本文選題：慢性阻塞性肺疾病 + 頻繁發(fā)作　； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:有關(guān)慢性阻塞性肺疾病(acute exacerbation of chronic obstructive pulmonary disease,COPD)頻繁發(fā)作患者不同表型(phenotype)特征的研究甚少。本研究試圖探討頻繁發(fā)作(frequent exacerbation,FE)和非頻繁發(fā)作(infrequent exacerbation,i FE)的慢性支氣管炎(chronic bronchitis,CB)、肺氣腫(emphysema,EM)和哮喘-COPD重疊綜合征(Asthma COPD overlap Syndrome,ACOS)三種表型患者臨床特征的差異,為臨床治療和管理頻繁和非頻繁加重患者提供參考。方法:回顧性分析142例入住我院呼吸科的COPD患者臨床資料,根據(jù)患者急性發(fā)作的病史將其分為頻繁發(fā)作組(frequent exacerbation,FE)和非頻繁發(fā)作組(infrequent exacerbation,i FE),再依據(jù)既定的分型標(biāo)準(zhǔn)分別分為慢性支氣管炎、肺氣腫和哮喘-COPD重疊綜合征(ACOS)表型組,比較該三種不同表型的FE或i FE患者臨床特征、生理學(xué)及影像學(xué)指標(biāo)的差異。結(jié)果:排除肺部其它疾病后,共收集符合入組條件的患者共142例,其中頻繁發(fā)作(FE)組患者60例,非頻繁發(fā)作(i FE)組82例。與非頻繁發(fā)作組相比,頻繁發(fā)作組患者的病史更長、吸煙指數(shù)更高,FEV1占預(yù)計(jì)值的百分比(FEV1%pred)和FEV1/FVC%值顯著降低,CAT(COPD Assessment Test,COPD評(píng)估測(cè)試)評(píng)分、m MRC(modified Medical Research Council,改良醫(yī)學(xué)研究委員會(huì))呼吸困難評(píng)分及支氣管管壁增厚得分更高;同時(shí)動(dòng)脈血二氧化碳分壓(arterial carbon dioxide pressure,Pa CO2)升高并且合并癥如冠心病和糖尿病發(fā)生率更高。與非頻繁發(fā)作組相比,頻繁發(fā)作的慢性支氣管炎表型患者年齡明顯偏大(P=0.003)、體重指數(shù)(body mass index,BMI)更低(P=0.016),FEV1%pred(P=0.004)和FEV1/FVC(%)(P=0.028)值明顯降低,而CAT評(píng)分(P=0.000)、m MRC呼吸困難評(píng)分(P=0.000)、肺氣腫評(píng)分(P=0.001)和Pa CO2(P=0.000)更高。多變量分析顯示,FEV1%pred(OR=0.899,P=0.044)和Pa CO2(OR=1.215,P=0.017)是頻繁發(fā)作的慢性支氣管炎表型患者的兩個(gè)獨(dú)立危險(xiǎn)因素。相對(duì)于非頻繁發(fā)作組,頻繁發(fā)作的肺氣腫表型患者年齡更大(P=0.012),病史更長(P=0.000),FEV1/FVC(%)更低(P=0.005),CAT(P=0.000)與m MRC呼吸困難評(píng)分(P=0.000)更高。CAT評(píng)分(OR=2.601,P=0.001)是該組患者的獨(dú)立危險(xiǎn)因素。除頻繁發(fā)作患者動(dòng)脈血?dú)夥治龅腜H值顯著降低(P=0.032)外,無論頻繁發(fā)作或非頻繁發(fā)作的ACOS表型患者,其余臨床、生理及影像學(xué)指標(biāo)均無明顯差異(P0.05)。結(jié)論:不同表型的慢性阻塞性肺疾病頻繁發(fā)作患者,其臨床特征可能有各自不同的特點(diǎn),明確頻繁和非頻繁發(fā)作患者間不同表型的臨床、生理及影像學(xué)特征將有助于對(duì)患者提供更加個(gè)性化治療和更具針對(duì)性的管理方案。
[Abstract]:Objective: to investigate the phenotypic phenotypic phenotypic phenotypes of patients with chronic obstructive pulmonary disease (COPD) acute exacerbation of chronic obstructive pulmonary disease (Copd).To provide a reference for clinical treatment and management of frequent and infrequent aggravation patients.Methods: the clinical data of 142 patients with COPD admitted to respiratory department in our hospital were analyzed retrospectively.According to the patient's history of acute attack, they were divided into frequent attack group and infrequent exacerbationi FEN group. According to the established classification criteria, they were divided into chronic bronchitis, emphysema and asthmatic and COPD overlap syndrome (ACOS) phenotypic group, respectively, according to the established classification criteria, the patients were divided into two groups: chronic bronchitis, emphysema and asthmatic and COPD overlap syndrome (ACOSphenotype).The clinical characteristics, physiological and imaging features of the three different phenotypes of FE or I FE were compared.Results: after excluding other pulmonary diseases, 142 patients were included in the study group, including 60 patients with frequent onset of FEI and 82 patients with infrequent episodes of FEE.Patients with frequent episodes had a longer history than those with less frequent episodes.Higher smoking index and FEV1 / FVC% significantly decreased the score of MRC(modified Medical Research Council (improved Medical Research Council), higher score of dyspnea and thickening of bronchial wall;At the same time, the arterial carbon dioxide pressure Pa CO _ 2 was increased and the incidence of complications such as coronary heart disease and diabetes was higher.Multivariate analysis showed that FEV1 predite 0.899P0.044) and Paco _ 2 OR1.215P ~ 0.017) were two independent risk factors for phenotypic patients with chronic bronchitis.Except that the PH value of arterial blood gas analysis in patients with frequent episodes decreased significantly (P 0.032), there was no significant difference in the other clinical, physiological and imaging indexes in patients with ACOS phenotypes in both frequent and infrequent episodes (P 0.05).Conclusion: the clinical characteristics of patients with different phenotypes of chronic obstructive pulmonary disease may have different clinical characteristics.Physiological and imaging features will help to provide more individualized treatment and more targeted management programs for patients.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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