摘要
目的分析有症状的保留比值受损肺功能(PRISm)患者肺一氧化碳弥散量(D_(L)CO)降低的发生率及其临床特征。方法本研究为横断面研究,采用非随机抽样的方法选取2023年10月至2024年8月于陆军军医大学新桥医院就诊的有咳嗽、咳痰、呼吸困难等症状的332例PRISm患者为研究对象。根据PRISm患者的吸烟情况分为当前吸烟组(89例)、既往吸烟组(57例)和从不吸烟组(186例)。根据D_(L)CO占预计值百分比(%pred)是否降低,将146例有吸烟史的PRISm患者分为D_(L)CO降低组(53例)和D_(L)CO正常组(93例)。收集患者的性别、年龄、身体质量指数(BMI)、合并症(高血压、冠状动脉粥样硬化性心脏病、糖尿病、支气管哮喘)、粉尘暴露情况、临床症状(咳嗽、咳痰、呼吸困难)、慢性阻塞性肺疾病评估测试(CAT)评分、6分钟步行距离(6MWD)和肺功能指标[舒张前后用力肺活量、舒张前后第1秒用力呼气容积、舒张前后一秒率、D_(L)CO、D_(L)CO/肺泡容积(V_(A))、校正后D_(L)CO(D_(L)COc)/V_(A)、舒张前后用力呼出25%肺活量的呼气流量、舒张前后用力呼出50%肺活量的呼气流量、舒张前后用力呼出75%肺活量的呼气流量]。采用Pearson相关分析评估有吸烟史的PRISm患者肺弥散功能与临床特征的相关性。结果当前吸烟组男81例,女8例,年龄(59.82±9.92)岁;既往吸烟组男41例,女16例,年龄(60.40±9.92)岁;从不吸烟组男41例,女145例,年龄(60.44±11.14)岁。3组患者年龄比较差异无统计学意义(F=0.11,P=0.897)。既往吸烟组与从不吸烟组的男性患者占比均低于当前吸烟组,且从不吸烟组的男性患者占比低于既往吸烟组;从不吸烟组合并支气管哮喘的患者占比高于当前吸烟组;既往吸烟组与从不吸烟组有咳嗽、咳痰症状的患者占比均低于当前吸烟组,从不吸烟组有呼吸困难症状的患者占比低于既往吸烟组;既往吸烟组与从不吸烟组CAT评分均低于当前吸烟组;从不吸烟组6MWD高于当前吸烟组(均P<0.05)。3组有症状的PRISm患者D_(L)CO%pred降低的发生率为28.0%(93/332),从不吸烟组D_(L)CO%pred降低的发生率低于当前吸烟组与既往吸烟组[21.5%(40/186)比36.0%(32/89)、36.8%(21/57),均P<0.05];从不吸烟组D_(L)CO%pred、D_(L)CO/V_(A)和D_(L)COc/V_(A)均高于当前吸烟组(均P<0.05)。Pearson相关分析显示,在有吸烟史的PRISm患者中,D_(L)CO%pred、D_(L)CO/V_(A)与BMI、6MWD均呈正相关(均P<0.05)。D_(L)CO正常组男78例,女15例,年龄(59.23±9.78)岁;D_(L)CO降低组男44例,女9例,年龄(61.49±10.03)岁,2组患者性别、年龄比较差异均无统计学意义(χ^(2)=0.02,t=1.33,均P>0.05)。D_(L)CO降低组患者的BMI和6MWD均低于D_(L)CO正常组[(23.03±3.80)kg/m^(2)比(25.60±3.88)kg/m^(2),(514.00±68.89)m比(578.85±67.41)m,t值分别为3.89、3.74,均P<0.001]。结论在有症状的PRISm患者中,D_(L)CO降低较为常见,有吸烟史的PRISm患者D_(L)CO降低的发生率更高,D_(L)CO降低与有吸烟史的PRISm患者运动耐受性下降有关。
ObjectiveTo investigate the incidence and clinical characteristics of reduced diffusion capacity of carbon monoxide of lung(D_(L)CO)in patients with symptomatic preserved ratio impaired spirometry(PRISm).MethodsThis was a cross-sectional study.Using non random sampling,332 PRISm patients with symptoms of cough,sputum and dyspnea who visited Xinqiao Hospital,Army Military Medical University from October 2023 to August 2024 were enrolled.According to the smoking status of PRISm patients,they were divided into the current smoking group(89 cases),the former smoking group(57 cases),and the never smoking group(186 cases).A total of 146 PRISm patients with a history of smoking were divided into a reduced D_(L)CO group(53 cases)and a normal D_(L)CO group(93 cases)based D_(L)CO as a percentage of predicted(%pred).The gender,age,body mass index(BMI),comorbidities(hypertension,coronary atherosclerotic heart disease,diabetes,bronchial asthma),dust exposure,clinical symptoms(cough,sputum and dyspnea),chronic obstructive pulmonary disease assessment test(CAT)score,6-minute walking distance(6MWD),and lung function(forced vital capacity[FVC]and forced expiratory volume in one second[FEV 1]and FEV 1/FVC before and after diastole,D_(L)CO,D_(L)CO/alveolar volume[V_(A)],corrected D_(L)CO[D_(L)COc]/V_(A),max expiratory at 25%,50%and 75%forced vital capacity before and after diastole)were collected.Pearson correlation analysis was used to evaluate the correlation between pulmonary diffusion function and clinical features in PRISm patients with a history of smoking.ResultsThere were 81 males and 8 females in the current smoking group,with an average age of 59.82±9.92 years.There were 41 males and 16 females in the former smoking group,with an average age of 60.40±9.92 years.There were 41 males and 145 females in the never smoking group,with an average age of 60.44±11.14 years.There was no significant difference in age among the three groups of patients(F=0.11,P=0.897).The proportion of male patients in the former smoking group and the never smoking group was significantly lower than that in the current smoking group,and the proportion of male patients in the never smoking group was significantly lower than that in the former smoking group.The proportion of patients with bronchial asthma in the never smoking group was significantly higher than that in the current smoking group.The proportion of patients with cough and sputum in the former smoking group and never smoking group was significantly lower than that in the current smoking group.The proportion of patients with dyspnea in the never smoking group was significantly lower than that in the former smoking group.The CAT scores of the former smoking group and the never smoking group were significantly lower than those of the current smoking group.The 6MWD of the never smoking group was significantly higher than that of the current smoking group(all P<0.05).The incidence of decreased D_(L)CO%pred in the three symptomatic PRISm patients was 28.0%(93/332),while the incidence of decreased D_(L)CO%pred in the never smoking group was significantly lower than that in the current smoking group and the former smoking group(21.5%[40/186]vs 36.0%[32/89],36.8%[21/57],both P<0.05).The D_(L)CO%pred,D_(L)CO/V_(A),and D_(L)COc/V_(A)in the never smoking group were all significantly higher than those in the current smoking group(all P<0.05).Pearson correlation analysis showed that in PRISm patients with a history of smoking,D_(L)CO%pred,D_(L)CO/V_(A)were positively correlated with BMI and 6MWD(all P<0.05).There were 78 males and 15 females in the normal D_(L)CO group,with an average age of 59.23±9.78 years;There were 44 males and 9 females in the reduced D_(L)CO group,with an average age of 61.49±10.03 years.There were no significant differences in gender and age between the two groups of patients(χ^(2)=0.02,t=1.33,both P>0.05).The BMI and 6MWD of patients in the reduced D_(L)CO group were significantly lower than those in the normal D_(L)CO group(23.03±3.80 kg/m^(2)vs 25.60±3.88 kg/m^(2),and 514.00±68.89 m vs 578.85±67.41 m,the t-values were 3.89 and 3.74,respectively,both P<0.001).ConclusionsD_(L)CO reduction is more common in symptomatic PRISm patients,and the incidence of D_(L)CO reduction is higher in those with a history of smoking.D_(L)CO reduction is associated with decreased exercise tolerance in PRISm patients with a history of smoking.
作者
张雯
叶东樊
龙舟
向青
王霞
刘熙
徐智
王关嵩
Zhang Wen;Ye Dongfan;Long Zhou;Xiang Qing;Wang Xia;Liu Xi;Xu Zhi;Wang Guansong(Center of Pulmonary and Critical Care Medicine,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)
出处
《国际呼吸杂志》
2025年第3期243-250,共8页
International Journal of Respiration
基金
重庆市科卫联合医学科研项目(2024GGXM001、2023QNXM045)。
关键词
肺疾病
慢性阻塞性
保留比值受损肺功能
肺弥散能力
肺一氧化碳弥散量
6分钟步行距离
Pulmonary disease,chronic obstructive
Preserved ratio impaired spirometry
Pulmonary diffusing capacity
Diffusion capacity of carbon monoxide of lung
6-minute walking distance
