摘要
目的通过脉冲振荡(IOS)法测定不同嗜酸粒细胞水平的慢性阻塞性肺疾病(COPD)患者呼吸阻抗的变化及与小气道病变的相关性。方法本研究为病例对照研究。采用随机抽样法,选择2020年12月至2021年12月于上海市肺科医院门诊就诊时处于COPD稳定期的患者,根据筛选时外周血嗜酸粒细胞比值分为2组,A组为嗜酸粒细胞比率≥2%的患者,B组为嗜酸粒细胞比率<2%的患者。纳入106例COPD患者,最后94例患者参与本研究,男性患者比例为74%,入组时收集相关临床资料,测定常规肺功能指标、IOS指标,随后开展小气道病变、呼吸阻抗等方面的分析。结果从入组人群看,外周血嗜酸粒细胞持续提升的患者比例50%,从吸烟指数的角度看,B组高于A组(P<0.05),2组在阻抗占预计值百分比(Z5%pred)、共振频率(Fres)、总气道阻力占预计值百分比(R5%pred)、周边气道阻力(R5-R20)及周边气道弹性阻力(X5)的差异均有统计学意义(均P<0.05),Pearson研究结果表明,X5与第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV3%pred、呼出用力肺活量25%时流速百分比(FEF25%pred)、FEF50%pred、FEF75%pred均呈正相关(r值分别为0.57、0.49、0.56、0.54、0.40,均P<0.05),Z5%pred、R5%pred和Fres与FEV1%pred(r值分别为-0.57、-0.43、-0.89,均P<0.05)、FEV3%pred(r值分别为-0.45、-0.30、-0.73,均P<0.05)、FEF75%pred(r值分别为-0.57、-0.44、-0.76,均P<0.05)、FEF50%pred(r值分别为-0.55、-0.44、-0.80,均P<0.05)、FEF25%pred(r值分别为-0.47、-0.39、-0.74,均P<0.05)均呈负相关。R5-R20与FEV1%pred、FEV3%pred、FEF75%pred、FEF50%pred、FEF25%pred均无相关性(均P>0.05)。结论IOS在评估COPD患者小气道功能障碍方面有一定临床价值,Fres与X5和常规肺功能指标有较强的相关性,也是临床评估的常用手段。
Objective To determine the correlation between change of respiratory impedance and small airway lesions in chronic obstructive pulmonary disease(COPD)patients with different eosinophilic granulocyte levels by impulse oscillometry system(IOS).Methods This was a case-control study.Random sampling method was used to select patients with COPD at stable stage at the time of outpatient treatment in Shanghai Pulmonary Hospital from December 2020 to December 2021,and the patients were assigned into two groups according to the peripheral blood eosinophil ratio during screening.Patients with eosinophil ratio≥2%were included in Group A,and patients with eosinophil ratio<2%were included in Group B.A total of 106 patients with COPD were included,94 patients were involved in the present research finally,and proportion of male patients was 74%.Relevant clinical data were collected at the time of enrollment.Routine pulmonary function indexes and IOS indexes were measured,and then small airway lesions and respiratory impedance were analyzed.Results Viewed from the enrollment group,the proportion of patients with continued ascent of peripheral blood eosinophilia was 50%,from the smoking index,Group B were higher than that of Group A(P<0.05).Differences in respiratory impedance at the percent of predicted value(Z5%pred),resonant frequency(Fres),respiratory resistance in percent of predicted value(R5%pred),peripheral airway resistance(R5-R20)and peripheral airway resistance(X5)between two groups were statistically significant(all P<0.05).The results of Pearson′s study showed that X5 with the percentage of forced expiratory volume in the first second of prediction value(FEV1%pred),FEV3%pred,percentage of flow rate at 25%vital capacity of exhalation force(FEF25%pred),FEF50%pred and FEF75%pred were positively correlated(r values were 0.57,0.49,0.56,0.54,and 0.40,respectively,all P<0.05),Z5%pred,R5%pred and Fres were compared with FEV1%pred(r values were-0.57,-0.43,and-0.89,all P<0.05),FEV3%pred(r values were-0.45,-0.30,and-0.73,respectively,all P<0.05),FEF75%pred(r values were-0.57,-0.44,and-0.76,respectively,all P<0.05),FEF50%pred(r values were-0.55,-0.44,and-0.80,respectively,all P<0.05),FEF25%pred(r values were-0.47,-0.39,and-0.74,all P<0.05)were negatively correlated.There was no direct correlation between R5-R20 and FEV1%pred,FEV3%pred,FEF75%pred,FEF50%pred,FEF25%pred(all P>0.05).Conclusions IOS delivers certain clinical value in evaluating the small airway dysfunction in patients with COPD.Fres is strongly correlated with X5 and conventional lung function indexes,and it is eligible to serve as common means for clinical evaluation.
作者
孙晓丽
程克斌
白久武
Sun Xiaoli;Cheng Kebin;Bai Jiuwu(Department of Respiratory and Critical Care Medicine,Shanghai Pulmonary Hospital Affiliated to Tongji University,Shanghai 200433,China)
出处
《国际呼吸杂志》
2023年第2期181-186,共6页
International Journal of Respiration
基金
上海市卫生和计划生育委员会课题(20184Y0002)。
关键词
肺疾病
慢性阻塞性
外周血嗜酸粒细胞
呼吸阻抗
小气道功能
Pulmonary disease,chronic obstructive
Peripheral blood eosinophils
Respiratory impedance
Small airway function
