韩晓彧,
金霞云,
曹丽华^,
大连医科大学附属第二医院 呼吸内科, 辽宁 大连 116027

详细信息 作者简介: 韩晓彧(1991-)女, 硕士研究生。E-mail:915783784@qq.com



通讯作者: 曹丽华, 教授。E-mail:clhdmu@163.com 中图分类号: R714.253


摘要:目的探讨慢性阻塞性肺病（COPD）患者的高分辨率CT（HRCT）表型与气道炎症和临床特征的关系。方法收集2015年11月至2017年4月于大连医科大学附属第二医院住院的COPD患者87例，按照HRCT影像特点分为3种类型，其中A型：无或轻微有肺气肿（LAA ≤ 1级），合并或不合并支气管管壁增厚；E型：LAA ≥ 2级肺气肿，但无支气管管壁增厚；M型：LAA ≥ 2级的肺气肿同时有支气管管壁增厚。比较3型间吸烟指数、过去1年内急性加重次数、肺功能及血清肺泡表面活性蛋白-D（SP-D）、超敏C反应蛋白（hs-CRP）和血浆纤维蛋白原（Fig）水平。结果A型患者吸烟指数为（21.41±23.28）包年，明显低于E型（38.71±41.28）包年和M型（38.07±33.84）包年（P < 0.05）。A型过去1年内急性加重≥ 2次的患者比例为21.3%，明显少于E型（42.9%）和M型（89.5%），差异有统计学意义（P < 0.05）。A型患者FEV1/FVC（59.82±11.17）%，优于E型和M型[（50.65±9.26）%、（51.75±8.89）%]（P < 0.05）；A型患者的RV/TLC为（50.66±9.8）%，明显低于E型和M型[（74.71±13.75）%、（77.20±10.56）%]（P < 0.05）。M型患者的血浆Fig和血清hs-CRP水平分别为（5.23±1.67）g/L和（37.81±40.8）mg/L，明显高于A型[（4.26±1.37）g/L、（9.57±13.66）mg/L]和E型[（3.86±1.48）g/L、（6.28±4.35）mg/L]（P < 0.05），而血清SP-D水平3组之间无差异。LAA ≥ 2级患者的吸烟指数、RV/TLC和血清hs-CRP水平明显高于LAA ≤ l级的患者（P < 0.05）；支气管管壁增厚≥ 2级患者的RV/TLC和血浆Fig和血清hs-CRP水平均高于支气管管壁增厚≤ l级患者（P < 0.05）。结论HRCT不同表型的COPD患者的临床特征和气道炎症水平不同，其中M型吸烟指数和炎症指标更高，急性加重更频繁。
关键词: 慢性阻塞性肺疾病/
高分辨率CT/
肺泡表面活性蛋白D/
纤维蛋白原


Abstract:ObjectiveTo investigate the relationship between high resolution CT (HRCT) phenotype and airway inflammation, as well as clinical features of patients with chronic obstructive pulmonary disease (COPD).MethodsTotally 87 COPD patients, who were admitted to the second affiliated Hospital of Dalian Medical University from November 2015 to April 2017, were enrolled in the study. According to the features of HRCT, they were divided into three types, Type A with no or mild emphysema (LAA ≤ 1), with or without bronchial wall thickening; Type E with emphysema (LAA ≥ 2) but no thickening of bronchial wall; and Type M with emphysema and bronchial wall thickening. We compared the smoking index, the number of acute exacerbation during the last year, pulmonary function and serum levels of alveolar surface active protein-D (SP-D), fibrinogen (Fig) and hypersensitive c-reactive protein (hs-CRP) among the groups.ResultsThe smoking index of type A patients was (21.41±23.28) pack/year, which was significantly lower than that of type E (38.71±41.28) pack/year and type M (38.07±33.84) pack/year (P < 0.05). The ratio of patients with more than two acute exacerbations within last year in type A was 21.3%, which was significantly less than that of type E (42.9%) and type M (89.5%) (P < 0.05). The ratio of FEV1 and FVC of type A patients was (59.82±11.17)%, which was higher than that of type E (50.65±9.26)% and type M (51.75±8.89)% (P < 0.05); while the RV/TLC of type A (50.66±9.8)% was significantly lower than that of type E (74.71±13.75)% and type M (77.20±10.56)% (P < 0.05). The serum levels of Fig and hs-CRP in patients with type M were (5.23±1.67)g/L and (37.81±40.8)mg/L respectively, which were significantly higher than those of type A[(4.26±1.37)g/L and (9.57±13.66)mg/L] and type E[(3.86±1.48)g/L and (6.28±4.35)mg/L] (P < 0.05). The levels of SP-D were similar among three phenotypes. The smoking index, RV/TLC and serum hs-CRP level in patients with LAA ≤ l were significantly lower than those in patients with LAA ≥ 2 (P < 0.05). RV/TLC, levels of Fig, SP-D and hs-CRP in patients with ≥ 2 bronchial wall thickening were higher than those with ≤ l bronchial wall thickening (P < 0.05).ConclusionThe clinical characteristics and airway inflammation level in COPD patients with different HRCT phenotypes are different. The patients with phenotype M have higher smoking index, airway inflammation and acute exacerbations.
Keywords:chronic obstructive pulmonary disease/
high-resolution computed tomography/
SP-D/
fibrinogen

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