脉冲振荡法测定慢性阻塞性肺疾病频繁急性加重表型的气道阻力表现

Measurement of airway resistance in patients with chronic obstructive pulmonary disease experiencing frequent acute exacerbations by impulse oscillometry system

目的探讨脉冲振荡法(IOS)气道阻力测定在鉴别慢性阻塞性肺疾病(COPD)频繁急性加重表型中的作用。方法回顾性病例对照研究。选取2017年3月至2019年8月曲靖市第一人民医院确诊的COPD患者,以上一年度急性发作次数,分为频繁急性加重表型组(n=32)与非频繁急性加重表型组(n=47),健康对照组为正常体检者30人,采用IOS测定的气道阻力及频谱微分均值图,肺功能测定用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV1/FVC等指标并比较。结果频繁急性加重表型组较非频繁急性加重表型组吸-呼相X5差值(ΔX5)升高(0.14±0.03比0.09±0.03,P<0.05),电抗流量依赖性降低(-0.70±0.13比-0.60±0.09,P<0.05),2组FVC、FEV1、FEV1%pred、FEV1/FVC、黏性阻力总气道阻力、周边气道阻力,呼吸阻抗中周边气道弹性阻力(X5)差异均无统计学意义(P值均>0.05)。多重线性相关提示年发作次数与ΔX5、改良版英国医学研究委员会呼吸困难量表评分呈正相关。结论IOS肺功能测定ΔX5可用于COPD频繁急性加重表型的鉴别。

Objective To investigate the role of impulse oscillometry system(IOS)in the diagnosis of frequent acute exacerbations of chronic obstructive pulmonary disease(COPD).Methods This study is a retrospective case-control study.Patients with COPD diagnosed in the First People′s Hospital of Qujing City from March 2017 to August 2019 were divided into frequent acute exacerbation phenotype group(n=32)and non-frequent acute exacerbation phenotype group,the control group was 30 healthy people.The airway resistance and intrabreath graph by impulse oscillometry system,forced vital capacity(FVC),forced expiratory volume in one second(FEV1),forced expiratory volume in one second accounts for predicted value(FEV1%pred),FEV1/FVC by lung function instrument were measured and compared.Results The inspiratory-expiratory variations in Xrs at 5 Hz(Δx5)in the frequent acute exacerbation phenotype group was higher than that in the non frequent acute exacerbation phenotype group(0.14±0.03 vs 0.09±0.03,P<0.05),and the reactance flow dependence was decreased(-0.70±0.13 vs-0.60±0.09,P<0.05).There was no significant difference in FVC,FEV1,FEV1%pred,FEV1/FVC%,R5,R5-20,X5 between the two groups.Multiple linear correlation indicated that the number of attacks per year was positively correlated withΔX5 and the scores of modified Medical Research Council.Conclusions TheΔX5 by IOS can be used to identify COPD with frequent acute exacerbation.