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  本文選題：哮喘-慢性阻塞性肺疾病重疊綜合征 + 肺功能��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:探討ACOS患者肺功能及FeNO、血清總IgE、過敏原陽性率的水平及與哮喘、COPD患者之間的差異,從而評估ACOS患者的氣道炎癥及氣道阻塞的程度,分析肺功能及FeNO、血清總IgE、過敏原對ACOS患者的診斷意義;研究天晴速樂(噻托溴銨粉霧劑)聯(lián)合信必可(布地奈德福莫特羅粉吸入劑)吸入治療ACOS、哮喘和COPD的療效,并比較ACOS與哮喘、COPD患者的療效差異。擬為臨床醫(yī)生在ACOS診治方面提供新的思路。方法:本研究收集2015年2月到2016年7月于吉林大學白求恩第一醫(yī)院呼吸內(nèi)科就診的ACOS患者60例,平均(71.3±5.2)歲,其中男性30例,女性30例。診斷標準按照GINA 2014指南提出的ACOS的定義及推薦的五個診斷步驟。同時,根據(jù)哮喘及慢性阻塞性肺疾病的診斷指南隨機選取同期住院的哮喘患者65例,COPD患者60例,在我院體檢的健康體檢者60例。詳細記錄患者的性別、年齡、身高、體重、吸煙史等資料。對四組患者均行肺功能、FeNO、血清總IgE、過敏原測定,準確的記錄測定結果。所有資料用SPSS19.0統(tǒng)計軟件進行處理,計量資料根據(jù)是否符合正態(tài)分布應用單因素方差分析或秩和檢驗(Kruskal-Wallis H檢驗),計數(shù)資料應用χ2檢驗分析各組間的差異有無統(tǒng)計學意義;從ACOS組、哮喘組、慢性阻塞性肺疾病組中分別選取FEV1%Pred、FEV1/FVC不具有統(tǒng)計學差異的患者重新分組,命名為ACOS治療組、哮喘治療組、慢性阻塞性肺疾病治療組,各組患者在院期間給予基礎治療(包括抗感染、化痰、平喘),出院后均給予天晴速樂聯(lián)合信必可吸入治療,隨訪6個月,觀察患者的FEV1%Pred、FEV1/FVC的改善情況,應用配對t檢驗及方差分析計算組內(nèi)治療前后及組間治療后的差異是否顯著。結果:(1)ACOS組FEV1%Pred、FEV1/FVC水平明顯低于哮喘組及對照組,差異有統(tǒng)計學意義(P0.05),而高于COPD組,差異不具有統(tǒng)計學意義(P0.05)。(2)三組患者行支氣管舒張試驗后FEV1的改善率ACOS組明顯高于COPD組及對照組,差異有統(tǒng)計學意義(P0.05),低于哮喘組,差異不具有統(tǒng)計學意義(P0.05)。(3)ACOS組患者FeNO水平明顯高于COPD組及對照組,差異有統(tǒng)計學意義(P0.05),而較哮喘組低,差異不明顯(P0.05)。(4)ACOS組患者血清總IgE水平明顯高于COPD組及對照組,低于哮喘組,差異均有統(tǒng)計學意義(P0.05)。(5)ACOS組過敏原陽性的比率明顯高于COPD組和對照組,差異顯著(P0.05),而低于哮喘組,差異不明顯(P0.05)。(6)ACOS治療組、哮喘治療組、慢性阻塞性肺疾病治療組三組患者治療3個月、6個月后FEV1%Pred、FEV1/FVC均升高,與治療前相比差異明顯(P0.05)。(7)治療組的三組患者用藥6個月后FEV1%Pred、FEV1/FVC改善程度由高到低分別為:哮喘治療組、ACOS治療組、慢性阻塞性肺疾病治療組,各組間差異明顯(P0.05)。結論:(1)FeNO、肺功能、血清總IgE及過敏原聯(lián)合檢查有助于ACOS的診斷。ACOS患者上述指標的改變介于哮喘和COPD之間。(2)ACOS患者的氣道炎癥水平及氣道阻塞嚴重程度介于哮喘和COPD之間。(3)對于FeNO和(或)血清總IgE升高的COPD患者或者出現(xiàn)不完全可逆氣流受限的哮喘患者,應考慮有無ACOS的可能。(4)ACOS患者應用天晴速樂聯(lián)合信必可吸入治療效果較好,但好轉程度介于哮喘和COPD之間。
[Abstract]:Objective: To investigate the pulmonary function and FeNO, the serum total IgE, the positive rate of allergen and the difference between the patients with asthma and COPD, so as to evaluate the airway inflammation and the degree of airway obstruction in the patients with ACOS, to analyze the pulmonary function and FeNO, the serum total IgE, the diagnostic significance of the allergen to the patients of ACOS, and the study of the Tiotropium Bromide Powder for Inhalation Association (Tiotropium Bromide Powder for Inhalation). Combined with Budesonide and Formoterol Fumarate Powder for Inhalation (Budesonide and Formoterol Fumarate Powder for Inhalation) inhalation for the treatment of ACOS, asthma and COPD, and comparing the difference between ACOS and asthma and COPD patients. To provide a new way of thinking for clinicians in the diagnosis and treatment of ACOS. Methods: This study was collected from February 2015 to July 2016 in the Department of respiratory medicine, Bethune first hospital, Jilin University 60 cases of ACOS, average (71.3 + 5.2) years old, including 30 men and 30 women, were defined according to the definition of ACOS and five diagnostic steps proposed in the GINA 2014 guide. At the same time, according to the diagnostic guidelines for asthma and chronic obstructive pulmonary disease, 65 patients were hospitalized at the same time, 60 in COPD patients, and health examination in our hospital. 60 cases of physical examination. The sex, age, height, weight and smoking history of the patients were recorded in detail. The lung function, FeNO, serum total IgE, allergens were measured and the results were recorded in four groups. All the data were processed by SPSS19.0 software, and the measurement data were based on the normal distribution of the single factor variance analysis or rank. And test (Kruskal-Wallis H test), count data using chi 2 test analysis of the differences between groups of statistical significance; from the ACOS group, asthma group, chronic obstructive pulmonary disease group selected FEV1%Pred, FEV1/FVC did not have statistical difference of the patients regrouping, life named ACOS treatment group, asthma treatment group, chronic obstructive pulmonary disease. In the treatment group, the patients in each group were given basic treatment (including anti infection, phlegm and asthma) during the hospital period. After discharge, all the patients were given the combination of Tian Qing Yue Yue and Xin must inhalation treatment. The patients were followed up for 6 months to observe the improvement of FEV1%Pred and FEV1/FVC. Whether the difference between the treatment and the treatment in the group before and after the paired t test and analysis of variance was observed. Results: (1) ACOS group FEV1%Pred, FEV1/FVC level was significantly lower than the asthma group and the control group, the difference was statistically significant (P0.05), but higher than the COPD group, the difference was not statistically significant (P0.05). (2) the improvement rate of FEV1 in the three groups after the bronchodilation test was significantly higher than the COPD group and the control group, the difference was statistically significant (P0.05), low (P0.05), low In the asthma group, the difference was not statistically significant (P0.05). (3) the level of FeNO in the ACOS group was significantly higher than that in the COPD group and the control group. The difference was statistically significant (P0.05), but the difference was not significant (P0.05). (4) the serum total IgE level in the ACOS group was significantly higher than that in the COPD group and the control group, which was lower than the asthma group, the difference was statistically significant (P0.05). (5) the positive rate of allergen in ACOS group was significantly higher than that in COPD group and control group, the difference was significant (P0.05), but the difference was not significant (P0.05). (6) the three groups of ACOS treatment group, asthma treatment group and chronic obstructive pulmonary disease group were treated for 3 months, 6 months later, FEV1%Pred and FEV1/FVC were all higher (P0.05). (7 Three groups of patients in the treatment group were treated with FEV1%Pred after 6 months of medication, and the improvement of FEV1/FVC from high to low were as follows: asthma treatment group, ACOS treatment group and chronic obstructive pulmonary disease treatment group, the difference was obvious (P0.05). Conclusion: (1) FeNO, lung function, serum total IgE and hypersensitivity test are helpful to the diagnosis of.ACOS patients with the changes of the above index. Between asthma and COPD. (2) the level of airway inflammation and the severity of airway obstruction in ACOS patients are between asthma and COPD. (3) the possibility of ACOS should be considered for the COPD patients with FeNO and / or serum total IgE or the presence of incomplete reversible airflow. (4) ACOS sufferers apply the combination of sunny and quick music. Inhalation treatment is better, but the improvement is between asthma and COPD.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.9;R562.25

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