文章摘要
黄 艳,朱 毅.非吸烟间质性肺炎患者气道功能状态评估[J].南京医科大学学报,2019,(7):993~996
非吸烟间质性肺炎患者气道功能状态评估
Assessment on the airway function of non-smoking patients with interstitial lung disease
投稿时间:2018-09-12  
DOI:10.7655/NYDXBNS20190709
中文关键词: 间质性肺疾病  气道功能  肺功能
英文关键词: interstitial lung disease  airway function  lung function test
基金项目:国家自然科学基金面上项目(81770031)
作者单位
黄 艳 南京中医药大学附属南京医院(南京市第二医院)呼吸内科江苏 南京 210003 
朱 毅 南京医科大学第一附属医院呼吸内科江苏 南京 210029 
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中文摘要:
      目的:对间质性肺炎患者进行常规肺功能及脉冲振荡(impulse oscillometry system,IOS)肺功能检查,评估患者的气道功能状态。方法:129例间质性肺炎患者与143例对照人群进行了常规肺功能检查和IOS肺功能检查。间质性肺炎患者均为非吸烟的自身免疫性疾病相关性间质性肺疾病(connective tissue disease related interstitial lung disease,CTD?ILD)或伴有自身免疫特征的间质性肺疾病(interstitial pneumonia with autoimmune features,IPAF)患者。比较两组各项肺功能参数的差异,并分析一氧化碳弥散量(DLCO)与其他肺功能参数的相关性。结果:间质性肺炎患者中51.2%存在限制性通气功能障碍,2.3%存在阻塞性通气功能障碍。间质性肺炎患者肺活量(VC)、用力肺活量(FVC)、残气量(RV)、肺总量(TLC)低于对照组;第1秒用力呼气量占所有呼气量的比例(FEV1/FVC)高于对照组,差异具有统计学意义。残总比(RV/TLC)与对照组相比差异无统计学意义。最大呼气中期流速(MMEF75/25)高于对照但差异无统计学意义。各项IOS气道黏性阻力参数在两组之间差异无统计学意义。DLCO与VC、1秒用力呼气容积(FEV1)、MMEF75/25、RV、TLC呈显著正相关,与周边气道阻抗R5?R20和小气道阻抗R5?R10呈显著负相关,与FEV1/FVC无相关性。结论:非吸烟的CTD?ILD和IPAF患者,通气功能障碍以限制性为主,阻塞性通气功能障碍者极少,IOS肺功能对患者肺功能异常的判断没有帮助。随着DLCO水平下降和疾病进展,远端气道阻抗有增加趋势,但FEV1/FVC没有变化,提示CTD?ILD和IPAF患者的小气道阻抗增加不导致气体潴留,无需对小气道功能进行药物干预。
英文摘要:
      Objectives:To assess the airway function of the patients with interstitial lung disease(ILD)using the conventional lung function test and the impulse oscillometry system(IOS). Methods:Totally 129 patients with ILD and 143 coughing patients were included for the assessment. The ILD patients were all non?smokers and of connective tissue disease?associated interstitial lung disease(CTD?ILD)or interstitial pneumonia with autoimmune features(IPAF). Lung function test results were compared between the two groups. Correlations of the diffusion capacity of the lung for carbon monoxide(DLCO)with other parameters were analyzed. Results:Restrictive and obstructive ventilation dysfunctions were observed in 51.2% and 2.3% of the patients with ILD,respectively. The vital capacity(VC),forced vital capacity(FVC),residual volume(RV)and total lung capacity(TLC)of the patients with ILD were significantly lower than those of the control group,but the forced expiratory volume in one second/forced vital capacity(FEV1/FVC)in the ILD patients was higher,which is of statistical significance(P < 0.05). Residual volume/total lung capacity(RV/TLC)was similar in two groups(P > 0.05). Maximal mid?expiratory flow(MMEF75/25)in the ILD group is higher but the difference is statistically insignificant(P > 0.05). IOS airway resistance values are similar in two groups(P > 0.05). DLCO is positively correlated with VC,FEV1,MMEF75/25,RV,TLC(P < 0.05),but negatively correlated with R5?R20,R5?R10(P < 0.05),and shows no correlation with FEV1/FVC. Conclusion:In non?smoking patients with CTD?ILD and IPAF,the restrictive ventilation dysfunction is overwhelmingly common compared with obstructive dysfunction. IOS is of no value in diagnosing ILD. With the progression of ILD and the declination of DLCO,the measured distal airway resistances using IOS show slight increase,but FEV1/FVC remain unchanged,suggesting air retention is unlikely and it is generally unnecessary to use bronchodilators during the course of CTD?ILD and IPAF.
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