对哮喘—慢性阻塞性肺疾病重叠综合征临床特征及药物疗效的临床观察

发布时间：2018-04-21 19:55

本文选题：哮喘-慢性阻塞性肺疾病重叠综合征 + 肺功能　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨ACOS患者肺功能及FeNO、血清总IgE、过敏原阳性率的水平及与哮喘、COPD患者之间的差异,从而评估ACOS患者的气道炎症及气道阻塞的程度,分析肺功能及FeNO、血清总IgE、过敏原对ACOS患者的诊断意义;研究天晴速乐(噻托溴铵粉雾剂)联合信必可(布地奈德福莫特罗粉吸入剂)吸入治疗ACOS、哮喘和COPD的疗效,并比较ACOS与哮喘、COPD患者的疗效差异。拟为临床医生在ACOS诊治方面提供新的思路。方法:本研究收集2015年2月到2016年7月于吉林大学白求恩第一医院呼吸内科就诊的ACOS患者60例,平均(71.3±5.2)岁,其中男性30例,女性30例。诊断标准按照GINA 2014指南提出的ACOS的定义及推荐的五个诊断步骤。同时,根据哮喘及慢性阻塞性肺疾病的诊断指南随机选取同期住院的哮喘患者65例,COPD患者60例,在我院体检的健康体检者60例。详细记录患者的性别、年龄、身高、体重、吸烟史等资料。对四组患者均行肺功能、FeNO、血清总IgE、过敏原测定,准确的记录测定结果。所有资料用SPSS19.0统计软件进行处理,计量资料根据是否符合正态分布应用单因素方差分析或秩和检验(Kruskal-Wallis H检验),计数资料应用χ2检验分析各组间的差异有无统计学意义;从ACOS组、哮喘组、慢性阻塞性肺疾病组中分别选取FEV1%Pred、FEV1/FVC不具有统计学差异的患者重新分组,命名为ACOS治疗组、哮喘治疗组、慢性阻塞性肺疾病治疗组,各组患者在院期间给予基础治疗(包括抗感染、化痰、平喘),出院后均给予天晴速乐联合信必可吸入治疗,随访6个月,观察患者的FEV1%Pred、FEV1/FVC的改善情况,应用配对t检验及方差分析计算组内治疗前后及组间治疗后的差异是否显著。结果:(1)ACOS组FEV1%Pred、FEV1/FVC水平明显低于哮喘组及对照组,差异有统计学意义(P0.05),而高于COPD组,差异不具有统计学意义(P0.05)。(2)三组患者行支气管舒张试验后FEV1的改善率ACOS组明显高于COPD组及对照组,差异有统计学意义(P0.05),低于哮喘组,差异不具有统计学意义(P0.05)。(3)ACOS组患者FeNO水平明显高于COPD组及对照组,差异有统计学意义(P0.05),而较哮喘组低,差异不明显(P0.05)。(4)ACOS组患者血清总IgE水平明显高于COPD组及对照组,低于哮喘组,差异均有统计学意义(P0.05)。(5)ACOS组过敏原阳性的比率明显高于COPD组和对照组,差异显著(P0.05),而低于哮喘组,差异不明显(P0.05)。(6)ACOS治疗组、哮喘治疗组、慢性阻塞性肺疾病治疗组三组患者治疗3个月、6个月后FEV1%Pred、FEV1/FVC均升高,与治疗前相比差异明显(P0.05)。(7)治疗组的三组患者用药6个月后FEV1%Pred、FEV1/FVC改善程度由高到低分别为:哮喘治疗组、ACOS治疗组、慢性阻塞性肺疾病治疗组,各组间差异明显(P0.05)。结论:(1)FeNO、肺功能、血清总IgE及过敏原联合检查有助于ACOS的诊断。ACOS患者上述指标的改变介于哮喘和COPD之间。(2)ACOS患者的气道炎症水平及气道阻塞严重程度介于哮喘和COPD之间。(3)对于FeNO和(或)血清总IgE升高的COPD患者或者出现不完全可逆气流受限的哮喘患者,应考虑有无ACOS的可能。(4)ACOS患者应用天晴速乐联合信必可吸入治疗效果较好,但好转程度介于哮喘和COPD之间。
[Abstract]:Objective: To investigate the pulmonary function and FeNO, the serum total IgE, the positive rate of allergen and the difference between the patients with asthma and COPD, so as to evaluate the airway inflammation and the degree of airway obstruction in the patients with ACOS, to analyze the pulmonary function and FeNO, the serum total IgE, the diagnostic significance of the allergen to the patients of ACOS, and the study of the Tiotropium Bromide Powder for Inhalation Association (Tiotropium Bromide Powder for Inhalation). Combined with Budesonide and Formoterol Fumarate Powder for Inhalation (Budesonide and Formoterol Fumarate Powder for Inhalation) inhalation for the treatment of ACOS, asthma and COPD, and comparing the difference between ACOS and asthma and COPD patients. To provide a new way of thinking for clinicians in the diagnosis and treatment of ACOS. Methods: This study was collected from February 2015 to July 2016 in the Department of respiratory medicine, Bethune first hospital, Jilin University 60 cases of ACOS, average (71.3 + 5.2) years old, including 30 men and 30 women, were defined according to the definition of ACOS and five diagnostic steps proposed in the GINA 2014 guide. At the same time, according to the diagnostic guidelines for asthma and chronic obstructive pulmonary disease, 65 patients were hospitalized at the same time, 60 in COPD patients, and health examination in our hospital. 60 cases of physical examination. The sex, age, height, weight and smoking history of the patients were recorded in detail. The lung function, FeNO, serum total IgE, allergens were measured and the results were recorded in four groups. All the data were processed by SPSS19.0 software, and the measurement data were based on the normal distribution of the single factor variance analysis or rank. And test (Kruskal-Wallis H test), count data using chi 2 test analysis of the differences between groups of statistical significance; from the ACOS group, asthma group, chronic obstructive pulmonary disease group selected FEV1%Pred, FEV1/FVC did not have statistical difference of the patients regrouping, life named ACOS treatment group, asthma treatment group, chronic obstructive pulmonary disease. In the treatment group, the patients in each group were given basic treatment (including anti infection, phlegm and asthma) during the hospital period. After discharge, all the patients were given the combination of Tian Qing Yue Yue and Xin must inhalation treatment. The patients were followed up for 6 months to observe the improvement of FEV1%Pred and FEV1/FVC. Whether the difference between the treatment and the treatment in the group before and after the paired t test and analysis of variance was observed. Results: (1) ACOS group FEV1%Pred, FEV1/FVC level was significantly lower than the asthma group and the control group, the difference was statistically significant (P0.05), but higher than the COPD group, the difference was not statistically significant (P0.05). (2) the improvement rate of FEV1 in the three groups after the bronchodilation test was significantly higher than the COPD group and the control group, the difference was statistically significant (P0.05), low (P0.05), low In the asthma group, the difference was not statistically significant (P0.05). (3) the level of FeNO in the ACOS group was significantly higher than that in the COPD group and the control group. The difference was statistically significant (P0.05), but the difference was not significant (P0.05). (4) the serum total IgE level in the ACOS group was significantly higher than that in the COPD group and the control group, which was lower than the asthma group, the difference was statistically significant (P0.05). (5) the positive rate of allergen in ACOS group was significantly higher than that in COPD group and control group, the difference was significant (P0.05), but the difference was not significant (P0.05). (6) the three groups of ACOS treatment group, asthma treatment group and chronic obstructive pulmonary disease group were treated for 3 months, 6 months later, FEV1%Pred and FEV1/FVC were all higher (P0.05). (7 Three groups of patients in the treatment group were treated with FEV1%Pred after 6 months of medication, and the improvement of FEV1/FVC from high to low were as follows: asthma treatment group, ACOS treatment group and chronic obstructive pulmonary disease treatment group, the difference was obvious (P0.05). Conclusion: (1) FeNO, lung function, serum total IgE and hypersensitivity test are helpful to the diagnosis of.ACOS patients with the changes of the above index. Between asthma and COPD. (2) the level of airway inflammation and the severity of airway obstruction in ACOS patients are between asthma and COPD. (3) the possibility of ACOS should be considered for the COPD patients with FeNO and / or serum total IgE or the presence of incomplete reversible airflow. (4) ACOS sufferers apply the combination of sunny and quick music. Inhalation treatment is better, but the improvement is between asthma and COPD.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R562.25

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