Nakamura Craig T, Ng Gladys Y, Paton James Y, Keens Thomas G, Witmer James C, Bautista-Bolduc Daisy, Woo Marlyn S
Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California 90027, USA.
Pediatr Pulmonol. 2002 May;33(5):332-8. doi: 10.1002/ppul.10082.
The correlation between digital clubbing and certain pulmonary function derangements (hypoxemia and FEV(1)) was previously described. However, the relationship between digital clubbing and other measures of pulmonary function or the presence of liver disease in patients with cystic fibrosis (CF) is poorly defined. Hence we compared the digital clubbing index (CI: ratio of distal phalangeal depth to interphalangeal depth) of 100 patients with CF (43 males, 57 females; mean age, 15.7 +/- 7.3 years) with that of 100 age- and gender-matched healthy controls. Digital clubbing was defined as a CI > or = 1.00 (mean + 2.6 SD; 99% of normal subjects). The CI and its relationship to pulmonary function and to liver disease was then evaluated in the CF patients. Digital clubbing was present in 75/100 (75%) of CF patients but was absent in all controls (P < 0.0001). In CF patients, CI was inversely correlated with PaO(2) (r = -0.555; P < 0.001), FEV(1) (r = -0.499; P < 0.001), and FEF(25-75%) (r = -0.404; P < 0.001), and was positively correlated with RV (r = 0.285; P < 0.05) and the slope of phase 3 of single-breath nitrogen washout (SP3N(2)) (r = 0.532; P < 0.01). There was no significant correlation between CI and age (r = 0.020; P = 0.84), TLC (r = -0.097; P = 0.34), PaCO(2) (r = 0.167; P = 0.10), or history of liver disease (P = 0.08). We conclude that in CF, the degree of digital clubbing is related to degree of hypoxemia, airways obstruction, hyperinflation, and nonuniformity of ventilation.
既往曾描述过杵状指与某些肺功能紊乱（低氧血症和第1秒用力呼气容积[FEV₁]）之间的相关性。然而，在囊性纤维化（CF）患者中，杵状指与其他肺功能指标或肝脏疾病存在情况之间的关系尚不清楚。因此，我们将100例CF患者（43例男性，57例女性；平均年龄15.7±7.3岁）的杵状指指数（CI：远节指骨深度与指间深度之比）与100例年龄和性别匹配的健康对照者进行了比较。杵状指定义为CI≥1.00（均值+2.6标准差；99%的正常受试者）。然后在CF患者中评估CI及其与肺功能和肝脏疾病的关系。100例CF患者中有75例（75%）存在杵状指，而所有对照者均无杵状指（P<0.0001）。在CF患者中，CI与动脉血氧分压（PaO₂）呈负相关（r=-⺁555；P<0.001）、与FEV₁呈负相关（r=-⺁499；P<0.001）、与用力呼气中期流速（FEF₂₅₋₇₅%）呈负相关（r=-⺁404；P<0.001），与残气量（RV）呈正相关（r=⺁285；P<0.05）以及与单次呼吸氮洗脱第3相斜率（SP3N₂）呈正相关（r=⺁532；P<0.01）。CI与年龄（r=⺁020；P=⺁84）、肺总量（TLC）（r=-⺁097；P=⺁34）、动脉血二氧化碳分压（PaCO₂）（r=⺁167；P=⺁10）或肝脏疾病史（P=⺁08）之间无显著相关性。我们得出结论，在CF中，杵状指的程度与低氧血症程度、气道阻塞、肺过度充气和通气不均匀性有关。
