哮喘-慢性阻塞性肺疾病重叠综合征40例临床特点分析

Analysis of clinical features of 40 cases with asthma-chronic obstructive pulmonary overlap syndrome

目的分析哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者临床特征.方法收集2015年1月至2017年12月舟山医院收治的ACOS、哮喘和慢性阻塞性肺疾病(COPD)住院患者各40例作为研究对象,比较三组患者的一般资料指标、实验室检查指标、肺功能检测指标以及支气管舒张试验后的一秒用力呼气容积(FEV1)变异率.结果哮喘组、ACOS组和COPD组患者的年龄[(45.36±5.27)岁比(54.45 ±4.69)岁比(67.57 ±5.18)岁,F=9.334,P=0.004]、吸烟史患者比例(92.50%比75.00%比60.00%,χ^2=11.550,P=0.003)以及家族哮喘史比例(7.50%比20.00%比30.00%,χ^2=6.562,P=0.038)差异均有统计学意义;哮喘组、ACOS组和COPD组患者的外周血嗜酸性粒细胞百分比[(8.46±0.94)%比(6.13±0.78)%比(3.75±0.45)%,F=11.626,P=0.001]和血清IgE水平[(353.41 ±45.74) IU/mL比(252.65±30.45) IU/mL比(155.26±22.77) IU/mL,F=7.605,P=0.001]依次降低,差异均有统计学意义;ACOS组的一秒用力呼气容积/用力肺活量的比值(FEV1/FVC%)[(54.26±6.86)%比(72.43±8.52)%,t=10.506,P=0.001]与第1秒用力呼气容积占预计值百分比(FEV1% pred)[(50.35±6.22)%比(62.60±7.52)%,t=7.939,P=0.001]低于哮喘组,但与COPD组差异无统计学意义[(54.26±6.86)%比(53.88±7.25)%,t=0.241,P=0.810和(50.35±6.22)%比(50.56±6.46)%,t=0.148,P=0.883];ACOS组小气道功能障碍的比例高于哮喘组(82.50%比57.50%,χ^2=5.952,P=0.015),但与COPD组差异无统计学意义(82.50%比85.00%,χ^2=0.092,P=0.762);ACOS组的残气量/肺总量比值(RV/TLC%)高于哮喘组[(46.71±5.31)%比(32.46±4.52)%,t=12.924,P=0.001],但与COPD组差异无统计学意义[(46.71±5.31)%比(46.92±5.75)%,t=0.170,P=0.866];ACOS组的一氧化碳弥散量与肺泡气量之比(DLCO%)低于哮喘组[(64.37±4.66)%比(82.62±4.53)%,t =17.760,P=0.001],但高于COPD组[(64.37±4.66)%比(51.25±4.35)%,t=13.017,P=0.001];支气管舒张试验后,ACOS患者的FEV1变异率高于COPD组[(20.86±2.05)%比(6.52±0.55)%,t=42.730,P=0.001],但与哮喘组差异无统计学意义[(20.86±2.05)%比(21.13±2.14)%,t=0.576,P=0.566].结论相对于哮喘,ACOS患者年龄偏大,外周血嗜酸粒细胞百分比和血清IgE水平更低,肺通气功能较低,小气道功能障碍及残气量更显著,肺弥散功能较低,嗜酸性粒细胞气道炎性反应较轻;与COPD患者相比,ACOS患者则年龄偏小,外周血嗜酸粒细胞百分比和血清IgE水平更高,肺弥散功能较好,嗜酸性粒细胞气道炎性反应较重.

Objective To analyze the clinical characteristics of patients with asthma-chronic obstructive pulmonary overlap syndrome (ACOS).Methods From January 2015 to December 2017,40 patients with ACOS,40 patients with asthma and 40 patients with chronic obstructive pulmonary disease (COPD) in Zhoushan Hospital were collected.The general information,laboratory test indicators,lung function test indicators and FEV1 mutation after bronchodilator test were compared among the three groups.Results There were statistically significant differences in age[(45.36 ±5.27) vs.(54.45 ±4.69) vs.(67.57 ±5.18),F=9.334,P=0.004],the proportion of smoking patients (92.50% vs.75.00% vs.60.00%,χ^2 =11.550,P =0.003),and the proportion of family history of asthma (7.50% vs.20.00% vs.30.00%,χ^2 =6.562,P =0.038) among the patients with ACOS,asthma and COPD.The percentage of eosinophils in peripheral blood [(8.46 ± 0.94) % vs.(6.13 ± 0.78) % vs.(3.75 ±0.45) %,F =11.626,P =0.001] and the serum IgE levels [(353.41 ± 45.74) IU/mL vs.(252.65 ± 30.45) IU/ mL vs.(155.26 ± 22.77) IU/mL,F =7.605,P =0.001] were decreased in turn,the differences were statistically significant.The FEV1/FVC% and FEV1% pred in the ACOS group were lower than those in the asthma group [(54.26 ± 6.86) % vs.(72.43 ± 8.52) %,t =10.506,P =0.001 and (50.35 ± 6.22) % vs.(62.60 ± 7.52) %,t =7.939,P =0.001],however,there were no significant differences compared with the COPD group [(54.26 ± 6.86)% vs.(53.88 ±7.25)%,t =0.241,P =0.810 and (50.35 ±6.22)% vs.(50.56 ±6.46)%,t =0.148,P =0.883].The proportion of small airway dysfunction in the ACOS group was higher than that in the asthma group (82.50% vs.57.50%,χ^2 =5.952,P =0.015),however,there was no statistically significant difference compared with COPD group(82.50% vs.85.00%,χ^2 =0.092,P =0.762).The RV/TLC% in the ACOS group was higher than that in the asthma group [(46.71 ± 5.31) % vs.(32.46 ± 4.52) %,t =12.924,P =0.001],however,there was no statistically significant difference compared with the COPD group [(46.71 ± 5.31)% vs.(46.92 ± 5.75)%,t =0.170,P =0.866].The DLCO% in the ACOS group was lower than that in the asthma group [(64.37 ±4.66) % vs (82.62 ± 4.53) %,t =17.760,P =0.001],but higher than that of the COPD group [(64.37 ± 4.66) % vs.(51.25 ± 4.35) %,t =13.017,P =0.001].After bronchodilator test,the FEV1 mutation rate of the ACOS group was higher than that of the COPD group [(20.86 ± 2.05) % vs.(6.52 ± 0.55) %,t =42.730,P =0.001],but there was no statistically significant difference compared with the asthma group [(20.86 ± 2.05)% vs.(21.13 ±2.14)%,t =0.576,P=0.566].Conclusion Compared with asthma patients,the age of ACOS patients is older,the percentage of peripheral blood eosinophils and the level of serum IgE are lower,the pulmonary ventilation function is lower,the airway dysfunction is more significant,the residual volume is more significant,the lung diffuse function is lower,acidic granulocyte airway inflammation is mild.But compared with patients with COPD,the age of ACOS patients is younger,the percentage of peripheral blood eosinophils and serum IgE levels are higher,the lung diffuse function is higher,and acidic granulocyte airway inflammation is heavier.