO_2)、酸碱值(p H)低于COPD组,二氧化碳分压(PaCO_2)、呼出气一氧化氮(Fe NO)、总免疫球蛋白E(Ig E)、高敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞比率、嗜酸性粒细胞水平均高于COPD组(P<0.05)。结论 ACOS高龄群体所占比例高,大部分均有过敏史,肺部体征以伴干湿啰音多见,患者肺功能受损更严重,气道炎症浸润程度更高。

To discuss the differences in clinical manifestations and related test indexes between patients with asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS)and patients with chronic obstructive pulmonary disease(COPD).A retrospective analysis was made to the clinical data of48patients with ACOS(ACOS group)and60patients with COPD(COPD group and the differences in clinical manifestations and lab test indexes between the2groups were compared.Patients in ACOS group were older than those in COPD group;the proportions of smoking history,lung moist rales,pulmonary emphysema in CT images and bullae of lung in ACOS group were lower than those in COPD group while the proportions of allergic history,shortness of breath as the initial symptom and pulmonary signs with dry and moist rales were higher than those in COPD group(P<0.05);the forced expiratory volume in1second(FEV1),FEV1/FVC,partial pressure of oxygen(PaO2)and pH value(pH)in ACOS group were smaller and lower than those in COPD group while the partial pressure of carbon dioxide(PaCO2),exhaled nitric oxide(FeNO),total immunoglobulin E(IgE),high-sensitivity C reactive protein(hs-CRP),white blood cell count(WBC),the percentage of neutrophils and levels of eosinophils were higher than those in COPD group(P<0.05).The proportion of elderly patients with ACOS is high,and most of them have allergic history,dry and moist rales are common lung signs;the injury to pulmonary function is usually more serious with a higher invasive degree of airway inflammation.