慢性阻塞性肺疾病－哮喘重叠综合征和COPD患者临床特征的差异性

摘要

目的：通过回顾性研究，与慢性阻塞性肺疾病（COPD）组比较，探讨慢性阻塞性肺疾病－哮喘重叠综合征（ACOS）患者的危险因素，急性加重期的临床特征，并通过规律治疗后随访1年内的急性发作频率。方法：采集2013－2015年 ACOS 患者56例、COPD 患者80例，稳定期肺功能为30％≤ FEV1＜80％，收集患者一般情况（年龄、性别、既往吸烟情况、过敏性鼻炎史及家族性过敏性疾病史），统计分析其急性加重时实验室指标（包括PaO2、PaCO2、CRP、白细胞数、IgE 水平）及住院期间治疗情况（包括使用抗生素比例、使用全身皮质激素比例、使用无创通气比例）。并随访1年，观察其规律应用ICS联合LABA／LAMA治疗后急性发作频率。结果：ACOS组年龄、吸烟指数明显低于COPD组（P ＜0．05）。与COPD组对比，过敏性鼻炎或家族性过敏性疾病病史、年龄＜60岁、血 IgE 升高为 ACOS 危险因素。在急性加重期，ACOS 组血 PaCO2、血IgE水平、白细胞计数较COPD组升高（P＜0．05）。 ACOS患者住院时间中位数位为12 d，COPD患者住院时间中位数为8 d。 ACOS抗生素使用率、全身性糖皮质激素使用率及无创通气使用率则明显高于COPD组（P＜0．05）。应用ICS 联合LABA／LAMA治疗，ACOS组和COPD组每年内急性发作次数较前明显降低（P＜0．05）。结论：过敏性疾病可能参与ACOS发病，ACOS患者可能更有家族聚集性，在急性加重期，ACOS患者炎症反应更剧烈，病程进展较单一COPD明显。规律使用吸入ICS联合LABA／LAMA能明显降低其急性加重频率。%Objective We make a retrospective analysis , to compare to COPD group and discuss the risk factors and the clinical features in acute exacerbation in patients with ACOS to follow-up the exacerbating frequency after regular treatment in both two groups in one year. Methods There were 56 patients with ACOS and 80 patients with COPD from 2013 to 2015 in our hospital in 30%≤FEV1<80% in the stable phase. The common data of the enrolled patients included the age,sex,smoking, and allergic rhinitis or other allergic diseases in family. We analyzed laboratory index including PaO2,PaCO2,CRP,white blood cells,IgE of serums and compared the proportion of antibiotics,system used of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation and followed up exacerbating frequency after using ICS united LABA/LAMA. Results The age and smoking index in the ACOS group were lower than the COPD group (P < 0.05). The allergic rhinitis or other familial allergic diseases,lower age of 60,the high IgE in serum were risk factor, in ACOS. In acute exacerbation, the PaCO2,IgE and WBC in serum were higher than that of the COPD group(P <0.05). The midian length of stay in hosipital was 12 days in the ACOS group and 8 days in the COPD group. The proportion of antibiotics,systemic administration of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation in the ACOS group were higher than that of the COPD group (P < 0.05). The exacerbating frequency was decreased after using ICS united LABA/LAMA(1.2±0.6 vs 3.8±1.3,P < 0.05)in both ACOS and COPD groups. Conclusions The allergic diseases may participate in ACOS, in which it has familial tendency. In acute exacerbation, ACOS patients had even more inflammation and faster course than COPD patients. Using ICS united LABA/LAMA can reduce exacerbating frequency in ACOS.