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目的:探讨慢性阻塞性肺疾病(COPD)弥散功能变化及其对运动能力的影响。方法:选择稳定期COPD患者27人(均为男性)。受试者进行静息肺功能检查和心肺运动试验。静息肺通气功能检查指标包括:用力肺活量(FVC)、第一秒用力呼气容积(FEV1)。根据FEV1占预计值%将全部患者分为三组,分别为Ⅰ级组(轻度,n=6)、Ⅱ级组(中度,n=13)、Ⅲ级组(重度,n=8)。单次呼吸法测定静息时不同肺泡气氧分压下的一氧化碳弥散量(DLCO);采用Roughton和Forster的方法计算肺泡毛细血管膜弥散能力(Dm)和肺毛细血管床血容量(Vc)。心肺运动试验检测最大摄氧量(VO2max)、最大二氧化碳排出量(VCO2max)、最大功率(Wmax)、氧脉搏(O2pulse)等。结果:三组患者DLCO及Vc无显著差异。Ⅲ级组Dm显著低于Ⅱ级组(P<0.05)。Ⅲ级组COPD患者的VO2max、VCO2max、Wmax、O2pulse显著低于Ⅰ级组和Ⅱ级组(P<0.05)。COPD患者的DLCO与VCO2max(r=0.450,P<0.05)、VO2max(r=0.526,P<0.01)、Wmax(r=0.565,P<0.01)、O2pulse(r=0.517,P<0.01)呈正相关,Dm与VO2max(r=0.469,P<0.05)、VCO2max(r=0.514,P<0.01)、Wmax(r=0.532,P<0.01)呈正相关。结论:(1)即使是DLCO无明显变化的COPD患者,其Dm也可出现降低;(2)随着病情的加重,COPD患者运动能力下降,且其运动能力与其弥散功能尤其是Dm密切相关。
Objective: To investigate the changes of diffuse function in chronic obstructive pulmonary disease (COPD) and its effect on motor ability. Methods: 27 stable COPD patients (all male) were selected. Subjects underwent resting lung function tests and cardiopulmonary exercise tests. Resting pulmonary function tests included FVC and FEV1. All patients were divided into three groups according to the predicted value of FEV1: grade Ⅰ (n = 6), grade Ⅱ (n = 13), grade Ⅲ (n = 8) . The single breath method was used to measure the diffusivity of carbon monoxide (DLCO) at different alveolar oxygen pressures at rest. The diffusibility of pulmonary alveolar capillaries (Dm) and pulmonary capillary bed volume (Vc) were calculated by Roughton and Forster methods. Cardiopulmonary exercise test to detect the maximum oxygen uptake (VO2max), the maximum carbon dioxide emissions (VCO2max), the maximum power (Wmax), oxygen pulse (O2pulse) and so on. Results: The three groups of patients with DLCO and Vc no significant difference. The Dm in grade Ⅲ group was significantly lower than that in grade Ⅱ group (P <0.05). VO2max, VCO2max, Wmax and O2pulse in COPD patients in grade Ⅲ group were significantly lower than those in grade Ⅰ and Ⅱ patients (P <0.05). DLCO in patients with COPD was positively correlated with VCO2max (r = 0.450, P <0.05), VO2max (r = 0.526, P <0.01), Wmax , Dm was positively correlated with VO2max (r = 0.469, P <0.05), VCO2max (r = 0.514, P <0.01) and Wmax (r = 0.532, P <0.01). Conclusions: (1) Dm can be decreased even in COPD patients with no significant changes in DLCO. (2) With the aggravation of the disease, the exercise capacity of COPD patients decreases, and their exercise capacity is closely related to their diffusing function, especially Dm.