Changes in the functional and structural parameters of small airway in patients with acute exacerbations of chronic obstructive pulmonary disease
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摘要:
目的评价慢阻肺急性加重期患者小气道功能结构的变化。 方法59例慢阻肺急性加重期患者在入院24 h内(Visit 1)、出院前1 d(Visit 2)、出院后第8天(Visit 3)、第21天(Visit 4)完成CAT评分、mMRC评分、SGRQ评分、脉冲震荡、肺通气功能、高分辨CT(HRCT,Visit 1、Visit 4)。 结果随访过程中总气道阻力(R5)、中心气道阻力(R20)、外周气道阻力(R5-R20)显著下降(P<0.05),外周弹性阻力及响应频率(Fres)在Visit 2后未显著下降。右上叶尖段支气管第3级分支气管壁径线、伴行肺动脉直径(BWT)较前明显下降(P<0.05)。在Visit 4-Visit 1间,ΔR5、ΔR20、ΔR5-R20、ΔZ5、ΔFres分别与ΔCAT、ΔmMRC、ΔSGRQ呈正相关(P<0.05);ΔBWT与ΔCAT、ΔmMRC、ΔSGRQ分别呈正相关(r=0.45、0.37、0.92,P<0.05);ΔWT与ΔCAT、ΔSGRQ分别呈正相关(r=0.42、0.40,P<0.05)。 结论脉冲震荡、高分辨CT代表的小气道功能、结构指标随病情恢复而明显改善,可以良好评价急性加重期的治疗策略。 Abstract:ObjectiveTo evaluate the changes in the functional and structural parameters of small airway in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsFify-nine patients with AECOPD were required to complete the COPD assessment test (CAT), modified Medical Research Council Questionnaire for assessing the severity of breathlessness (mMRC), St George's respiratory questionnaire(SGRQ), impulse oscillation (IOS),pulmonary function test and high-resolution computerized tomography(HRCT, Visit 1 and Visit 4)at four time points: within 24 h of admission (Visit 1), the day before discharge (Visit 2), 8th day after discharge (Visit 3), 21st day after discharge (Visit 4). ResultsResistance at 5 Hz (R5), resistance at 20 Hz(R20) and R5-R20 decreased significantly during follow-up, whilereactance at 5 Hz (X5) and resonant frequency(Fres) not continue to decline significantly after Visit 2. The thickness of the third generation of apical bronchus of the right upper lobe (WT) and the adjacentpulmonary artery diameter (BWT) decreased significantly compared with before (P<0.05). During the change between Visit 4 and Visit 1,ΔR5,ΔR20,ΔR5-R20,ΔZ5,ΔFres were positively associated withΔCAT,ΔmMRC,ΔSGRQ respectively (P<0.05).ΔBWT were positively correlated toΔCAT,ΔmMRC,ΔSGRQ (r=0.45, 0.37, 0.92, P<0.05), andΔWT were positively related toΔCAT,ΔSGRQ (r=0.42, 0.40, P<0.05). ConclusionThe functional and structural indexes of small airway represented by IOS and HRCT are obviously improved with the recovery of AECOPD. They can be used to evaluate the treatment strategy of acute exacerbation. -
表 1 受试者随访过程肺功能及症状评分变化(n=59,Mean±SD)
指标 Visit 1 Visit 2 Visit 3 Visit 4 年龄(岁) 71.62±6.83 − − − 体质量指数(kg/m2) 21.27±2.36 − − − 吸烟指数 42.10±21.91 − − − PaO2(kPa) 10.46±1.89 10.92±1.94 − − PaCO2(kPa) 5.17±0.43 4.98±0.62 − − FVC(L) 2.42±0.38 2.77±0.31* 2.82±0.45* 2.76±0.39* FEV1(L) 0.98±0.32 1.26±0.28* 1.23±0.31* 1.21±0.28* FEV1 /FVC% 42.54±12.21 45.56±10.12* 43.76±12.15 43.12±7.65 FEV1%pred 39.47±14.32 49.15±7.89* 47.56±12.09* 46.57±8.76* DLCO(%pred) 43.12±18.56 47.78±16.25* 49.23±13.24*# 48.25±12.31*# CAT评分 19.20±4.75 16.18±3.78* 14.78±5.21*# 13.12±3.76*#△ mMRC评分 2.42±0.77 2.18±0.65* 1.89±0.72*# 1.68±0.43*#△ SGRQ评分 33.59±7.79 − − 24.35±5.83* *P<0.05 vs Visit 1;#P<0.05 vs Visit 2;△P<0.05 vs Visit 3. 表 2 受试者随访过程小气道功能变化(n=59,Mean±SD)
指标 Visit 1 Visit 2 Visit 3 Visit 4 R5[kPa/(L/s)] 0.43±0.09 0.34±0.07* 0.34±0.08* 0.31±0.06*#△ R20[kPa/(L/s)] 0.24±0.05 0.23±0.04 0.22±0.06 0.20±0.07*#△ R5-R20[kPa/(L/s)] 0.35±0.06 0.29±0.05* 0.28±0.07* 0.26±0.08*#△ Z5[kPa/(L/s)] 0.47±0.11 0.34±0.09* 0.34±0.12* 0.31±0.08*# X5[kPa/(L/s)] −0.24±0.09 −0.12±0.08* −0.14±0.09* −0.13±0.07* Fres(Hz) 23.16±5.41 17.24±3.64* 16.82±5.21* 16.02±4.32* *P<0.05 vs Visit 1; #P<0.05 vs Visit 2; △P<0.05 vs Visit 3. 表 3 受试者随访过程小气道结构变化(n=59)
指标 Visit 1 Visit 2 Visit 3 Visit 4 变化率 LAA% 13.56±4.47 − − 12.93±4.87 25.13 WT(mm) 1.42±0.17 − − 1.33±0.27* 5.34*# BWT(mm) 3.83±0.73 − − 3.52±0.45* 4.72*# *P<0.05 vs Visit 1;#Visit 4-Visit 1变化率. 表 4 各生理参数及症状评分变化情况分析(n=59)
指标 Visit 2-Visit 1(%) Visit 3-Visit 2(%) Visit 4-Visit 3(%) FVC(L) 15.89* 4.67 2.79 FEV1(L) 25.09* 4.12 4.43 FEV1 /FVC% 8.72* 0.98 1.89 FEV1%pred 26.28* 4.15 4.79 R5[kPa/(L/s)] 22.17* 3.62 6.69* R20[kPa/(L/s)] 0.37 0.99 7.90* R5-R20[kPa/(L/s)] 17.77* 4.77 7.31* Z5[kPa/(L/s)] 26.74* 4.16 6.19 X5[kPa/(L/s)] 49.36* 27.57 4.89 Fres(Hz) 21.79* 1.59 0.23 DLCO(%pred) 8.98* 8.51* 0.73 CAT评分 11.46* 7.27* 10.77* mMRC评分 9.48* 10.34* 5.75* SGRQ评分 — — 27.15*# *P<0.05;#Visit 4-Visit 1变化率. 表 5 Visit 4-Visit 1各客观指标变化量与症状评分变化量的相关性分析(n=59)
Visit 4-Visit 1 ΔCAT评分 ΔmMRC评分 ΔSGRQ评分 ΔFVC −0.75 −0.29 −0.26 ΔFEV1 −0.20 −0.29 −0.19 ΔFEV1 /FVC% −0.39* −0.31 −0.32 ΔFEV1%pred −0.27 −0.32 −0.17 ΔR5[kPa/(L/s)] 0.55* 0.61* 0.56* ΔR20[kPa/(L/s)] 0.47* 0.38* 0.39* ΔR5-R20[kPa/(L/s)] 0.56* 0.61* 0.55* ΔZ5[kPa/(L/s)] 0.44* 0.58* 0.47* ΔX5[kPa/(L/s)] −0.10 −0.41* −0.31 ΔFres(Hz) 0.52* 0.64* 0.56* ΔDLCO(%pred) −0.01 −0.10 0.34 ΔLAA% −0.13 0.10 0.31 ΔWT(mm) 0.42* 0.31 0.40* ΔBWT(mm) 0.45* 0.37* 0.92* *P<0.05. -
[1] Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease Gold executive summary[J]. Am J Respir Crit Care Med, 2013, 187(4): 347-65. doi: 10.1164/rccm.201204-0596PP [2] Thomson NC. Respiratory symptoms and small airway dysfunction in current and former smokers without spirometric COPD[J]. Respirology, 2018, 23(5): 446-7. doi: 10.1111/resp.2018.23.issue-5 [3] O'donnell DE. Lam M, Webb K A measurement of symptoms,lung hyperinflation,and endurance during exercise in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 1998, 158(5 Pt 1): 1557-65. [4] Spencer S, Jones PW, Globe SG. Time course of recovery of health status following an infective exacerbation of chronic bronchitis[J]. Thorax, 2003, 58(7): 589-93. doi: 10.1136/thorax.58.7.589 [5] Bhatt SP, Soler X, Wang X, et al. Association between functional small airway disease and FEV1 decline in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2016, 194(2): 178-84. doi: 10.1164/rccm.201511-2219OC [6] Bodduluri S, Reinhardt JM, Hoffman EA, et al. Signs of gas trapping in normal lung density regions in smokers[J]. Am J Respir Crit Care Med, 2017, 196(11): 1404-10. doi: 10.1164/rccm.201705-0855OC [7] Woodruff PG, Barr RG, Bleecker E, et al. Clinical significance of symptoms in smokers with preserved pulmonary function[J]. N Engl J Med, 2016, 374(19): 1811-21. doi: 10.1056/NEJMoa1505971 [8] Chen SY, Fang ZK, Fang S, et al. Comparison of functional parameters of small airways between patients with typical asthma and cough-variant asthma[J]. J South Med Univ, 2017, 37(3): 330-6. [9] Usmani OS, Singh D, Spinola M, et al. The prevalence of small airways disease in adult asthma:a systematic literature review[J]. Respir Med, 2016, 116(1): 19-27. [10] 张攀, 于化鹏, 樊慧珍, 等. 慢性阻塞性肺疾病小气道不同评价方法的相关性研究[J]. 中国呼吸与危重监护杂志, 2016, 32(2): 109-14. doi: 10.7507/1671-6205.2016028 [11] Oostveen E, Macleod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments[J]. Eur Respir J, 2003, 22(6): 1026-41. doi: 10.1183/09031936.03.00089403 [12] Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry[J]. Eur Respir J, 2005, 26(2): 319-38. doi: 10.1183/09031936.05.00034805 [13] 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南——肺弥散功能检查[J]. 中华结核和呼吸杂志, 2015, 38(3): 164-9. doi: 10.3760/cma.j.issn.1001-0939.2015.03.003 [14] Hasegawa M, Nasuhara Y, Onodera Y, et al. Airflow limitation and airway dimensions in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2006, 173(12): 1309-15. doi: 10.1164/rccm.200601-037OC [15] Kitaguchi Y, Fujimoto K, Kubo K, et al. Characteristics of COPD phenotypes classified according to the findings of HRCT[J]. Respir Med, 2006, 100(10): 1742-52. doi: 10.1016/j.rmed.2006.02.003 [16] Manoharan A, Anderson WJ, Lipworth J, et al. Assessment of spirometry and impulse oscillometry in relation to asthma control[J]. Lung, 2015, 193(1): 47-51. doi: 10.1007/s00408-014-9674-6 [17] Parker CM, Voduc N, Aaron SD, et al. Physiological changes during symptom recovery from moderate exacerbations of COPD[J]. Eur Respir J, 2005, 26(3): 420-8. doi: 10.1183/09031936.05.00136304 [18] Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2000, 161(5): 1608-13. doi: 10.1164/ajrccm.161.5.9908022 [19] Skwarska E, Cohen G, Skwarski KM, et al. Randomized controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary disease[J]. Thorax, 2000, 55(11): 907-12. doi: 10.1136/thorax.55.11.907 [20] Walters JA, Gibson PG, Wood-Baker RA, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2009, 21(1): D1288-99. [21] Johnson MK, Birch M, Carter R, et al. Measurement of physiological recovery from exacerbation of chronic obstructive pulmonary disease using within-breath forced oscillometry[J]. Thorax, 2007, 62(4): 299-306. doi: 10.1136/thx.2006.061044 [22] Shimizu K, Konno S, Makita H, et al. Transfer coefficients better reflect emphysematous changes than carbon monoxide diffusing capacity in obstructive lung diseases[J]. J Appl Physiol, 2018, 125(1): 183-9. doi: 10.1152/japplphysiol.01062.2017 [23] Wise RA, Calverley PM, Carter KA, et al. Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR (R) trial[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13(5): 605-16. [24] Jabbal S, Lipworth BJ. Sensitivity of lung resistance and compliance to Beta-Blocker induced bronchoconstriction and long acting beta-agonist withdrawal in COPD[J]. Lung, 2018, 196(1): 15-8. doi: 10.1007/s00408-017-0079-1 [25] Mineshita M, Kida H, Handa H, et al. The correlation between lung sound distribution and pulmonary function in COPD patients[J]. PLoS One, 2014, 9(9): e107506-18. doi: 10.1371/journal.pone.0107506 [26] Ostridge K, Williams NP, Kim VA, et al. Relationship of CT-quantified emphysema, small airways disease and bronchial wall dimensions with physiological, inflammatory and infective measures in COPD[J]. Respir Res, 2018, 19(1): 31-43. doi: 10.1186/s12931-018-0734-y
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