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Evaluation of lung capacity and diffusing capacity in patients with chronic obstructive pulmonary disease

Objective To observe the changes in pulmonary function in chronic obstructive pulmonary disease (COPD) patients with different GOLD grades, diffusing capacity for carbon monoxide in percent predicted value (DLCO%pred), and the relationship between DLCO%pred and hyperinflation parameter, the ratio of residual volume to total lung capacity (RV/TLC). Methods Their age, sex, body mass index (BMI), and lung function parameters were recorded. Group according to GOLD grade, and compare the lung function among different groups; With DLCO%pred 60% as the cut-off value, the lung function of each group was compared. Pearson and Spearman correlation determined the relationship between DLCO%pred and age, RV/TLC, and other factors. Results Four hundred and thirty-one patients were enrolled. With the increase of GOLD grade, the pulmonary function became worse (P<0.05). Compared with DLCO%pred ≥ 60%, the group with DLCO%pred<60% had lower BMI (t=–5.642, P<0.001) and worse pulmonary function (P<0.001). The correlation analysis showed that BMI (r=0.352, P<0.001), forced vital capacity in percent predicted value (FVC%pred) (r=0.349, P<0.001), forced expiratory volume in one second in percent predicted value (FEV1%pred) (r=0.414, P<0.001), the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (r=0.434, P<0.001), peak expiratory flow in percent predicted value (PEF%pred) (r=0.335, P<0.001), maximal mid expiratory flow in percent predicted value (MMEF%pred) (r=0.405, P<0.001), inspiratory capacity in percent predicted value (IC%pred) (r=0.301, P<0.001) were positively correlated with DLCO%pred; while RV/TLC (r=–0.328, P<0.001), GOLD grade (r=–0.430, P<0.001) were negatively correlated with DLCO%pred; However, there was no significant correlation between age (r=–0.012, P=0.810), sex (r=0.076, P=0.117) and DLCO%pred. Conclusions With the increase of GOLD grade, DLCO%pred decreases, and RV/TLC increases. RV/TLC is negatively correlated with DLCO%pred. Attaching importance to the evaluation of hyperinflation and diffusing capacity of COPD patients is helpful in evaluating COPD in all aspects, and has particular clinical significance.

中性粒细胞与淋巴细胞比值、血浆D-二聚体及B型钠尿肽联合检测对慢性阻塞性肺疾病急性加重患者预后的预测意义

目的 探究联合检测中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、血浆 D-二聚体及 B 型钠尿肽（B-type natriuretic peptide，BNP）水平预测慢性阻塞性肺疾病（简称慢阻肺）急性加重期患者预后的价值。方法 回顾性分析 2015 年 12 月—2018 年 2 月于四川大学华西医院呼吸与危重症医学科住院治疗的慢阻肺急性加重期患者 565 例，按照住院结局分为好转组（n=469）和未愈或死亡组（n=96），收集患者的基本临床资料和入院 24 h 内 NLR、血浆 D-二聚体及 BNP 检查结果，进行组间比较，分析上述指标单独及联合检测对慢阻肺急性加重患者住院结局的预测效能。结果 未愈或死亡组患者 NLR、血浆 D-二聚体、血浆 BNP 水平均显著高于好转组，差异有统计学意义（P<0.05）。在单独预测慢阻肺急性加重患者预后方面，血浆 BNP 水平的曲线下面积最大，为 0.665（P<0.001），血浆D-二聚体的敏感性最高，为73.7%。与单独预测相比，各指标联合预测的曲线下面积提高为 0.681（P<0.001），敏感性提高为 81.1%。结论 联合检测NLR、血浆D-二聚体及BNP水平对预测慢阻肺急性加重患者预后有一定的价值，值得在临床上推广。

慢性阻塞性肺疾病过度充气的研究进展