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[稳定期慢性阻塞性肺疾病患者中的哮喘-慢性阻塞性肺疾病重叠综合征]

[Asthma-COPD overlap syndrome among patients with stable COPD].

作者信息

Nguyen M-S, Nguyen Dang D, Schleich F, Manise M, Corhay J-L, Louis R

出版信息

Rev Med Liege. 2015 Jan;70(1):37-43.

Abstract

The purpose of this research was to describe the frequency and characteristics of the overlap syndrome among stable COPD patients (stage 2 to 4 according to GOLD). Material and method: We studied 46 patients with stable COPD recruited from the outpatient clinic of the CHU of Liege from May 2013 to April 2014. Definition of the overlap syndrome was based on the coexistence of post-bronchodilation FEV1/FVC < 70% and, either, an asthmatic history before the age of 40, or, at least, two functional and immune-inflammatory asthmatic traits : 1) significant FEV1 reversibility to inhaled bronchodilator (FEVI change >/= 200 ml and >/= 12% after bronchodilation), 2) eosinophilic inflammation : sputum eosinophils ≥ 3%,blood eosinophils ≥ 400/μl, or FENO ≥ 45 ppb, 3) clinical history of airway allergy, or total serum IgE ≥ 113 KU/l, or RAST ≥ 0,35 KU/l against major aeroallergens. 37% patients had the COPD-asthma overlap syndrome and this group had a higher CAT score reflecting more severe symptoms (24,6 ± 8,1 vs 19,4 ± 8, p < 0,05) despite similar level of airway obstruction. The transfer coefficient DLCO/VA was preserved in the overlap group (97 ± 24%), but altered in the pure COPD group (80 ± 20%), p < 0,05. Approximately one third of COPD patients present with the overlap syndrome and they are more symptomatic without any evidence of more severe airway obstruction.

摘要

本研究旨在描述稳定期慢性阻塞性肺疾病(COPD,根据GOLD标准为2至4期)患者重叠综合征的发生率及特征。材料与方法:我们研究了2013年5月至2014年4月从列日大学医院门诊招募的46例稳定期COPD患者。重叠综合征的定义基于支气管扩张后FEV1/FVC<70%,以及以下任一情况:40岁前有哮喘病史,或至少有两项功能性和免疫炎症性哮喘特征:1)吸入支气管扩张剂后FEV1有显著可逆性(支气管扩张后FEV1变化≥200 ml且≥12%),2)嗜酸性粒细胞炎症:痰嗜酸性粒细胞≥3%,血嗜酸性粒细胞≥400/μl,或呼出一氧化氮(FENO)≥45 ppb,3)气道过敏临床病史,或血清总IgE≥113 KU/l,或针对主要空气过敏原的放射性变应原吸附试验(RAST)≥0.35 KU/l。37%的患者患有COPD-哮喘重叠综合征,尽管气道阻塞程度相似,但该组患者的慢性阻塞性肺疾病评估测试(CAT)评分更高,反映症状更严重(24.6±8.1对19.4±8,p<0.05)。重叠组的肺一氧化碳弥散量与肺泡通气量比值(DLCO/VA)保持正常(97±24%),而单纯COPD组则发生改变(80±20%),p<0.05。约三分之一的COPD患者存在重叠综合征,他们症状更明显,但无更严重气道阻塞的证据。

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