不同HRCT表型COPD患者戒烟后肺功能、炎性因子和临床症状变化

doi:10.3969/j.issn.1004-583X.2024.07.007

摘要/Abstract

摘要：

目的比较不同高分辨率CT(HRCT)表型慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)吸烟患者戒烟后的获益。方法纳入2021年6月至2022年6月于我院呼吸与危重症医学科就诊行HRCT检查的吸烟COPD患者272例。在延续COPD基础治疗的前提下,根据患者戒烟意愿、戒烟是否成功进行资料分类,最终纳入戒烟成功者104例。根据HRCT下密度减低区域面积(low attenuation arears, LAA)的分级以及气管壁的厚度将104例COPD患者分为3型:A型33例,E型35例,M型34例,记录其肺功能指标(FEV1、FEV1/FVC)、炎症因子(Th17/Treg、TNF-α)表达水平、动脉血二氧化碳分压(PaCO₂)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、咳嗽评分和急性发作次数。结果 ①肺功能指标:戒烟前3组FEV1、FEV1/FVC差异均无统计学意义(P>0.05)。戒烟后,与M型组比较,A型组和E型组FEV1、FEV1/FVC均较高,差异有统计学意义(P<0.05)。②细胞因子表达水平:戒烟前3组Th17/Treg、TNF-α差异均无统计学意义(P>0.05)。戒烟后,与M型组比较,A型组和E型组Th17/Treg、TNF-α均较低,差异有统计学意义(P<0.05)。③PaCO₂、ESR:戒烟前3组PaCO₂、ESR差异均无统计学意义(P>0.05)。戒烟后,与E型组比较,A型组和M型组PaCO₂均较低;与M型组比较,A型组和E型组ESR均较低,差异有统计学意义(P<0.05)。④急性发作次数和咳嗽评分:戒烟前3组急性发作次数、咳嗽评分差异均无统计学意义(P>0.05)。戒烟后,与E型组比较,A型组和M型组急性发作次数均较少;与M型组比较,A型组和E型组咳嗽评分均较高,差异有统计学意义(P<0.05)。结论不同HRCT表型COPD患者戒烟后的急性发作次数和疗效存在差异。尤其是对于E型和M型患者来说,戒烟后的改善效果较弱。而戒烟对A型患者急性发作次数、肺功能和炎症因子改善程度较佳。

关键词: 肺疾病, 慢性阻塞性, 戒烟, 高分辨率CT, 呼吸功能试验, 炎症因子

Abstract:

Objective This study aims to evaluate the advantages of smoking cessation in patients with chronic obstructive pulmonary disease (COPD) across various high-resolution CT (HRCT) phenotypes. Methods We included 272 COPD patients who were smokers and underwent HRCT examination at our hospital's Department of Respiratory and Critical Care Medicine between June 2021 and June 2022. Patients were categorized based on their willingness to quit smoking and their success in doing so, while continuing their basic COPD treatment. A total of 104 successful quitters were selected for this study. These 104 COPD patients were further classified into three types according to the classification of low attenuation areas (LAA) under HRCT and the thickness of the airway wall: Type A (33 cases), Type E (35 cases), and Type M (34 cases). We recorded their lung function indicators (forced expiratory volume in the first second [FEV1], FEV1/forced vital capacity [FVC]), expression levels of inflammatory factors (T helper 17 cells/regulatory T cells [Th17/Treg], tumor necrosis factor alpha [TNF-α]), arterial carbon dioxide pressure (PaCO₂), erythrocyte sedimentation rate (ESR), cough score, and number of acute exacerbations. Results ①Lung Function Indicators: Prior to smoking cessation, there was no statistically significant difference in FEV1 and FEV1/FVC among the three groups (P>0.05). Post-cessation, both the A and E groups exhibited higher FEV1 and FEV1/FVC compared to the M group, with a statistically significant difference (P<0.05). ②Cytokine Expression Levels: Prior to smoking cessation, there was no statistically significant difference in Th17/Treg and TNF-α among the three groups (P>0.05). Post-cessation, both the A and E groups demonstrated lower Th17/Treg and TNF-α levels compared to the M group, with a statistically significant difference (P<0.05). ③PaCO₂ and ESR: Prior to smoking cessation, there was no statistically significant difference in PaCO₂ and ESR among the three groups (P>0.05). Post-cessation, both the A and M groups had lower PaCO₂ levels compared to the E group; both the A and E groups had lower ESR levels compared to the M group, with a statistically significant difference (P<0.05). ④Number of Acute Exacerbations and Cough Score: Prior to smoking cessation, there was no statistically significant difference in the number of acute exacerbations and cough score among the three groups (P>0.05). Post-cessation, both the A and M groups experienced fewer acute exacerbations compared to the E group; both the A and E groups had higher cough scores compared to the M group, with a statistically significant difference (P<0.05). Conclusion There are variations in the number of acute exacerbations and therapeutic effects post-smoking cessation among COPD patients with different HRCT phenotypes. Specifically, patients with Type E and Type M exhibit a weaker improvement effect after quitting smoking. However, quitting smoking has a more pronounced improvement effect on the number of acute exacerbations, lung function, and inflammatory factors in patients with Type A.

Key words: pulmonary disease, chronic obstructive, smoking cessation, high-resolution CT, respiratory function tests, inflammatory factors

中图分类号:

R563.9

刘翠翠, 朱亚芳, 吕文娟. 不同HRCT表型COPD患者戒烟后肺功能、炎性因子和临床症状变化[J]. 临床荟萃, 2024, 39(7): 625-629.

Liu Cuicui, Zhu Yafang, Lyu Wenjuan. Changes in pulmonary function, inflammatory factors, and clinical symptoms after smoking cessation in COPD patients with varied HRCT phenotypes[J]. Clinical Focus, 2024, 39(7): 625-629.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.07.007

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I7/625

图/表 4

表1 3组FEV1、FEV1/FVC比较( x -±s)

Tab.1 FEV1 and FEV1/FVC among the three groups( x -±s)

组别	例数	FEV1(%)		FEV1/FVC(%)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	44.62±12.64	51.41±3.02^*	43.64±10.64	54.64±5.64^*
E型组	35	45.61±12.87	51.94±4.27^*	44.97±10.72	55.27±5.72^*
M型组	34	42.72±12.95	47.47±3.23	44.67±10.57	47.67±4.57
$F$ 值		0.376	8.279	0.215	9.315
P值		0.719	0.001	0.805	0.001

表1 3组FEV1、FEV1/FVC比较( x -±s)

Tab.1 FEV1 and FEV1/FVC among the three groups( x -±s)

组别	例数	FEV1(%)		FEV1/FVC(%)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	44.62±12.64	51.41±3.02^*	43.64±10.64	54.64±5.64^*
E型组	35	45.61±12.87	51.94±4.27^*	44.97±10.72	55.27±5.72^*
M型组	34	42.72±12.95	47.47±3.23	44.67±10.57	47.67±4.57
$F$ 值		0.376	8.279	0.215	9.315
P值		0.719	0.001	0.805	0.001

表2 3组Th17/Treg、TNF-α比较( x -±s)

Tab.2 Th17/Treg and TNF-α among the three groups( x -±s)

组别	例数	Th17/Treg(%)		TNF-α(ng/L)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	2.42±0.59	1.91±0.52^*	18.08±3.51	5.64±2.19^*
E型组	35	2.45±0.57	1.94±0.39^*	15.19±3.18	4.27±2.26^*
M型组	34	2.64±0.55	2.37±0.26	18.28±3.29	7.29±2.14
$F$ 值		1.176	7.552	0.315	8.315
P值		0.352	<0.001	0.715	<0.001

表2 3组Th17/Treg、TNF-α比较( x -±s)

Tab.2 Th17/Treg and TNF-α among the three groups( x -±s)

组别	例数	Th17/Treg(%)		TNF-α(ng/L)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	2.42±0.59	1.91±0.52^*	18.08±3.51	5.64±2.19^*
E型组	35	2.45±0.57	1.94±0.39^*	15.19±3.18	4.27±2.26^*
M型组	34	2.64±0.55	2.37±0.26	18.28±3.29	7.29±2.14
$F$ 值		1.176	7.552	0.315	8.315
P值		0.352	<0.001	0.715	<0.001

表3 3组PaCO2、ESR比较( x -±s)

Tab.3 PaCO2 and ESR among the three groups( x -±s)

组别	例数	PaCO₂(mmHg)		ESR(mm/1h)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	47.73±10.87	41.41±9.82^#	29.18±9.29	25.64±10.19^*
E型组	35	55.89±21.42	48.39±12.38	38.25±11.45	33.14±10.26^*
M型组	34	47.14±8.73	47.47±10.09^#	46.38±15.19	41.29±12.14
$F$ 值		1.284	5.143	3.284	6.315
P值		0.256	0.033	0.951	0.014

表3 3组PaCO2、ESR比较( x -±s)

Tab.3 PaCO2 and ESR among the three groups( x -±s)

组别	例数	PaCO₂(mmHg)		ESR(mm/1h)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	47.73±10.87	41.41±9.82^#	29.18±9.29	25.64±10.19^*
E型组	35	55.89±21.42	48.39±12.38	38.25±11.45	33.14±10.26^*
M型组	34	47.14±8.73	47.47±10.09^#	46.38±15.19	41.29±12.14
$F$ 值		1.284	5.143	3.284	6.315
P值		0.256	0.033	0.951	0.014

表4 3组急性发作次数、咳嗽评分比较( x -±s)

Tab.4 Acute attack frequency and cough score among the three groups( x -±s)

组别	例数	急性发作次数(次)		咳嗽评分(分)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	3.73±1.17	1.49±1.23^#	2.28±0.53	1.04±0.39^*
E型组	35	3.24±1.22	3.35±1.32	2.19±0.58	1.87±0.46^*
M型组	34	3.42±1.42	2.45±1.39^#	2.18±0.59	1.09±0.84
$F$ 值		0.912	8.143	0.315	7.912
P值		0.352	<0.001	0.715	<0.001

表4 3组急性发作次数、咳嗽评分比较( x -±s)

Tab.4 Acute attack frequency and cough score among the three groups( x -±s)

组别	例数	急性发作次数(次)		咳嗽评分(分)
组别	例数	戒烟前	戒烟后	戒烟前	戒烟后
A型组	33	3.73±1.17	1.49±1.23^#	2.28±0.53	1.04±0.39^*
E型组	35	3.24±1.22	3.35±1.32	2.19±0.58	1.87±0.46^*
M型组	34	3.42±1.42	2.45±1.39^#	2.18±0.59	1.09±0.84
$F$ 值		0.912	8.143	0.315	7.912
P值		0.352	<0.001	0.715	<0.001

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