女性慢性阻塞性肺疾病的临床特点

Clinical features of chronic obstructive pulmonary disease in women

目的探讨女性慢性阻塞性肺疾病(COPD)患者患病危险因素、症状严重程度、急性加重风险及肺功能的临床特点。方法调查2017年1月至2019年12月在中南大学湘雅二医院、湖南省职业病防治院、桂林医学院附属医院、桂林市第二人民医院就诊的COPD患者4 204例,其中女性COPD患者533例,男性COPD患者3 671例,对患病危险因素、症状严重程度、急性加重风险及肺功能临床特点进行综合分析。结果男、女COPD患者的年龄差异无统计学意义(P>0.05),吸烟史、职业暴露史、生物燃料暴露史差异有统计学意义(P<0.001),其中吸烟史、职业暴露史方面男性明显高于女性患者(P<0.001),生物燃料暴露史方面女性显著高于男性患者(P<0.001)。男、女COPD患者的慢性阻塞性肺疾病评估测试(CAT)评分差异有统计学意义(P<0.05),女性CAT评分均值高于男性。男女COPD患者的改良版英国医学研究委员会呼吸困难问卷(mMRC)分级结果差异有统计学意义(P<0.05),且女性mMRC分级高于男性。男、女患者在急性加重风险方面差异无统计学意义(P>0.05)。男、女COPD患者在第一秒用力呼气容积占预计值百分比(FEV1%预计值)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)均值比较差异有统计学意义(P<0.001),且女性的FEV1%预计值、FEV1/FVC均优于男性。结论女性COPD的患病危险因素、症状严重程度及肺功能的临床特点有异于男性,为女性COPD患者个性化治疗提供参考。

Objective To investigate the risk factors,severity of symptoms,acute exacerbations,and pulmonary function in women with chronic obstructive pulmonary disease(COPD).Methods A total of 4204 COPD patients,including 533 female COPD patients and 3671 male COPD patients,were investigated from January 2017 to December 2019 in Second Xiangya Hospital of Central South University,Hunan Prevention and Treatment Institute for Occupational Disease,affiliated Hospital of Guilin Medical College and Guilin Second Peoples hospital.The risk factors,severity of symptoms,risk of acute exacerbation and clinical characteristics of pulmonan function in patients with COPD were comprehensively analyzed.Results There was no statistical difference in age between male and female COPD patients(P>0.05).There were statistically significant differences in smoking histoiy,occupational exposure history and biofuel exposure history(P<0.001),among which smoking history and occupational exposure history were significantly higher in males than in females(P<0.001),and exposure history of biofuels was significantly higher in females than in males(P<0.001).The COPD assessment test(CAT)score of male and female patients was statistically different(PV 0.05),and the mean CAT score of female patients was higher than that of male patients.The modified medical research council dyspnea scale(mMRC)grading results of male and female patients were statistically different(P<0.05),and the mMRC grading of female patients was higher than that of male patients.There was no statistical difference in the risk of acute exacerbation between male and female patients(P>0.05).There were statistically significant differences between male and female patients in first second exertional volume as a percentage of predicted value(FEV1%)and forced expiratory volume in one second/forced vital capacity(FEV1/FVC)mean value(P<0.001),and EEV1%predicted value and FEV1/FVC of female patients were better than that of male patients.Conclusions The risk factors,symptom severity and pulmonary function of female patients with COPD are different from those of male patients,providing reference for the individualized treatment of female patients with COPD.