摘要
目的探讨慢性阻塞性肺疾病（COPD）患者的胸部高分辨率CT（HRCT）指标分型特征,以提高对COPD异质性特点的认识。方法选取2012年8月~2014年3月稳定期COPD患者,进行相关临床数据采集,包括胸部HRCT检查、肺功能检查、病史询问、COPD评分测试（CAT）、诱导痰中α-肿瘤坏死因子（TNF-α）及8异前列腺素F2α（8-iso-PGF2α）测定等。据HRCT指标分类进行特征对比研究。结果符合入选条件的稳定期COPD患者共72例。无肺气肿型32例,肺气肿型40例;无支气管管壁增厚型40例,支气管管壁增厚型32例;A型32例,E型19例,M型21例。肺气肿型患者BMI较低,肺通气功能更差,残总比增高,急性加重更频繁,CAT评分更高。支气管管壁增厚型患者全身炎症指标CRP增高,诱导痰中TNF-α、8-iso-PGF2α增高,急性加重次数更频繁,CAT评分更高。A型患者BMI较高,急性加重频率低,CAT评分低,病情较轻。E、M型的病情较重、生活质量差、肺功能指标下降明显;M型较其他两型气道炎症明显,急性加重频率高。结论可以通过HRCT区分出一组具有相同特征的COPD表型,即肺气肿型、支气管管壁增厚型,及结合综合因素分出A型、E型、M型三型。
Objective To explore the phenotype characteristics of chest high resolution computed tomography（ HRCT） indexes of patients with chronic obstructive pulmonary disease（ COPD） to improve the knowledge of the heterogeneity of COPD. Methods Clinical data（ chest HRCT examination,pulmonary function test（ PFT）,history taking,COPD assessment test（ CAT）,determination of tumor necrosis factor- α（ TNF- α） and 8- iso- prostaglandin F2α（ 8- iso-PGF2α） in induced sputum,etc.） were collected from COPD patients in stable phase from August 2012 to March 2014. Results A total of 72 COPD patients in stable phase met the inclusion criteria： 32 cases with no emphysema and 40 cases with emphysema; 40 cases with no bronchial wall thickening and 32 cases with bronchial wall thickening; 32 cases of type A,19 cases of type E and 21 cases of type M. Patients with emphysema had a lower BMI,poorer pulmonary ventilation function,higher RV / TCL,more frequent acute exacerbation and higher CAT score. Patients with bronchial wall thickening had a higher C Reactive Protein（ CRP）,increased TNF- α and 8- iso- PGF2α in induced sputum,more frequent acute exacerbation and higher CAT score. Patients of A type had a higher BMI,less frequent acute exacerbation,lower CAT score and milder clinical symptoms; Patients of type E and type M had severer clinical symptoms,poorer life quality and remarkably declined lung function indexes; Patients of type M had more obvious airway inflammation and more frequent acute exacerbation than patients of the other two types. Conclusion It is possible to distinguish between a group of COPD phenotypes with the same characteristics（ emphysema and bronchial wall thickening） and divide them into type A,E and M according to comprehensive factors.
出处
《现代医院》
2016年第4期514-517,共4页
Modern Hospitals
关键词
慢性阻塞性肺疾病
表型
高分辨率CT(HRCT)
肺气肿评分
支气管管壁增厚评分
chronic obstructive pulmonary disease
phenotype
High resolution computed tomography（HRCT）
emphysema score
bronchial wall thickening score
作者简介
通信作者：何正光
