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目的研究支气管哮喘(BA)患者和慢性阻塞性肺疾病(COPD)患者气流阻塞程度与气道阻力(Raw)变化的相关性。方法用体描法测定2005年9月至2009年2月684例福建医科大学省立临床学院呼吸内科收治的684例BA患者和766例COPD患者的Raw并与其第一秒用力呼气容积占预计值百分比(FEV1% pred)、呼气峰流速实测值占预计值百分比(PEF% pred)和FEV1与用力肺活量(FVC)比值(FEV1%)进行对比分析。结果 BA和COPD患者FEV1% pred>70%、PEF% pred>70%及FEV1%>70%各亚组Raw均正常,随上述3项通气指标依次递减,各组的Raw依次递增。两组患者FEV1% pred<70%及FEV1%<70%亚组和多数PEF%pred亚组与依次递减相邻两组间的Raw比较差异有统计学意义(P均<0.01)。BA组FEV1% pred、PEF% pred、FEV1%与Raw的相关系数依次分别为-0.814,-0.722和-0.757(P均<0.01);COPD组上述各相关系数依次分别为-0.813;-0.703和-0.696(P均<0.01)。BA组FEV1% pred<70%、PEF% pred<70%及FEV1%<70%各亚组的Raw均较COPD各亚组高,且多数差异有统计学意义(P<0.05)。BA组和COPD组中部分亚组的Raw均出现>3cmH2O/(L.S)的上升转折。除个别外,BA组出现Raw>3cmH2O/(L.S)的上升转折较COPD组提前1个亚组。BA组Raw异常率显著高于COPD组。结论呼气流速>70%时Raw正常;只有呼气流速降低到一定程度时,出现Raw>3cmH2O/(L.S)。相同气流阻塞程度BA患者的Raw比COPD患者高。FEV1%pred、PEF% pred和FEV1%与Raw均呈显著负相关,其中以FEV1% pred与Raw的相关性最强。
Objective To investigate the relationship between airway obstruction and airway resistance in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Methods 684 patients with BA and 686 patients with COPD who were admitted to Department of Respiratory Medicine, Fujian Medical University, from September 2005 to February 2009 were measured with the method of physical examination and their first-second forced expiratory volume was estimated (FEV1% pred), measured peak expiratory flow rate (PEF% pred), and forced vital capacity (FVC) ratio (FEV1%). Results The FEV1% pred> 70%, PEF% pred> 70%, and FEV1%> 70% of the patients with BA and COPD were all normal. Raw materials of all subgroups were decreased with the decreasing of the three ventilation indexes. There were significant differences in Raw between FEV1% pred <70% and FEV1% <70% subgroups and most PEF% pred subgroups and decreasing adjacent groups in the two groups (all P <0.01). The correlation coefficients of FEV1% pred, PEF% pred, FEV1% and Raw in BA group were -0.814, -0.722 and -0.757 respectively (P <0.01), and the correlation coefficients of COPD group were -0.813 and -0.703 -0.696 (P <0.01). The FEV1% pred <70%, PEF% pred <70%, and FEV1% <70% in the BA group were all higher than those in the COPD subgroup. Most of the differences were statistically significant (P <0.05). Raw subgroups of both BA and COPD groups showed a turning point of> 3 cmH2O / (L.S.). Except for a few cases, the rise of Raw> 3cmH2O / (L.S.) in BA group appeared one subgroup ahead of the COPD group. The abnormal rate of Raw BA in BA group was significantly higher than that in COPD group. Conclusions Rawness was normal when the expiratory flow rate was> 70%. Raw> 3cmH2O / (L.S.) appeared only when the expiratory flow rate decreased to a certain extent. Raw BA patients with the same degree of airflow obstruction higher than COPD patients. FEV1% pred, PEF% pred and FEV1% were negatively correlated with Raw, of which FEV1% pred had the strongest correlation with Raw.