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一项基于医院的关于慢性阻塞性肺疾病及其他疾病患者肺功能测试和运动耐量的研究。

A hospital-based study on pulmonary function tests and exercise tolerance in patients of chronic obstructive pulmonary disease and other diseases.

作者信息

Majumdar Sonali, Sen Sangita, Mandal Salil Kumar

机构信息

Department of Physiology, Institute of Postgraduate Medical Education and Research, Kolkata.

出版信息

J Indian Med Assoc. 2007 Oct;105(10):565-6, 568, 570 passim.

Abstract

A total of 105 male and 60 female patients were screened in the respiratory medicine outpatients' department, Institute of Postgraduate Medical Education & Research, Kolkata between December, 2002 and January, 2005. Chronic obstructive pulmonary disease patients were diagnosed on the basis of history and clinical examination while patients with body mass index > or =25 and otherwise disease-free were grouped as overweights. Patients suffering from other diseases like systemic hypertension, etc, were referred from other departments after proper evaluation. The patients and controls (n=10) each for male and female groups were subjected to spirometry using computerised electronic spirometer while exercise tolerance was evaluated by modified Harvard step test. Thirty-nine male and 21 female patients were diagnosed and grouped in chronic obstructive pulmonary disease group. Both purely obstructive [forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)% pred<70 and reduced FEV1% pred] and mixed (both obstructive and restrictive pattern ie, FEV1/FVC% pred normal or supernormal, FVC% pred <80 indicating restrictive pattern and forced expiratory flow between 25% and 75% of the vital capacity (FEF(25-75)) pred or peak expiratory flow rate (PEFR)% pred <70 indicating early small airway obstruction pattern were seen in both sexes. Although the exercise tolerance values were non-significant in both sexes in chronic obstructive pulmonary disease obstructive pattern group, in mixed pattern group it was seen significant reduction compared to control. Hypertensives (21 males and 7 females) showed obstructive spirometric pattern. Exercise tolerance values were significantly reduced compared to controls. Male overweights (n=13) showed restrictive pattern while female overweights (n=8) showed obstructive pattern in spirometry. Exercise tolerance values were non-significant compared to control in both the groups. In ischaemic heart disease patients (n=6) FEV1%pred showed significant reduction in spirometry. In patients suffering from type 2 diabetes mellitus (n=4), post-tuberculous group (n=7), hypothyroid (n=6), collagen vascular disease group (n=6) showed restrictive spirometric pattern and the above groups including IHD patients showed significant reduction in exercise tolerance values. Some authors have stated that mixed ventilatory defect is characterised by low FEV1/FVC% pred in spirometry and low lung volumes where the lung volumes have to be ascertained by other methods but in the present investigation it was observed that mixed ventilatory defect can be estimated by spirometry; PEFR and/or FEF(25-75%). pred <70% whereas FEV1/FVC% pred is normal or supernormal. This finding is completely new one to predict mixed ventilatory defect.

摘要

2002年12月至2005年1月期间,在加尔各答研究生医学教育与研究学院呼吸内科门诊共筛查了105名男性和60名女性患者。慢性阻塞性肺疾病患者根据病史和临床检查进行诊断,而体重指数≥25且无其他疾病的患者被归为超重组。患有其他疾病如系统性高血压等的患者在经过适当评估后从其他科室转诊而来。男性和女性组各选取患者及对照(每组10人),使用计算机化电子肺活量计进行肺量测定,同时通过改良哈佛台阶试验评估运动耐力。39名男性和21名女性患者被诊断并归入慢性阻塞性肺疾病组。在该组中,既有单纯阻塞性(第1秒用力呼气容积(FEV1)/用力肺活量(FVC)%预计值<70且FEV1%预计值降低),也有混合性(阻塞性和限制性模式均有,即FEV1/FVC%预计值正常或超常,FVC%预计值<80表明存在限制性模式,且肺活量25%至75%之间的用力呼气流量(FEF(25 - 75))%预计值或呼气峰值流速(PEFR)%预计值<70表明存在早期小气道阻塞模式),男女均有。虽然慢性阻塞性肺疾病阻塞性模式组中男女的运动耐力值无显著差异,但在混合性模式组中,与对照组相比有显著降低。高血压患者(21名男性和7名女性)表现出阻塞性肺量测定模式。与对照组相比,运动耐力值显著降低。男性超重者(n = 13)在肺量测定中表现出限制性模式,而女性超重者(n = 8)表现出阻塞性模式。两组与对照组相比,运动耐力值均无显著差异。在缺血性心脏病患者(n = 6)中,肺量测定显示FEV1%预计值显著降低。在2型糖尿病患者(n = 4)、肺结核后组(n = 7)、甲状腺功能减退患者(n = 6)、胶原血管病组(n = 6)中表现出限制性肺量测定模式,上述包括缺血性心脏病患者的组运动耐力值均显著降低。一些作者指出,混合性通气功能障碍的特征是肺量测定中FEV1/FVC%预计值低且肺容积低,其中肺容积必须通过其他方法确定,但在本研究中观察到,混合性通气功能障碍可通过肺量测定进行评估;PEFR和/或FEF(25 - 75)%预计值<70%,而FEV1/FVC%预计值正常或超常。这一发现是预测混合性通气功能障碍的全新成果。

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