肺部听诊可作为慢性阻塞性肺疾病初诊时评估病情严重程度的一项指标。
[Lung sounds can be used as an indicator for assessing severity of chronic obstructive pulmonary disease at the initial diagnosis].
作者信息
Chen Shifeng, Huang Minyu, Peng Xianru, Yuan Yafei, Huang Shuyu, Ye Yanmei, Zhao Wenqu, Li Bohou, Han Huishan, Yang Shuluan, Cai Shaoxi, Zhao Haijin
机构信息
Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Feb 29;40(2):177-182. doi: 10.12122/j.issn.1673-4254.2020.02.07.
OBJECTIVE
To assess the value of pulmonary auscultation for evaluating the severity of chronic obstructive pulmonary disease (COPD) at the initial diagnosis.
METHODS
The patients with newly diagnosed COPD in our hospital between May, 2016 and May, 2019 were enrolled in this study. According to the findings of pulmonary auscultation, the lung sounds were classified into 5 groups: normal breathing sounds, weakened breathing sounds, weakened breathing sounds with wheezing, obviously weakened breathing sounds, and obviously weakened breathing sounds with wheezing. The pulmonary function of the patients was graded according to GOLD guidelines, and the differential diagnosis of COPD from asthmatic asthma COPD overlap (ACO) was made based on the GOLD guidelines and the European Respiratory Criteria.
RESULTS
A total of 1046 newly diagnosed COPD patients were enrolled, including 949 male and 97 female patients with a mean age of 62.6± 8.71. According to the GOLD criteria, 88.1% of the patients were identified to have moderate or above COPD, 50.0% to have severe or above COPD; a further diagnosis of ACO was made in 347 (33.2%) of the patients. ANOVA analysis showed significant differences in disease course, FEV1, FEV1%, FEV1/FVC, FVC, FVC% and mMRC among the 5 auscultation groups ( < 0.001), but FENO did not differ significantly among them (=0.097). The percentage of patients with wheezing in auscultation was significantly greater in ACO group than in COPD group ( < 0.001). Spearman correlation analysis showed that lung sounds was significantly correlated with disease severity, FEV1, FEV1%, FVC and FVC% of the patients ( < 0.001); Multiple linear regression analysis showed that a longer disease course, a history of smoking and lung sounds were all associated with poorer lung functions and a greater disease severity.
CONCLUSIONS
Lung sounds can be used as an indicator for assessing the severity of COPD at the initial diagnosis.
目的
评估肺部听诊在慢性阻塞性肺疾病（COPD）初诊时对评估疾病严重程度的价值。
方法
选取2016年5月至2019年5月在我院新诊断为COPD的患者纳入本研究。根据肺部听诊结果，将肺部声音分为5组：正常呼吸音、呼吸音减弱、呼吸音减弱伴哮鸣音、明显呼吸音减弱、明显呼吸音减弱伴哮鸣音。根据GOLD指南对患者的肺功能进行分级，并根据GOLD指南和欧洲呼吸学会标准对COPD与哮喘-慢性阻塞性肺疾病重叠综合征（ACO）进行鉴别诊断。
结果
共纳入1046例新诊断的COPD患者，其中男性949例，女性97例，平均年龄62.6±8.71岁。根据GOLD标准，88.1%的患者被诊断为中度及以上COPD，50.0%的患者为重度及以上COPD；另有347例（33.2%）患者被进一步诊断为ACO。方差分析显示，5个听诊组在病程、第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1%）、FEV1/用力肺活量（FVC）、FVC、FVC占预计值百分比（FVC%）和改良英国医学研究委员会呼吸问卷（mMRC）评分方面存在显著差异（P<0.001），但呼出气一氧化氮（FENO）在各组间差异无统计学意义（P=0.097）。ACO组听诊时出现哮鸣音的患者比例显著高于COPD组（P<0.001）。Spearman相关性分析显示，肺部声音与患者的疾病严重程度、FEV1、FEV1%、FVC和FVC%显著相关（P<0.001）；多元线性回归分析显示，病程较长、有吸烟史和肺部声音均与肺功能较差及疾病严重程度较高相关。
结论
肺部声音可作为COPD初诊时评估疾病严重程度的指标。
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