中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

哮喘-慢性阻塞性肺疾病重叠综合征临床诊断的初步探讨

查看全文

目的 探讨慢性阻塞性肺疾病(简称慢阻肺)全球创议(GOLD)/哮喘全球创议(GINA)联合指南标准(简称 GOLD/GINA 标准)与西班牙慢阻肺指南标准(简称西班牙指南标准)诊断哮喘-慢阻肺重叠综合征(ACOS)的临床应用价值。 方法 连续入选稳定期慢阻肺门诊就诊患者,收集临床资料,进行肺功能测定及可逆试验,检测外周血嗜酸性粒细胞计数、血清总 IgE 水平、痰炎性细胞分类计数。分别根据 GOLD/GINA 标准和西班牙指南标准对 ACOS 做出诊断,比较 ACOS 在慢阻肺中的分布及其特征。 结果 在 104 例诊断明确的慢阻肺患者中,依据 GOLD/GINA 标准和西班牙指南标准分别诊断 ACOS 24 例(24/104,23.1%)和 10 例(10/104,9.6%),后者诊断的 ACOS 患者完全包含在前者诊断的患者中。GOLD/GINA 标准最常符合的条目是活动和(或)情绪诱发的喘息、可变的气流受限、哮喘家族史及其他过敏性疾病史;作为可变性气流受限的客观指标,呼气流量峰值平均每日昼夜变异率≥10% 的阳性率为 45.8%(11/24),而气道舒张试验的阳性率为 66.7%(16/24)。西班牙指南标准最常符合的条目为 40 岁以前哮喘病史、存在过敏性疾病、2 次以上支气管舒张试验阳性。 结论 GOLD/GINA 标准诊断 ACOS 的敏感性较高,且不需要特殊实验室检查,更适合临床使用;而西班牙指南标准则比较严格,有可能导致诊断不足。

Objective To study the clinical application of the GOLD/GINA criteria and the Spanish guideline in the diagnosis of asthma-COPD overlap syndrome (ACOS). Methods Patients with stable COPD were consecutively enrolled in the study. Clinical data were collected, lung function with bronchodilator test and peak expiratory flow (PEF) were performed, and peripheral blood eosinophils, total IgE, and sputum inflammatory cells were measured. Those overlap with asthma were identified by the 2 different criteria, and the prevalence and features of ACOS were compared. Results Among 104 cases of stable COPD, 24 (23.1%) and 10 (9.6%) were identified as ACOS by the GOLD/GINA criteria and the Spanish guideline, respectively; the latter 10 cases were all included in the former 24. For the GOLD/GINA criteria, the most common features were symptoms triggered by exercise or emotions, variable airflow limitation, family history of asthma, and other allergic conditions. Mean diurnal PEF variation≥10% was evident in 11 cases (45.8%, 11/24), while bronchodilator test was positive in 16 cases (66.7%, 16/24). For the Spanish guideline, the most common features were diagnosis of asthma before 40, other allergic diseases, positive bronchodilator test on 2 occasions. Conclusions The GOLD/GINA criteria may be more sensitive for the diagnosis of ACOS, and do not need sophisticated lab tests, which may be more applicable for clinical use. The Spanish guideline is restrictive, and therefore may lead to under-diagnosis.

关键词: 哮喘; 慢性阻塞性肺疾病; 哮喘-慢性阻塞性肺疾病重叠综合征

Key words: Asthma; Chronic obstructive pulmonary disease; Asthma-COPD overlap syndrome

引用本文: 李瑞敏, 徐伟涵, 金建敏, 张永祥, 孙永昌. 哮喘-慢性阻塞性肺疾病重叠综合征临床诊断的初步探讨. 中国呼吸与危重监护杂志, 2018, 17(6): 557-560. doi: 10.7507/1671-6205.201705034 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Global strategy for asthma management and prevention. Revised 2014. Available at: http://www.ginasthma.org.
2. 孙永昌. 哮喘-慢阻肺重叠综合征指南解读. 中国呼吸与危重监护杂志, 2014, 13(4): 325-329.
3. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD Guidelines (GesEPOC). Prim Care Respir J, 2013, 22(1): 117-121.
4. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
5. Vignola AM, Rennar SI, Hargreave FE, et al. Standardised methodology of sputum induction and processing: future directions. Eur Respir J, 2002, 20(Suppl 37): 51s-55s.
6. Barrecheguren M, Esquinas C, Miravitlles M. The asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): opportunities and challenges. Curr Opin Pulm Med, 2015, 21(1): 74-79.
7. Gibson PG, McDonald VM. Asthma-COPD overlap 2015: now we are six. Thorax, 2015, 70(7): 683-691.
8. Menezes AMB, Montes de Oca M, Pérez-Padilla R, et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest, 2014, 145(2): 297-304.
9. Rubio MC, Casamor R, Miravitlles M. Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study. Int J COPD, 2017, 12: 2373-2383.
10. Cosio BG, Soriano JB, Lopez-Campos JL, et al. Defining the asthma-COPD overlap syndrome in a COPD cohort. Chest, 2016, 149(1): 45-52.
11. Jin JM, Liu XF, Sun YC. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res, 2014, 15: 130.
12. Tamada T, Sugiura H, Takahashi T, et al. Biomarker-based detection of asthma-COPD overlap syndrome in COPD population. Int J COPD, 2015, 10: 2169-2176.