吸烟与慢性阻塞性肺疾病患者肺部结构改变的相关性

摘要

目的 了解慢性阻塞性肺疾病患者肺部结构改变的特点,探讨吸烟与肺部结构改变的相关性.方法 选择2014年6月至2016年3月间于嘉定区中心医院就诊并收治入院的慢阻肺患者352例,以胸部计算机断层扫描(CT)影像为标准,了解患者肺部结构改变的特点;依据患者的吸烟史分为不吸烟组(n=148)及吸烟组(n=204),再根据吸烟指数水平分为低吸烟指数组(n=68)及高吸烟指数组(n=80),比较患者肺部结构的差异性,并采用Spearman相关分析对吸烟与肺部结构进行相关性分析.结果 慢阻肺患者的院内死亡率为7.7％,肺部结构改变中以胸膜增厚(63.1％)、肺气肿(46％)、斑片/点样钙化(24.4％)、间质性改变(21.3％)、肺大疱(20.5％)为主,合并症中以胸腔积液(27.3％)为主;吸烟组患者肺大疱(31.1％ vs 12.7％,P＜0.001)、肺气肿(63.5％ vs 33.3％,P＜0.001)的发生率显著高于不吸烟组,但支气管扩张(6.1％ vs20.6％,P＜0.001)的发生率显著低于不吸烟组;高吸烟指数组患者的胸膜增厚(72.5％ vs 54.4％,P=0.022)、肺大疱(40％ vs 20.6％,P=0.011)、间质性改变(28.8％ vs 14.7％,P=0.041)的发生率显著高于低吸烟指数组;吸烟与男性(r =0.479,P＜0.001)、肺大疱(r=0.224,P＜0.001)及肺气肿(r=0.299,P＜0.001)的发生呈显著正相关;同时还发现,吸烟指数与肺大疱(r =0.228,P＜0.001)的发生呈显著正相关.结论 慢阻肺患者肺部结构以胸膜增厚、肺气肿、间质性改变等改变为主,吸烟与慢阻肺患者肺部结构改变密切相关,高吸烟指数可能导致肺大疱的发生率增加.%Objective To investigate the pulmonary structural characteristics in patients with chronic obstructive pulmonary disease,and to explore the correlation between smoking and lung structural changes.Methods From June 2014 to March 2016,a total of 352 patients with COPD in our Emergency Department were enrolled.According to the chest computed tomography (CT) image,the pulmonary structural characteristics of the COPD patients were analyzed.The patients were divided into the non-smoking group (n =148) and the smoking group (n =204) based on their smoking history.Then according to the smoking index,they were divided into the low smoking index group (n =68) and the high smoking index group (n =80).The difference of lung structure were compared.Results The hospital mortality was 7.7％.The major lung structure changes were pleural thickening (63.1％),emphysema (46％),patch/calcification (24.4％),interstitial changes (21.3％) and bulla (20.5％).Pleural effusion (27.3％) was the major complication.Compared with the non-smoking group,pulmonary bulla (31.1％ vs 12.7％,P ＜0.001) and emphysema (63.5％ vs 33.3％,P ＜ 0.001) were significantly increased in the smoking group.Compared with the low smoking index group,pleural thickening (72.5％ vs 54.4％,P =0.022),pulmonary bulla (40％ vs 20.6％,P =0.011) and interstitial changes (28.8％ vs 14.7％,P =0.041) were significantly increased in the high smoking index group.Smoking is closely related with pulmonary bulla,emphysema and bronchiectasis.Conclusion Pleural thickening,emphysema and interstitial changes are major changes of pulmonary structure in COPD patients.Smoking is closely related with the lung structural changes in patients with COPD.