摘要目的 观察多次呼吸氮冲洗技术获取的肺通气不均指数(Sacin、Scond)在慢性阻塞性肺疾病(慢阻肺)患者中的水平并进行相关性分析,探讨肺通气不均指数对病情严重程度的指导意义.方法 收集2014年11月至2015年2月北京大学第三医院呼吸门诊长期随访的稳定期慢阻肺患者43例,均为男性,平均年龄(67±9)岁;以同时期门诊体检的非吸烟健康者56名为对照组,其中男14名,女42名,平均年龄(37±13)岁.比较慢阻肺组及健康对照组肺通气不均指数的差异,应用pearson直线相关分析观察Sacin和Scond指数与传统肺功能指标的相关性,并将慢阻肺患者以FEV1占预计值％为50％为界分为2组,比较组间Sacin和Scond的差异.结果 慢阻肺组Sacin[0.320(0.238,0.432)]和Scond[0.082(0.043,0.103)],较健康对照组[0.097 (0.073,0.144),0.018(0.007,0.028)]明显升高,差异有统计学意义(u=144.5,103.5,均P＜0.001).Sacin和Scond与FVC占预计值％(r=-0.686,-0.551)、FEV1占预计值％(r=-0.681,-0.475)和FEV,/FVC(r=-0.4581-0.210)均呈负相关,Sacin与DLCO呈负相关(r=-0.413),差异有统计学意义(均P＜0.01).随着病情严重程度的增加,Sacin和Scond逐渐升高.结论 慢阻肺患者肺通气不均指数(Sacin、Scond)明显升高,与传统肺功能指标具有显著相关性,提示慢阻肺患者传导区及腺泡区存在显著的通气不均,肺通气不均指数可作为评估病情严重程度的指标.

abstractsObjective We investigated ventilation inhomogeneity indices(Sacin,Scond)in patients with chronic obstructive pulmonary disease (COPD) using the multiple breath nitrogen washout test (MBNW) and determined the correlation between the 2 indices (Scond and Sacin,as a measure of ventilation inhomogeneity in conductive and acinar zones of the lungs,respectively) and lung function to investigate the significance of assessing the COPD severity with ventilation inhomogeneity indices.Methods Forty-three stable COPD patients and 56 non-smoking healthy subjects were recruited from November 2014 to February 2015.The differences of ventilation inhomogeneity indices (Sacin,Scond) between the 2 groups were compared,and the correlation between ventilation inhomogeneity indices and traditional parameters of lung function were determined using Pearson linear correlation.According to the FEV1 ％ pred =50％,COPD patients were divided into 2 groups and ventilation inhomogeneity indices (Sacin,Scond)were compared between groups.Results Compared with the healthy control group,Sacin [0.320(0.238,0.432)vs 0.097 (0.073,0.144),u =144.5,P ＜ 0.001],and Scond [0.082 (0.043,0.103) vs 0.018 (0.007,0.028),u =103.5,P ＜ 0.001] in COPD patients were significantly increased,and the difference was statistically significant.Sacin and Scond were negatively correlated with FVC％ pred (r =-0.686,-0.551,both P ＜ 0.001),FEV1％pred(r =-0.681,-0.475,both P ＜ 0.01),FEV1/FVC(r =-0.458,-0.210,both P＜0.01).Sacin was negatively correlated with DLCO(r =0.413,P ＜0.01).With the increase in the severity of the disease,Sacin and Scond increased gradually.Conclusion Sacin and Scond in COPD patients increased significantly,which was significantly correlated with lung function.COPD has ventilation inhomogeneity in conductive and acinar zones and ventilation inhomogeneity indices can be used to evaluate the severity of COPD.