不同低密度衰减区分级慢性阻塞性肺疾病急性加重期和哮喘-慢性阻塞性肺疾病重叠患者临床特征分析

Clinical Characteristics of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Asthma-chronic Obstructive Pulmonary Disease Overlap Patients with Different Low Attenuation Area Grades

背景慢性阻塞性肺疾病(COPD)是异质性疾病,哮喘-COPD重叠(ACO)同时具有哮喘和COPD相关临床特征,部分患者无法配合行肺功能检查,难以判断气流受限程度。目的比较COPD急性加重期(AECOPD)及ACO患者不同低密度衰减区(LAA)分级的临床资料,分析第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)与LAA分级的关联性,为肺功能检查受限患者提供参考指标。方法收集2020年3月—2022年5月在河北医科大学第二医院呼吸与危重症医学科住院的AECOPD及ACO患者的临床资料,LAA≥2级归为肺气肿型,LAA<2级归为支气管炎型,共分为4组:(1)支气管炎型AECOPD组(84例):LAA 0级33例和LAA 1级51例;(2)肺气肿型AECOPD组(150例):LAA 2级55例、LAA 3级63例和LAA 4级32例;(3)支气管炎型ACO组(59例):LAA 0级26例和LAA 1级33例;(4)肺气肿型ACO组(47例):LAA 2级21例、LAA 3级17例和LAA 4级9例。比较AECOPD和ACO患者各组及组内不同LAA分级患者的临床特点。ACO患者及AECOPD患者的FEV_(1)%pred影响因素采用多重线性回归分析。结果与支气管炎型AECOPD组比,肺气肿型AECOPD组BMI、氧合指数(PaO_(2)/FiO_(2))、FEV_(1)%pred更低,吸烟量、男性、吸烟比例更高(P<0.05)。支气管炎型AECOPD组:与LAA 0级组比,LAA 1级患者BMI、FEV_(1)%pred、PaO_(2)/FiO_(2)、血清白蛋白(ALB)更低,外周血中性粒细胞/淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)、纤维蛋白原降解产物(FDP)、白介素(IL)-6更高(P<0.05)。肺气肿型AECOPD组:与LAA4级患者相比,LAA3级患者年龄、BMI、FEV_(1)%pred更高,LAA2级患者BMI、FEV_(1)%pred更高,住院天数更短;LAA 3级患者NLR、hs-CRP、FEV_(1)%pred高于LAA 2级(P<0.05)。与支气管炎型ACO组相比,肺气肿型ACO组年龄、吸烟量、男性比例、吸烟比例更高,BMI、FEV_(1)%pred更低(P<0.05)。支气管炎型ACO组:与LAA 1级患者相比,LAA 0级患者应用全身激素、激素总量更高,FEV_(1)%pred更低(P<0.05)。肺气肿型ACO组:LAA 4级组FEV_(1)%pred低于LAA3级和LAA2级,LAA3级患者FEV_(1)%pred低于LAA2级(P<0.05)。多重线性回归分析结果显示,AECOPD和ACO患者LAA分级与FEV_(1)%pred呈负相关(P<0.05)。结论在AECOPD和ACO患者中,LAA分级不同,临床特征不同。ACO患者LAA 1级比LAA 0级对激素更不敏感。LAA分级与FEV_(1)%pred呈负相关,LAA分级可以为肺功能检查受限的AECOPD和ACO患者在评估气流受限程度方面提供参考。

Background Chronic obstructive pulmonary disease(COPD)is a heterogeneous disease.Asthma-COPD overlap(ACO)has clinical features both related to asthma and COPD.Some patients are unable to cooperate with pulmonary function tests,so it is difficult to determine the degree of airflow limitation.Objective To compare the clinical characteristics of different low attenuation area(LAA)grades in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and asthma-chronic obstructive pulmonary disease overlap(ACO),and analyze the correlation between forced expiratory volume in 1 second as a percentage of predicted value(FEV_(1)%pred)and LAA grades,so as to provide a reference index for patients who are unable to receive pulmonary function tests.Methods The clinical data of AECOPD and ACO patients hospitalized in the Department of Pulmonary and Critical Care Medicine of the Second Hospital of Hebei Medical University from March 2020 to May 2022 were collected.The participants were divided into the four groups including the emphysema AECOPD group(150 cases),bronchitis AECOPD group(84 cases),emphysema ACO group(47 cases)and bronchitis ACO group(59 cases)according to the LAA grade,LAA≥2 as emphysema groups,LAA<2 as bronchitis groups.The clinical characteristics of the AECOPD and ACO groups and the patients with different LAA grades within the group were compared.Multiple linear regression analysis was used to analyze the influencing factors of FEV_(1)%pred in ACO and AECOPD patients.Results Compared with the bronchitis AECOPD group,BMI,PaO_(2)/FiO_(2) and FEV_(1)%pred of the bronchitis AECOPD group were lower,and the amount of cigarette smoking,proportions of males and smokers were higher(P<0.05).In the bronchitis AECOPD group,BMI,FEV_(1)%pred,PaO_(2)/FiO_(2),and albumin(ALB)were lower in patients with LAA grade 1 than those with LAA grade 0(P<0.05);Neutrophil/lymphocyte ratio(NLR),high-sensitivity C-reactive protein(hs-CRP),fibrinogen degradation product(FDP)and interleukin-6(IL-6)were higher(P<0.05).In the emphysema AECOPD group,compared with patients with LAA grade 4,patients with LAA grade 3 were elder,with higher BMI and FEV_(1)%pred(P<0.05),patients with LAA grade 2 had higher BMI and FEV_(1)%pred,and shorter hospital stay(P<0.05);NLR,hs-CRP,and FEV_(1)%pred in patients with LAA grade 3 were higher than those with LAA grade 2(P<0.05).Compared with the bronchitis ACO group,the emphysema ACO group had higher amount of cigarette smoking,proportions of males and smokers,and lower BMI and FEV_(1)%pred(P<0.05).In the bronchitis ACO patients,patients with LAA grade 0 had higher proportion and total amount of systemic steroids and lower FEV_(1)%pred than those with LAA grade 1(P<0.05).In the emphysema ACO patients,FEV_(1)%pred was lower in patients with LAA grade 4 than those with LAA grade 3 and LAA grade 2,and FEV_(1)%pred in patients with LAA grade 3 was lower than patients with LAA grade 2.Multiple linear regression analysis showed that LAA grades were negatively correlated with FEV_(1)%pred in AECOPD and ACO patients.Conclusion In AECOPD and ACO patients,different LAA grades are manifested as various clinical characteristics.ACO patients with LAA grade 1 were less sensitive to corticosteroids than those with LAA grade 0.There is a negative correlation between LAA grades and FEV_(1)%pred.LAA grades can provide a reference for evaluating the degree of airflow limitation in AECOPD and ACO patients who are unable to receive pulmonary function tests.