哮喘和慢性阻塞性肺疾病所致固定性气流受限老年患者的异同
Similarity and differences in elderly patients with fixed airflow obstruction by asthma and by chronic obstructive pulmonary disease.
作者信息
Di Lorenzo Gabriele, Mansueto Pasquale, Ditta Vito, Esposito-Pellitteri Maria, Lo Bianco Claudia, Leto-Barone Maria S, D'Alcamo Alberto, Farina Cristina, Di Fede Gaetana, Gervasi Francesco, Caruso Calogero, Rini GiovamBattista
机构信息
Dipartimento di Medicina Clinica e delle Patologie Emergenti, Università degli Studi di Palermo, Italy.
出版信息
Respir Med. 2008 Feb;102(2):232-8. doi: 10.1016/j.rmed.2007.09.007. Epub 2007 Nov 19.
BACKGROUND
Epidemiologic studies have demonstrated that elderly patients with fixed airflow obstruction can be affected by asthma or chronic obstructive pulmonary disease (COPD).
METHODS
We studied 49 consecutive elderly outpatients, presenting fixed airflow obstruction, by clinical history (smoking), pulmonary function tests, blood gas analysis, and induced sputum.
RESULTS
The age was not different in patients with COPD (n=28) and asthma (n=21) (70.2+/-3.9 years vs. 69.6+/-3.7 years), also the degree of fixed airflow obstruction was similar (FEV1: 58.3+/-1.5% vs. 59.0+/-1.4% of predicted). Patients with asthma had significantly more eosinophils in peripheral blood (0.43+/-0.05x10(-3)microL vs. 0.27+/-0.1x10(-3)microL, P<0.0001), and in induced sputum (5.0% [(p25th and p75th) 5.0-6.0%] vs. 1.0% [(p25th and p75th) 0.01-1.0%]; P<0.0001), as well as serum ECP (18.6+/-4.9ng/mL vs. 7.7+/-4.7ng/mL, P<0.0001) and ECP in the induced sputum (31.6+/-2.9ng/mL vs. 5.6+/-4.9ng/mL, P<0.0001). Finally, in induced sputum the eosinophils EG2+ were higher in patients with asthma than in patients with COPD (40.5 [(p25th and p75th) 39.3-44.3] MFI vs. 3.9 [(p25th and p75th) 0-11.4] MFI, P<0.0001). They also had significantly higher diffusing capacity, and a greater reversibility to steroids, after 14-day course of therapy, whereas the reversibility to 400microg of salbutamol was similar.
CONCLUSION
Despite similar fixed airflow obstruction, elderly patients with asthma have distinct characteristics compared with patients with COPD.
背景
流行病学研究表明，患有固定性气流受限的老年患者可能受到哮喘或慢性阻塞性肺疾病（COPD）的影响。
方法
我们通过临床病史（吸烟情况）、肺功能测试、血气分析和诱导痰检查，对49例连续就诊的患有固定性气流受限的老年门诊患者进行了研究。
结果
COPD患者（n = 28）和哮喘患者（n = 21）的年龄无差异（分别为70.2±3.9岁和69.6±3.7岁），固定性气流受限程度也相似（FEV1：分别为预测值的58.3±1.5%和59.0±1.4%）。哮喘患者外周血中的嗜酸性粒细胞显著更多（分别为0.43±0.05×10⁻³/μL和0.27±0.1×10⁻³/μL，P<0.0001），诱导痰中的嗜酸性粒细胞也更多（分别为5.0%[第25和第75百分位数为5.0 - 6.0%]和1.0%[第25和第75百分位数为0.01 - 1.0%]；P<0.0001），血清嗜酸性粒细胞阳离子蛋白（ECP）也更高（分别为18.6±4.9ng/mL和7.7±4.7ng/mL，P<0.0001），诱导痰中的ECP同样更高（分别为31.6±2.9ng/mL和5.6±4.9ng/mL，P<0.0001）。最后，诱导痰中哮喘患者的嗜酸性粒细胞EG2⁺高于COPD患者（分别为40.5[第25和第75百分位数为39.3 - 44.3]平均荧光强度和3.9[第25和第75百分位数为0 - 11.4]平均荧光强度，P<0.0001）。哮喘患者的弥散能力也显著更高，在接受14天疗程的治疗后对类固醇的反应性更强，而对400μg沙丁胺醇的反应性相似。
结论
尽管固定性气流受限情况相似，但老年哮喘患者与COPD患者相比具有不同的特征。
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