摘要
目的探究中老年人群中慢性阻塞性疾病(COPD)、哮喘和哮喘-慢阻肺重叠综合征(ACO)的临床特征差异,以提高临床对于慢性阻塞性炎症疾病的诊治水平。方法采用回顾性研究,选取安徽医科大学附属宿州医院2018年1月至2019年7月收治ACO患者50例,单纯哮喘患者52例,单纯COPD患者58例。分析3组患者的临床症状、肺部听诊、肺功能水平、痰细胞学检测和住院时长、住院花费的差异。结果3组患者在圣乔治呼吸问卷(SCQR)呼吸疾病问卷分级上差异有统计学意义(P<0.05),ACO组患者和COPD组患者多以Ⅲ级评分为主(42.00%和37.93%),而哮喘组患者多以Ⅱ级为主(38.46%)。3组患者的肺部听诊特征差异有统计学意义(P<0.05),ACO组患者多以干啰音合并湿啰音为主(50.00%),COPD组患者多以中水泡音或大水泡音为主(36.20%),哮喘组患者以哮鸣音为主要体征(59.62%)。COPD组患者的第1秒用力呼气容积占预计值百分比(FEV1%)、用力肺活量(FVC)、FEV1/FVC值显著低于ACO组和哮喘组,差异有统计学意义(P<0.05)。COPD组和ACO组以肺泡壁损害和肺部弥散功能下降为主的患者比率高于哮喘组,而肺部气道功能性改变为主的患者比率低于哮喘组,差异有统计学意义(P<0.05)。COPD组和ACO组的嗜酸粒细胞百分比表达显著低于哮喘组,差异有统计学意义(P<0.05);COPD组的中性粒细胞百分比表达显著高于ACO组和哮喘组,差异有统计学意义(P<0.05)。COPD组患者在伴有并发症和合并症方面花费显著高于ACO组和哮喘组,差异有统计学意义(P<0.05),ACO组和COPD组患者在使用呼吸机花费上显著高于哮喘组,差异有统计学意义(P<0.05)。3组患者入院时花费比较,差异无统计学意义(P>0.05)。结论不同慢性阻塞性疾病在临床特点、肺功能水平、CT检查、痰细胞检测和费用花费、住院时长上均存在差异,临床实践中应根据患者的不同病情给予相应的治疗方案。
Objective To investigate the clinical characteristics of chronic obstructive pulmonary disease(COPD),asthma and asthma-COPD overlap(ACO)in middle-aged and elderly people,so as to improve the clinical diagnosis and treatment of chronic obstructive inflammatory disease.Methods Fifty cases of ACO,52 cases of asthma,and 58 cases of COPD treated in Suzhou Hospital Affiliated to Anhui Medical University from January 2018 to July 2019 were retrospectively analyzed,including the difference in the clinical symptoms,lung auscultation,lung function level,sputum cytology test,length of hospital stay,and hospitalization cost.Results The St.George's Respiratory Questionnaire(SGRQ)indexes of three groups had statistic difference.Patients with ACO and COPD were predominantly classified as gradeⅢ(42.00%and 37.93%),while asthma patients were predominantly classified as gradeⅡ(38.46%).The characteristics of lung auscultation also showed statistically significant difference among three groups(P<0.05).ACO group was mostly characterized as dry rales combined with wet rales(50.00%),and COPD group had typically large or medium bubbling rales(36.20%).In asthma group,wheezing was the main sign(59.62%).The forced expiratory volume in the first second predicted(FEV1%),forced vital capacity(FVC),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC)of COPD group were significantly lower than those of ACO group and asthma group,with significant difference(P<0.05).The proportion of patients with alveolar wall damage and decreased pulmonary diffusion function in COPD group and ACO group was higher than that in asthma group,while the proportion of patients with pulmonary airway function change was lower than that in asthma group(P<0.05).The percentage of eosinophils in COPD group and ACO group was significantly lower than that in asthma group(P<0.05),while the percentage of neutrophil in COPD group was significantly higher than that in ACO group and asthma group(P<0.05).The cost on complications and comorbidities treatm
作者
王晶
汪玉龙
郭锋
WANG Jing;WANG Yu-long;GUO Feng(Department of Respiratory Medicine,Suzhou Hospital Affiliated to Anhui Medical University(Suzhou Municipal Hospital),Suzhou Anhui 234000,China;Department of Clinical Laboratory,Suzhou Hospital Affiliated to Anhui Medical University(Suzhou Municipal Hospital),Suzhou Anhui 234000,China)
出处
《临床和实验医学杂志》
2020年第24期2626-2630,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省自然科学基金项目(编号:1508085MH177)。
