摘要目的 比较根据肺功能指标DLCO和深吸气量分组的慢性阻塞性肺疾病(慢阻肺)患者的临床特征,观察各组对吸入布地奈德福莫特罗治疗反应是否存在差别.方法 选取2012年6月至2014年6月在沧州市中心医院就诊的105例确诊中重度稳定期慢阻肺患者,其中男70例,女35例,年龄44～85岁,平均64.6岁,按照肺功能DLCO和深吸气量分为4个亚组:DLCO及深吸气量均正常组(A组)10例,DLCO减低深吸气量正常组(B组)18例,DLCO正常深吸气量减低组(C组)22例,DLCO及深吸气量均减低组(D组)55例.比较4组患者的临床特征及诱导痰炎症细胞计数,所有患者均吸入布地奈德福莫特罗(320 μg/9 μg,2次/d)治疗3个月,观察患者治疗后肺功能指标及慢阻肺评估测试问卷(CAT)评分的变化.结果 D组CAT评分为(27.6±6.4),高于其他各组;C组喘息症状18例,在各组中比例最高,且诱导痰中嗜酸粒细胞百分比最高[(7.6±3.2)％].吸入布地奈德福莫特罗治疗后C组FEV1改善最明显[(0.214-0.053)L],D组[(0.137±0.063)L]与B组[(0.092±0.048)L]相比改善较明显.C、B、D组的FVC增加量分别为(0.342±0.073)、(0.190±0.081)和(0.223±0.094)L,CAT改善分别为(4.4±2.0)、(2.3±1.3)和(3.9±1.9),C组FVC改善较B组和D组更明显,CAT评分改善差异有统计学意义(P＜0.05).结论 根据DLCO和深吸气量将慢阻肺患者分组后,不同组别患者的临床特征有差别,分组有助于区分对吸入激素+长效β～受体激动剂的治疗反应不同的患者.

abstractsObjective To compare the clinical characteristics and the therapeutic responses in chronic obstructive pulmonary disease (COPD) subgroups, classified by diffusing capacity of the lung for carbon monoxide (DLCO) and inspiratary capacity (IC).Methods A total of 105 mild-severe patients (70 males, 35 females, 44 to 85 years of age), with stable COPD were recruited in Cangzhou Central Hospital from June 2012 to June 2014.According to baseline DLCO and IC, the patients were divided into normal D LCO/IC group (group A, n =10), low DLCO/normal IC group (group B, n =18), normal DL CO/ low IC group (group C, n=22) and low DLCO/IC group (group D, n =55).We compared the clinical characteristics, induced sputum cells and the therapeutic responses to 3-month treatment of budesonide/ formoterol (320 μg/9 μg, inhale, bid) among the 4 groups.Results Group D showed the highest CAT scores (27.6 ± 6.4).Group C showed a higher prevalence of patients with wheezing(81.8)％ and the highest percentage of sputum eosinophils (7.6 ± 3.2) ％.Group C showed the greatest FEV1 increase (0.214 ± 0.053) L.Group D showed a greater FEV1 increase than Group B [(0.137 ± 0.063) vs (0.092 ± 0.048) L].Group C showed a greater FVC [(0.342 ± 0.073), (0.190 ± 0.081), (0.223 ± 0.094) L] increase and CAT[(4.4±2.0), (2.3 ± 1.3), (3.9± 1.9)] decrease than Group B and GroupD(P＜0.05).Conclusion These findings suggest that COPD subgroups classified by DLCO and IC show several clinical characteristics and may be helpful to predict responses to treatment.