哮喘-COPD重叠与哮喘及COPD临床特征的对比分析

Comparative analysis of clinical features of asthma-COPD overlap,asthma and COPD

目的 分析哮喘-COPD重叠(ACO)的临床特征,并与哮喘及COPD进行对比,有助于ACO的早期诊疗.方法 收集南京医科大学第一附属医院呼吸与危重症医学科2014~2018年住院的140例哮喘急性发作或COPD急性加重患者.分为:ACO组(40例),哮喘组(50例),C O PD组(50例).分析3组患者一般资料、实验室检查、影像学检查、肺功能及住院情况的差异,并评估通过临床资料从哮喘及COPD患者中初步筛选ACO患者的可行性.结果 ACO组平均年龄及吸烟患者比例高于哮喘组(P<0.01),而低于COPD组(P<0.01).ACO组中血嗜酸粒细胞(eosnophils,EOS)计数≥300/μl者占17.5%,血清总IgE升高者占55%,均高于COPD组(P<0.05);ACO组中血中性粒细胞百分比(NE%)升高者占47.5%,C-反应蛋白(CRP)升高者占22.5%,均高于哮喘组(P<0.05).ACO组第1秒用力呼气容积(FEV1)与FVC比值(FEV1/FVC)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、最大呼气流量占预计值百分比,肺一氧化碳弥散量占预计值百分比均低于哮喘组(P<0.05).ACO组残气容积占肺总量百分比高于哮喘组(P<0.05),低于COPD组(P<0.01).ACO组口服激素时间较COPD组长(P<0.05),使用吸入性糖皮质激素的患者比例较COPD组高(P<0.01),抗生素使用时间与COPD组比较,差异无统计学意义(P>0.05).综合分析患者年龄、吸烟史、血NE% 、胸部CT表现,鉴别ACO与哮喘患者的敏感度为90%,特异度为76%.综合分析患者性别、吸烟史、过敏史、血EOS计数、血清总IgE,鉴别ACO与COPD患者的敏感度为70%,特异度为76%.结论 ACO 的临床表现与哮喘及COPD有较多相似 ,同时具有其独特性 ,通过分析部分临床资料可初步鉴别 ACO 与哮喘及C O PD.

Objective To analyzing and comparing the clinical features of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) with asthma and COPD to promote the early diagnosis and treatment of ACO .Methods A total of 140 patients with either COPD or asthma hospitalized in the First Affiliated Hospital of Nanjing Medical University from 2014 to 2018 were recruited ,divided into three groups:ACO group ( 40 cases) ,asthma group ( 50 cases) , and COPD group ( 50 cases ) . The differences of demographic characteristics , laboratory examinations ,imaging features , lung functions and hospitalization conditions among the three groups were analyzed to evaluate the feasibility of initially screening ACO patients from those with asthma or COPD by clinical data .Results The mean age and proportion of smokers of ACO group were higher than asthma group ( P < 0 .01) and lower than COPD group ( P < 0 .01) .17 .5%patients with ACO had blood eosinophils ≥300/μl ,and 55% patients with ACO showed elevated serum total IgE ,both significantly higher than COPD group ( P < 0 .05) .47 .5% patients with ACO showed elevated blood neutrophils ,and 22 .5% patients with ACO showed elevated C-reactionprotein(CRP) ,both significantly higher than asthma group ( P <0 .05) .The average values of forced exhalation volume in the first second ( FEV 1 )/FVC ( FEV1/FVC ) ,forced exhalation volume in the first second per predicted ( FEV1% pred) ,peak expiratory flow per predicted and diffusing capacity of the lung for carbon monoxide per predicted of ACO group were lower than those of asthma group respectively ( P <0 .05) .Resistor variable/total lung capacity per predicted of ACO group was significantly higher than that of asthma group ( P <0 .05) ,but lower than that of COPD group ( P <0 .01) .The duration of oral glucocorticoids in ACO group was significantly longer than that of COPD group ( P <0 .05) ,and the proportion of using inhaled glucocorticoids (97 .5% ) was significantly higher than that of COPD group ( P < 0 .01) ,while the duration of using antibiotics showed no significant difference from that of COPD group ( P > 0 .05 ) .By comprehensive analysis of age , smoking history , blood neutrophils and chest CT features , the sensitivity and specificity of differentiating ACO from asthma were calculated to be 90% and 76%respectively . By comprehensive analysis of gender , smoking history , allergy history , blood eosinophils and serum total IgE ,the sensitivity and specificity of differentiating ACO from COPD were calculated to be 70% and 76% respectively .Conclusions ACO has its own unique features , although there are many clinical manifestations similar to asthma and COPD .It is beneficial for identifying ACO from asthma or COPD preliminarily by means of comprehensive analysis of clinical data .