摘要目的 探讨慢性阻塞性肺疾病(COPD)肺气肿表型急性加重期的临床特征.方法 研究对象为2009年4月至2010年6月就诊于首都医科大学附属北京同仁医院呼吸科COPD急性加重期患者95例,其中男性60例,女性35例,年龄41～92岁,平均年龄(75±9)岁.根据肺部HRCT肺气肿视觉评分,分为无/轻度肺气肿组(评分≤8分)和中/重度肺气肿组(评分＞8分),比较两组在临床资料,包括性别、年龄、体质量指数、吸烟指数、合并心脑血管疾病情况、肺功能、超声心动图、血常规、血气分析、系统性炎症指标[C-反应蛋白(CRP)、纤维蛋白原]等方面的差异.结果 无/轻度肺气肿组40例,肺气肿视觉评分为(4.54±2.08)分,其中男性26例,女性14例,年龄(72.98士10.98)岁.中/重度肺气肿组55例,肺气肿视觉评分为(17.67±6.31)分,其中男性34例,女性21例,平均年龄(76.48±7.60)岁.两组间在性别构成上差异无统计学意义(P＞0.05);中/重度组年龄明显大于轻度组,差异有统计学意义(P＜0.05).中/重度肺气肿组患者体质量指数明显低于无/轻度组;吸烟指数、合并心脑血管疾病比例、动脉血二氧化碳分压、第1秒用力呼气容积/用力肺活量、肺动脉高压发生比例、血浆纤维蛋白原、CRP水平明显高于无/轻度组,差异均有统计学意义(P＜0.05).两组间动脉血氧分压、第1秒用力呼气容积占预计值百分比、贫血发生率差异无统计学意义.结论 COPD的肺气肿表型与反映病情严重程度及系统性炎症的某些指标相关.

abstractsObjective To study whether there were clinical characteristics associated with the emphysema phenotype of chronic obstructive pulmonary disease (COPD). Methods We reviewed the clinical data of 95 patients who were admitted to Department of Respiratory Medicine, Beijing Tongren Hospital ,Capital Medical University, for severe exacerbation of COPD from April, 2009 to June, 2010.The patients, 60 were male and 35 were female, aged from 41 to 92 years old,average age (75±9) years old. Based on HRCT visual assessment of emphysema, the patients were classified into 2 groups: mild emphysema group (score≤8) and severe emphysema group (score＞8). Statistical analysis between these two groups regarding demographic and physical characteristics, such as gender, age, BMI, smoking index, comorbidities, lung function, ultrasonic cardiogram, blood routine, artery blood gas analysis,systemic inflammation marker (CRP, FIB, etc. ) was permormed. Results Among 95 subjects, 40 patients (26 were male and 14 were female) were in mild group and 55 patients(34 were male and 21 were female) in severe group. The average score and mean age in mild group were respectively (4. 54 ±2. 08)scores and (72. 98 ± 10. 98) years, and in severe group were respectively (17.67 ± 6.31) scores and (76. 48±7. 60) years. There was no statistical difference in gender between two groups. The mean age of patients in severe groups was much higher than mild group ( P＜0. 05). Significant differences can be seen between two groups with respects to BMI, smoking index, prevalence of cardiovascular disease,PCO2, FEV1/FVC, incidence of pulmonary hypertension, FIB and CRP level in plasma. These variances in severe emphysema group were higher than mild group. No significant difference was found in PO2,prevalence of anemia and FEV1 % pred between the two groups. Conclusions The emphysema phenotype of COPD is associated with some markers which can reflect the systemic inflammation and severity of the disease at acute exacerbations.