摘要目的 通过比较重度慢性阻塞性肺疾病(COPD)男性患者戒烟6个月时与戒烟12个月时两次测得相关肺功能指标及心肺运动试验(cardiopulmonary exercise test,CPET)结果,探讨戒烟时间对稳定期重度COPD患者运动耐力的影响.方法 随访52例处于稳定期的重度COPD男性患者,分别于其戒烟6个月时及戒烟12个月时两次进行静态常规肺功能(pulmonary function test,PFT)及CPET,测定相关肺通气功能参数、心肺运动功能参数,并将两次测得数据进行配对样本t检验.结果 ①此52例COPD患者于戒烟6个月时和戒烟12个月时两次测得的PFT结果显示,FEV1、FEV1％pred、FEV1/FVC、D(1.)CO两组间比较差异无统计学意义(P＞0.05).戒烟12个月时的IC[(2.21±0.62)L]高于戒烟6个月时的IC[(1.83±0.47)L],差异有统计学意义(P＜0.05).戒烟12个月时的RV[(4.02±0.82)L]、TLC[(7.30±1.21)L]、RV/TLC[(51.43±7.67)％]均低于戒烟6个月时的RV[(4.75±0.26) L]、TLC[(7.71±0.84)L]、RV/TLC[(56.33±8.79)％],差异均有统计学意义(P＜0.05);②CPET测定结果显示,此52例COPD患者戒烟12个月时的Peak Load[(91.21±15.12)W]、Peak(v)O2[(1 327.21±281.42) ml/min]、Peak(v)O2 ％pred[(63.07±17.15)％]、Peak(v)O2/kg[(21.58±4.13)ml·min-1·kg-1]、Peak(v)E[(38.33±8.79)L/min]、dO2/dW1[(8.67±0.73)ml·min-1·watt-1]、Peak O2 pulse[(10.62±2.67)ml/beat]均高于戒烟6个月时的Peak Load[(81.26±16.32)w]、Peak (v)O2 [(1075.18±276.45) ml/min]、Peak(v)O2 ％pred[(54.13±16.14)％]、Peak(v)O2/kg[( 17.49±4.37)ml·min-1·kg-1]、Peak(v)E[(34.29±7.12)L/min]、dO2/dW1[(8.51±0.72)ml·min-1·watt-1]、Peak O2 pulse[(9.57±2.47)ml/beat],差异有统计学意义(P＜0.05)；戒烟12个月时的Lowest(v)E/(v)CO2[(28.38±3.4)]低于戒烟6个月时的Lower(v)E/(v)CO2[(31.5±3.21)],差异有统计学意义(P＜0.05);③PFT中IC改善值与CPET中Peak(v)O2、Peak(v)O2/kg、Peak(v)E、Lowest(v)E/(v)CO2的改善值有良好的相关性,而FEV1的改善值与上述CPET的参数改善无显著相关.结论 戒烟时间的长短能影响COPD患者综合心肺能力和运动耐量,戒烟对于重度COPD患者仍有较大意义.IC值对于预估COPD患者的运动耐力受损程度有较大意义.

abstractsObjective To study the impact of quit-smoking time on exercise capacity in patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Pulmonary function test (PFT) and cardiopulmonary exercise testing(CPET) were tested in 52 male patients with stable severe COPD at quit-smoking of 6 months and 12 months.Results ①IC,RV,TLC and RV/TLC,but not FEV1 FEV1 ％pred,showed differences among the two groups ( P ＜0.05).IC was significantly higher in group of quit-smoking of 12 months [(2.21±0.62) L] than in group of quit-smoking of 6 months [(1.83±0.47) L].RV,TLC and RV/TLC was significantly lower in group of quit-smoking of 12 months [(4.02±0.82) L,(7.30±1.21) L,(51.43±7.67) ％] than in group of quit-smoking of 6 months [(4.75±0.26)L,(7.71±0.84) L,(56.33±8.79)％] ( P ＜0.05).②Within CPET parameters,the level of Peak Load,Peak (v) O2,Peak (v)O2 ％ pred,Peak (v) O2/Kg,Peak (v) E,dO2/dW1,Peak O2 pulse in group of quitsmoking of 12 months [(91.21±15.12) W,(1327.21±281.42) ml/min,(63.07±17.15)％,(21.58±4.13) ml· min-1 · kg-1,(38.33±8.79) L/min,(8.67±0.73) ml · min-1 · watt-1],(l0.62±2.67)ml/beat] were higher than that in group of quit-smoking of 6 months Peak Load [(81.26± 16.32) W,(1075.18±276.45) ml/min,(54.13±16.14) ％,(17.49±4.37) ml · min-1 · kg-1,(34.29±7.12) L/min,(8.51±0.72) ml · min-1 · watt-1,(9.57±2.47) ml/beat]( P ＜0.05),the level of Lowest (v)E/(v)CO2in group of quit-smoking of 12 months [(28.38±3.4)]were lower than that in group of quit-smoking of 6 months [(31.5±3.21 )]( P ＜0.05).③Postdose improvement in IC was significantly correlated with the increase in Peak (v) O2,Peak (v) O2/Kg,Peak (v) E and Lowest (v) E/(v) CO2,but not with FEV1.Conclusions The quit-smoking of time impact on the pulmonary function and exercise tolerance in patients with stble severe COPD.Smoking cessation is still one of the most important outcome measures in patients with severe COPD.