摘要
目的通过3年的随访研究探讨慢性阻塞性肺疾病（COPD）肺功能的变化特点及影响肺功能明显变化的危险因素。方法选2009年9月-2012年6月第三军医大学第二附属医院呼吸内科慢性呼吸道疾病管理中心确诊为COPD且定期随访满3年的患者，分析其肺功能[第一秒用力呼气容积（FEV1）]的变化。结果随访3年，尽管多数患者使用了包括吸入糖皮质激素联合长效支气管扩张剂等药物治疗，但FEV1仍呈进行性下降，平均下降值为（31．80±61．99）ml，年平均下降率为（3．74±6．18）％。78．3％（47／60）的患者FEV1下降，21．7％（13／60）的患者FE1上升。相关分析显示，FEV1年下降率与初始FEV1、FEV1占预计值百分比、急性加重次数有关（r值分别为0．298、0．361、0．273，P值均〈0．05）；logistic回归分析显示，支气管舒张剂反应阳性、初始FEV1水平是影响FEV1变化明显的独立危险因素（OR=5．54，95％CI1．55～19．73；OR=8．28，95％CI1．42—48．32）。结论COPD患者肺功能变化存在异质性，尽管多数患者在进行治疗，但近80％的患者肺功能仍进行性下降；FEV1的明显变化与其初始肺功能、支气管舒张剂反应性有关。
Objective To investigate the characteristics and the risk factors of pulmonary function in patients with chronic obstructive pulmonary disease （COPD） for a 3 year follow-up. Methods Subjects diagnosed as COPD were followed up for 3 years in the Management Center of Chronic Respiratory Disease at XINQIAO Hospital from September 2009 to June 2012. This was a retrospective study. Parameters related to respiratory function mainly first second forced expiratory volume （FEV1 ） , COPD assessment test （CAT） , 6 minutes walking distance （6MWD） and acute exacerbation were recorded during follow-up. Results Although the majority of patients were treated with drugs such as inhaled corticosteroid combined with long- term bronchial dilatation during the three years, FEV1 decreased progressively. The average annual decline of FEV1 was（31.80 ± 61.99） ml, translating into a mean annual decline of（3.74 ±6. 18）%. However, there were significant differences in changes of FEV1. Approximately, FEV1 in 78.3% （47/60） patients decreased, only 21.7% （13/60） patients kept stable FEVl. There was a correlation between decrease of FEV1, FEV1 % predicted and the exacerbation （ r = 0. 298, 0. 361,0. 273 ; P 〈 0. 05 ）. Logistic regression showed that the positive bronehodilator reversibility and the initial FEV1 were the independent factors associated with significant changes in FEV1 （ respectively, OR = 5.54,95% CI 1.55 - 19.73 ; OR = 8.28, 95% CI 1.42 -48.32 ）. Conclusion The changes of pulmonary function in patients with COPD are heterogeneous, although most patients are treated in a standard way. Nearly 80% patients still represent deterioration of pulmonary function. Decline of FEV1 is closely related to the initial pulmonary function and bronchodilator reversibility.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2016年第4期302-306,共5页
Chinese Journal of Internal Medicine
关键词
肺疾病
慢性阻塞性
肺功能
危险因素
Pulmonary disease, chronic obstructive
Pulmonary function
Risk factor
作者简介
通信作者：王长征，Email：czwang@netease．com
