煤工尘肺合并慢性阻塞性肺疾病临床特征分析

Clinical characteristics of pneumoconiosis complicated with chronic obstructive pulmonary disease

目的分析煤工尘肺合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、煤工尘肺及COPD患者的肺功能及临床特征,以提高煤工尘肺合并COPD的诊治水平。方法于2019年2月,收集2016年1月~2018年1月就诊于晋城煤业集团总医院呼吸科门诊及住院的煤工尘肺、COPD及煤工尘肺合并COPD患者资料共计172例。根据病情分为煤工尘肺组(70例),COPD组(50例),煤工尘肺合并COPD组(52例),用单因素方差分析和SNK检验分析3组患者的年龄、抽烟史、体重指数等一般情况及其临床症状评分、肺功能指标及合并低氧血症及呼吸衰竭情况。结果煤工尘肺组、COPD组及煤工尘肺合并COPD组患者平均年龄、抽烟指数、体重指数(BMI)差异无统计学意义(P>0.05)。与煤工尘肺组比较,煤工尘肺合并COPD组的第一秒用力呼气容积占预计值百分比(FEV1占预计值%)、第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC%)、肺一氧化碳弥散量占预计值百分比(DLco-SB占预计值%)明显下降,差异有统计学意义(P<0.05);与COPD组比较,煤工尘肺合并COPD组患者的FEV1占预计值%、DLco-SB占预计值%、用力肺活量占预计值百分比(FVC占预计值%)明显下降差异有统计学意义(P<0.05),FEV1/FVC%差异无统计学意义(P>0.05)。与煤工尘肺组比较,煤工尘肺合并COPD组临床症状CAT评分更高,差异有统计学意义(P<0.05)。煤工尘肺合并COPD组合并低氧血症率78.8%(41/52),高于煤工尘肺组[61.4%(43/70)]及COPD组[72.0%(36/50)];煤工尘肺合并COPD组合并呼吸衰竭率44.2%(23/52),高于煤工尘肺病组[4.3%(3/70)]及COPD组[16%(8/50)]。结论煤工尘肺合并COPD患者各项肺功能指标更差、临床症状更重,限制性通气功能障碍、弥散功能障碍更明显,且合并呼吸衰竭概率更高。

Objective To analyze the pulmonary function and clinical features of coal worker's pneumoconiosis complicated with chronic obstructive pulmonary disease(COPD),coal worker's pneumoconiosis and COPD,in order to improve the diagnosis and treatment of coal worker's pneumoconiosis complicated with chronic obstructive pulmonary disease.Methods Selected patients in respiratory department of General Hospital of Jincheng Coal Industry Group were classified as pneumoconiosis complicated with COPD group(n=52),pneumoconiosis group(n=70)and COPD group(n=50).Clinical data were collected and compared between three groups,including age,history of smoking,BMI,pulmonary function,CAT score and complication with Hypoxemia and respiratory faliure.Results The mean age,smoking index and BMI of the three groups were not significantly different.The FEV1%pred,FEV1/FVC%,DLco-SB%,FVC%pred were significantly lower in pneumoconiosis complicated with COPD group than pneumoconiosis group(P<0.05);The FEV1%pred,DLco-SB%,FVC%pred were significantly lower in pneumoconiosis complicated with COPD group than COPD group(P<0.05),but,the FEV1/FVC%was no significant different between pneumoconiosis complicated COPD group and COPD group(P>0.05);The CAT score for clinical symptoms of pneumoconiosis complicated with COPD group was significantly higher than that of pneumoconiosis group(P<0.05),but there was no significant difference between pneumoconiosis complicated COPD group and COPD group(P>0.05).The rate of hypoxemia in coal workers'pneumoconiosis combined with chronic obstructive pulmonary disease was 78.8%,which was higher than that of coal workers'pneumoconiosis group(61.4%)and chronic obstructive pulmonary disease group(72%);The respiratory failure rate of coal worker's pneumoconiosis combined with chronic obstructive pulmonary disease group was 44.2%,which was higher than that of coal worker's pneumoconiosis group(4.3%)and chronic obstructive pulmonary disease group(16%).Conclusion In pneumoconiosis patients,once complicate with COPD,the pulmonary function indexes are worse,the clinical symptoms are heavier,and the probability of hypoxemia and respiratory failure are higher.Compared with the COPD group,the patients with pneumoconiosis complicated with COPD have more restrictive ventilation dysfunction and diffuse dysfunction,and the clinical symptoms are heavier,and the probability of combined respiratory failure is higher.