非慢阻肺男性吸烟者的肺功能特点及戒烟后的变化特征

Pulmonary function characteristics of male smokers with non-Chronic Obstructive Pulmonary Disease and changes after smoking cessation

目的探讨非慢性阻塞性肺疾病(简称慢阻肺)吸烟男性肺功能损伤的特点及其影响因素。方法本研究为前瞻性队列研究。选取2021年10月至2022年8月在重庆医科大学附属第二医院戒烟门诊就诊的非慢阻肺男性230例。按照年龄分组,<40岁组(65例),包含吸烟者(53例)和非吸烟者(12例);40~60岁组(109例),包含吸烟者(73例)和非吸烟者(36例);>60岁组(56例),包含吸烟者(20例)和非吸烟者(36例),比较不同年龄段男性吸烟者与非吸烟者的肺功能指标,线性回归分析影响吸烟者肺功能的可能因素,对比戒烟前后男性吸烟者肺功能的变化。结果<40岁组:吸烟者用力肺活量(FVC)%预计值、最大呼气中期流量(MMEF)%预计值、用力呼出75%及50%肺活量时的瞬间呼气流量(FEF_(75)、FEF_(50))占预计值的百分比(%预计值)、一氧化碳弥散量(DLCO)%预计值和DLCO与肺泡通气量(VA)比值(DLCO/VA)%预计值均显著低于非吸烟者(均P<0.05);40~60岁组和>60岁组:吸烟者除上述指标外,第一秒用力呼气容积(FEV1)%预计值显著低于非吸烟者(P<0.05)。FEV1%预计值(β=-0.728,95%CI:-0.026~0.011)、FVC%预计值(β=-0.332,95%CI:-0.012~-0.003)、FEF_(50)%预计值(β=-0.455,95%CI:-0.03~-0.007)、残气容积(RV)%预计值(β=0.371,95%CI:0.008~0.041)、RV与肺总量(TLC)的比值(RV/TLC)%预计值(β=0.454,95%CI:0.011~0.035)和MMEF%预计值(β=-0.324,95%CI:-0.022~-0.002)均受吸烟指数影响。戒烟后小气道功能指标均有所改善(均P<0.05)。结论非慢阻肺男性吸烟者肺功能受损的特点是早期损害肺容量、肺弥散功能和小气道功能,而随着年龄增大,逐渐发展为损害肺流速,其影响因素是吸烟指数和年龄。

Objective To investigate the characteristics of lung function impairment and its influencing factors in smoking men with non-chronic obstructive pulmonary disease(COPD).Methods A total of 230 non-COPD men who attended the smoking cessation clinic of the Second Affiliated Hospital of Chongqing Medical University from October 2021 to August 2022 were prospectively assessed.Participants were categorized into three age groups:<40 years old group(65 cases),including smokers(53 cases)and non-smokers(12 cases);40-60 years old group(109 cases),including smokers(73 cases)and non-smokers(36 cases);>60 years old group(56 cases),including smokers(20 cases)and non-smokers(36 cases).In this study,we compared the lung function indices of male smokers and non-smokers in different age groups,analyzed the possible factors affecting the lung function of smokers by linear regression,and compared the changes in the lung function of male smokers before and after smoking cessation.Results In the<40 years old group,smokers′forced vital capacity ratio(FVC)%predicted value(%pred),maximal mid expiratory flow(MMEF)%pred,forced expiratory flow after 75%/50%of the FVC has been exhaled(FEF_(75),FEF_(50))%pred,diffusing capacity of the lungs for carbon monoxide(DLCO)%pred,and the ratio of DLCO to alveolar volume(DLCO/VA)%pred were all lower than non-smokers(all P<0.05).Similarly,in the 40-60 years old and>60 years old groups,compared with non-smokers,forced expiratory volume in one second(FEV 1)%pred was significantly lower in smokers than in non-smokers(P<0.05).FEV 1%pred(β=-0.728,95%CI:-0.026,0.011),FVC%pred(β=-0.332,95%CI:-0.012,0.003),FEF_(50)%pred(β=-0.455,95%CI:-0.03,-0.007),residual volume(RV)%pred(β=0.371,95%CI:0.008,0.041),RV to total lung capacity ratio(RV/TLC)%pred(β=0.454,95%CI:0.011,0.035)and MMEF%pred(β=-0.324,95%CI:-0.022,-0.002)were all influenced by the smoking index.All small airway function indices improved after smoking cessation(all P<0.05).Conclusion Impairment of lung function in male smokers with non-COPD is characterized by early impairment of lung volume,lung diffusion function and small airway function,which progresses to impairment of lung flow rate with age,as influenced by smoking index and age.