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慢阻肺急性加重期患者小气道功能及结构改变

钟景良 吴嘉锟 林荣辉 林锦锋 姚慧文

钟景良, 吴嘉锟, 林荣辉, 林锦锋, 姚慧文. 慢阻肺急性加重期患者小气道功能及结构改变[J]. 分子影像学杂志, 2019, 42(3): 388-392. doi: 10.12122/j.issn.1674-4500.2019.03.25
引用本文: 钟景良, 吴嘉锟, 林荣辉, 林锦锋, 姚慧文. 慢阻肺急性加重期患者小气道功能及结构改变[J]. 分子影像学杂志, 2019, 42(3): 388-392. doi: 10.12122/j.issn.1674-4500.2019.03.25
Jingliang ZHONG, Jiakun WU, Ronghui LIN, Jinfeng LIN, Huiwen YAO. Changes in the functional and structural parameters of small airway in patients with acute exacerbations of chronic obstructive pulmonary disease[J]. Journal of Molecular Imaging, 2019, 42(3): 388-392. doi: 10.12122/j.issn.1674-4500.2019.03.25
Citation: Jingliang ZHONG, Jiakun WU, Ronghui LIN, Jinfeng LIN, Huiwen YAO. Changes in the functional and structural parameters of small airway in patients with acute exacerbations of chronic obstructive pulmonary disease[J]. Journal of Molecular Imaging, 2019, 42(3): 388-392. doi: 10.12122/j.issn.1674-4500.2019.03.25

慢阻肺急性加重期患者小气道功能及结构改变

doi: 10.12122/j.issn.1674-4500.2019.03.25
详细信息
    作者简介:

    钟景良,本科,主治医师,E-mail:lianjianglhq@126.com

    通讯作者:

    姚慧文,主任医师,E-mail:lianjianglhq@126.com

Changes in the functional and structural parameters of small airway in patients with acute exacerbations of chronic obstructive pulmonary disease

  • 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,ΔR5ΔR20ΔR5-R20ΔZ5ΔFres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。

     

  • 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.
    下载: 导出CSV

    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.
    下载: 导出CSV

    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.
    下载: 导出CSV

    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.
    下载: 导出CSV

    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.
    下载: 导出CSV
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