【作者】 李平；

【导师】 加孜娜·托哈依；

【作者基本信息】 新疆医科大学 ， 内科学， 2008， 硕士

【摘要】 目的比较慢性阻塞性肺病(以下简称COPD)、支气管哮喘以及支气管哮喘合并COPD患者的临床特点以及行支气管舒张试验前后肺功能指标的异同之处,以探讨支气管舒张试验对三组疾病的诊断与鉴别诊断的意义,及其对哮喘合并COPD临床研究的价值。方法选择2005-2007年间350例经结合临床特征及支气管舒张试验的结果确诊分为支气管哮喘、COPD和支气管哮喘合并COPD三组的患者,将其临床特点及支气管舒张试验前后的肺功能指标进行比较分析。结果①临床资料比较:单纯哮喘组患者女性多于男性,在三组中患病年龄最年轻,病程最短,有吸烟史者最少,吸烟指数最小,有哮喘家族史者比例最大,单纯COPD组与哮喘合并COPD组患者一般资料和病史较相似;单纯哮喘组患者肺部体征以单纯哮鸣音为主,血常规以嗜酸性粒细胞增高为主,而单纯COPD组患者肺部体征以干湿啰音并存为主，血常规以中性粒细胞增高为主,哮喘合并COPD组的以上项目则介于单纯COPD与哮喘组之间。②肺功能比较:行支气管舒张试验前FEV1%、FEV1/FVC%、MMEF%值三组之间两两比较均有差异,哮喘合并COPD组气流受限最重,其次为单纯COPD组,单纯哮喘组最轻,同时FVC%、PEF%和sGaw%单纯哮喘组最大,Raw%最小,而单纯COPD组与哮喘合并COPD组以上指标较接近;支气管舒张试验后Raw%值三组两两比较均有差异,单纯哮喘组气道阻力最低,其次为哮喘合并COPD组,单纯COPD组最大,且哮喘合并COPD组的FEV1%、MMEF%和FVC%的改变率最大,PEF%、Raw%和sGaw%的改变率则接近于单纯哮喘组水平,单纯COPD组则以上肺功能指标的改变率最小。结论哮喘合并COPD组患者行支气管舒张试验前其大、小气道气流受限最重,支气管舒张试验后肺活量明显增高,气道阻力下降,且呼气流速改变率最大,其气流受限的可逆性介于单纯哮喘和COPD组之间,故支气管舒张试验有助于哮喘、COPD以及哮喘合并COPD的诊断和鉴别诊断,为哮喘合并COPD的临床研究提供了有力的依据。更多还原

【Abstract】 Objective To coduct a comparison with the pulmonary ventilation function of chronic obstructive pulmonary diseasese(COPD) and Asthma as well as combination of two diseases before and after inhaling salbutamol, simultaneous contrast to their clinical characteristics,so as to approach the significance of three groups’diagnose and antidiastole by means of broncho dilatation test as well as its value to the clinical research of Asthma combing with COPD. Methods To select 350 cases patients from 2005 to 2007who were final diagnosed and separated to three groups of Asthma、COPD and Asthma combing with COPD through connecting the clinical feature with their results of broncho dilatation test,then to compare with and analyze their clinical feasures and the pulmonary function parameter before and after broncho dilatation test. Results①compare with the clinical data:The patients of simple Asthma group who are female exceeding male,whose ages with disease are the youngest among the three groups, whose courses of disease are the shortest,the smoker are the least,the smoking exponent are the smallest as well as the proportion of those who have the family history are the biggest,while the general datas and case histories of simple COPD and Asthma combing with COPD are similar;the bellows objectives of simple Asthma group are mainly purely wheezing rale,and whose blood rules are mainly the acidophilic granulocyte,while the bellows objectives of simple COPD group are mainly the dry rales concomitance moist rales,and whose blood rules are mainly neutral granular cell ,the items above of Asthma combing with COPD group are between simple Asthma and COPD groups.②compare with the pulmonary function: there are all significance difference among three groups and comparing with each other in the target of FEV1%、FEV1/FVC% and MMEF% before the broncho dilatation test,the air current limited of Asthma combing with COPD group are the most serious,next to simple COPD group and which of simple Asthma group are lightest,at the same time the target of FVC%、PEF%、and sGaw% of simple Asthma group are the biggest,and Raw% are the smallest,while the target above of simple COPD and Asthma combing with COPD groups are fairly closing. There are all difference among three groups and comparing with each other in the target of Raw% after broncho dilatation test,the airway resistance of simple Asthma group are the lowest,next to Asthma combing with COPD group and which of simple COPD group are the largest,furthermore the variabilities of FEV1%、MMEF% and FVC% in Asthma combing with COPD group are the largest, and the variabilities of PEF%、Raw% and sGaw% close to the level of simple Asthma group,while the variabilities of pulmonary function parameter above in simple COPD group are the smallest. Conclusion The large and small airway air current limited of Asthma combining with COPD group are the most serious before broncho dilatation test, its lung capacity have increased and the airway resistance decended obviously, as well its variabilities of expiratory flow rate are the largest,its reversability of the air current limited is between simply Asthma and COPD groups.Therefore,the broncho dilatation test conduce to the diagnosis and antidiastole of Asthma and COPD as well Asthma combing with COPD,meanwhile it can provide the emphatic evidence to the clinical research of Asthma combing with COPD.更多还原