摘要目的 探讨支气管舒张试验后COPD患者的肺容量和呼气流量反应的差别.方法 2006年1月至2008年6月临床诊断为COPD稳定期无呼吸衰竭及心力衰竭的患者465例,其中男426例,女39例;年龄(42～86)岁,平均(67±8)岁.采用支气管舒张试验比较患者支气管舒张前后FEV_1和FVC的改变值和改变率.统计学分析采用自身配对t检验和配对秩和检验,各组间比较采用独立样本t检验和方差分析(正态分布)以及非参数秩和检验(非正态分布).结果 支气管舒张试验后,COPD患者的FEV_1平均增加117 ml,较基础值平均提高13.2%,舒张试验阳性率为18.7%(87/465);FVC平均增加258 ml,较基础值平均提高14.0%,舒张试验阳性率为44.1%(205/465).随着COPD严重程度的增加,FEV_1改变值逐渐减少,而FVC改变值却逐渐增加.结论 吸入支气管舒张剂后COPD患者的容量反应较流量反应更为明显,FVC改变值较FEV_1更大,且随着COPD的严重程度增加,FVC增加值越大.FVC应该作为COPD患者对支气管舒张剂反应的重要指标.

abstractsObjective The reversibility of chronic obstructive pulmonary disease (COPD) is evaluated mainly by FEV_1 after bronchodilators. However, lung volumes also change significantly in COPD, but few studies addressed the characteristics df the changes in post bronchodilator airflow and lung volume in patients with COPD. This study was carried out to evaluate the difference of FEV_1 response and forced vital capacity (FVC) response to bronchodilators in patients with COPD as well as the impact of severity of COPD on the flow and volume reversibility. Methods 465 patients with COPD (male 426, female 39), aged 67.1±8.3 (42-86) years were enrolled from Jan. 2006 to Jun. 2008. The severity of COPD was graded according to the GOLD criteria. The change and rate of change of FEV_1 and FVC 20 minutes after inhalation of salbutamol 400 μg via spacer were measured and compared. Positive response to the bronchodilator was determined as FEV_1 or FVC increased 12% as well as 200 ml or above. The impacts of severity on flow and volume response were also studied. Results Post-bronchodilator FEV_1 increased 117 ml with a 13. 2% improvement on average compared with baseline. Post-bronchodilator FVC increased 258 ml and improved by 14. 0% on average. The rate of positive reversibility in FEV_1 and FVC was 18. 7% (87/465) and 44. 1% (205/465), respectively. The improvement of FEV_1 decreased as a function of the severity of COPD. In contrast, the improvement of FVC was increased in those with more severe disease. Conclusion The improvement of lung volume is more significant and maybe more important than airflow response in patients with COPD, especially in those with severe disease. In addition to FEV_1, the reversibility of COPD should also be evaluated by FVC.