慢性阻塞性肺疾病频繁发作患者不同表型临床特征分析

发布时间：2018-04-12 17:28

本文选题：慢性阻塞性肺疾病 + 频繁发作　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:有关慢性阻塞性肺疾病(acute exacerbation of chronic obstructive pulmonary disease,COPD)频繁发作患者不同表型(phenotype)特征的研究甚少。本研究试图探讨频繁发作(frequent exacerbation,FE)和非频繁发作(infrequent exacerbation,i FE)的慢性支气管炎(chronic bronchitis,CB)、肺气肿(emphysema,EM)和哮喘-COPD重叠综合征(Asthma COPD overlap Syndrome,ACOS)三种表型患者临床特征的差异,为临床治疗和管理频繁和非频繁加重患者提供参考。方法:回顾性分析142例入住我院呼吸科的COPD患者临床资料,根据患者急性发作的病史将其分为频繁发作组(frequent exacerbation,FE)和非频繁发作组(infrequent exacerbation,i FE),再依据既定的分型标准分别分为慢性支气管炎、肺气肿和哮喘-COPD重叠综合征(ACOS)表型组,比较该三种不同表型的FE或i FE患者临床特征、生理学及影像学指标的差异。结果:排除肺部其它疾病后,共收集符合入组条件的患者共142例,其中频繁发作(FE)组患者60例,非频繁发作(i FE)组82例。与非频繁发作组相比,频繁发作组患者的病史更长、吸烟指数更高,FEV1占预计值的百分比(FEV1%pred)和FEV1/FVC%值显著降低,CAT(COPD Assessment Test,COPD评估测试)评分、m MRC(modified Medical Research Council,改良医学研究委员会)呼吸困难评分及支气管管壁增厚得分更高;同时动脉血二氧化碳分压(arterial carbon dioxide pressure,Pa CO2)升高并且合并症如冠心病和糖尿病发生率更高。与非频繁发作组相比,频繁发作的慢性支气管炎表型患者年龄明显偏大(P=0.003)、体重指数(body mass index,BMI)更低(P=0.016),FEV1%pred(P=0.004)和FEV1/FVC(%)(P=0.028)值明显降低,而CAT评分(P=0.000)、m MRC呼吸困难评分(P=0.000)、肺气肿评分(P=0.001)和Pa CO2(P=0.000)更高。多变量分析显示,FEV1%pred(OR=0.899,P=0.044)和Pa CO2(OR=1.215,P=0.017)是频繁发作的慢性支气管炎表型患者的两个独立危险因素。相对于非频繁发作组,频繁发作的肺气肿表型患者年龄更大(P=0.012),病史更长(P=0.000),FEV1/FVC(%)更低(P=0.005),CAT(P=0.000)与m MRC呼吸困难评分(P=0.000)更高。CAT评分(OR=2.601,P=0.001)是该组患者的独立危险因素。除频繁发作患者动脉血气分析的PH值显著降低(P=0.032)外,无论频繁发作或非频繁发作的ACOS表型患者,其余临床、生理及影像学指标均无明显差异(P0.05)。结论:不同表型的慢性阻塞性肺疾病频繁发作患者,其临床特征可能有各自不同的特点,明确频繁和非频繁发作患者间不同表型的临床、生理及影像学特征将有助于对患者提供更加个性化治疗和更具针对性的管理方案。
[Abstract]:Objective: to investigate the phenotypic phenotypic phenotypic phenotypes of patients with chronic obstructive pulmonary disease (COPD) acute exacerbation of chronic obstructive pulmonary disease (Copd).To provide a reference for clinical treatment and management of frequent and infrequent aggravation patients.Methods: the clinical data of 142 patients with COPD admitted to respiratory department in our hospital were analyzed retrospectively.According to the patient's history of acute attack, they were divided into frequent attack group and infrequent exacerbationi FEN group. According to the established classification criteria, they were divided into chronic bronchitis, emphysema and asthmatic and COPD overlap syndrome (ACOS) phenotypic group, respectively, according to the established classification criteria, the patients were divided into two groups: chronic bronchitis, emphysema and asthmatic and COPD overlap syndrome (ACOSphenotype).The clinical characteristics, physiological and imaging features of the three different phenotypes of FE or I FE were compared.Results: after excluding other pulmonary diseases, 142 patients were included in the study group, including 60 patients with frequent onset of FEI and 82 patients with infrequent episodes of FEE.Patients with frequent episodes had a longer history than those with less frequent episodes.Higher smoking index and FEV1 / FVC% significantly decreased the score of MRC(modified Medical Research Council (improved Medical Research Council), higher score of dyspnea and thickening of bronchial wall;At the same time, the arterial carbon dioxide pressure Pa CO _ 2 was increased and the incidence of complications such as coronary heart disease and diabetes was higher.Multivariate analysis showed that FEV1 predite 0.899P0.044) and Paco _ 2 OR1.215P ~ 0.017) were two independent risk factors for phenotypic patients with chronic bronchitis.Except that the PH value of arterial blood gas analysis in patients with frequent episodes decreased significantly (P 0.032), there was no significant difference in the other clinical, physiological and imaging indexes in patients with ACOS phenotypes in both frequent and infrequent episodes (P 0.05).Conclusion: the clinical characteristics of patients with different phenotypes of chronic obstructive pulmonary disease may have different clinical characteristics.Physiological and imaging features will help to provide more individualized treatment and more targeted management programs for patients.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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