桂西地区慢性阻塞性肺疾病合并肺结核的临床特点及免疫功能调查

李丽; 冯勤胜; 李慧; 周明明; 黄玉夏

doi:10.16190/j.cnki.45-1211/r.2023.03.026

桂西地区慢性阻塞性肺疾病合并肺结核的临床特点及免疫功能调查

Clinical characteristics and immune function of chronic obstructive pulmonary disease complicated with pulmonary tuberculosis in western Guangxi

摘要

摘要: 目的：了解桂西地区结核相关性慢性阻塞性肺疾病（T-COPD）的发病特点、免疫功能及肺功能，提高对该类疾病的诊治水平。方法：选取2019 年7 月至2020 年7 月在百色市人民医院呼吸内科住院及门诊就诊的T-COPD 患者150 例作为T-COPD组，有烟草暴露的慢性阻塞性肺疾病（S-COPD）患者150 例作为S-COPD 组。比较两组患者的临床症状、影像学特征、肺功能及免疫功能。根据T-COPD组患者的治疗意愿，分为A组（n=67，常规治疗）和B组（n=83，常规治疗联合抗结核治疗）。比较两组患者的肺功能、双肺阴影消失率、空洞改善率、痰菌转阴率及免疫功能，并进行2年随访，采用慢性阻塞性肺病评估测试评分（CAT）以及累积急性加重发生率评估病情严重程度。结果：T-COPD组患者胸痛、盗汗的发生率高于S-COPD组，肿块、“分叶”征、毛刺状结节、胸膜凹陷、空洞、条索影影像学特征发生率高于S-COPD 组（均P＜0.05）。T-COPD 组患者第1 秒用力呼气容积（FEV₁）、用力肺活量（FVC）、FEV₁与FVC比值（FEV₁/FVC）、CD4⁺、CD8⁺均低于S-COPD 组，IgA、IgG 高于S-COPD 组（均P＜0.05）。B 组FVC、CD4⁺、CD8⁺、双肺阴影消失率、空洞改善率、痰菌转阴率高于A 组，IgA、IgG、CAT 评分和累积急性加重发生率低于A 组（均P＜0.05）。结论：T-COPD 患者发生胸痛、盗汗较为明显，肺功能和免疫功能受损，建议建立临床综合分析，及时给予抗结核治疗，促进肺功能恢复，提高免疫水平。

Abstract: Objective: To understand the characteristics, immune function and pulmonary function of tuberculosis-associated chronic obstructive pulmonary disease (T-COPD) in western Guangxi, and to improve the diagnosis and treatment of these diseases.Methods: 150 patients with T-COPD in the respiratory medicine department of Baise People's Hospital from July 2019 to July 2020 were selected as the T-COPD group, and 150 patients with smoking-associated COPD (S-COPD) were selected as the S-COPD group.The clinical symptoms, imaging characteristics, pulmonary function and immune function of the patients in both groups were compared.Patients in the T-COPD group were divided into group A(n=67, conventional treatment)and group B(n=83, conventional treatment combined with anti-tuberculosis treatment) according to their willingness to be treated.The pulmonary function, disappearance rate of bilateral lung shadows, improvement rate of cavitation, sputum bacteria conversion rate and immune function were compared between the two groups.And 2-year follow-up was performed to assess the severity of the disease using the chronic obstructive pulmonary disease assessment test score (CAT)and the cumulative acute exacerbation rate.Results: The incidence of chest pain and night sweats in the T-COPD group was higher than that in the S-COPD group.The incidence of imaging features of mass, “lobar” sign, burrlike nodule, pleural sag, cavity and striated shadow in the T-COPD group was higher than that in the SCOPD group (all P＜0.05).Patients in the T-COPD group had lower forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), ratio of FEV1 to FVC(FEV₁/FVC), CD4⁺ and CD8⁺, and higher IgA and IgG levels than patients in the S-COPD group (all P＜0.05).FVC, CD4+, CD8+, disappearance rate of bilateral lung shadows, improvement rate of cavitation and sputum bacteria conversion rate in group B were higher than those in group A; IgA, IgG, CAT scores and cumulative acute exacerbation rate were lower than those in group A(all P＜0.05).Conclusion: T-COPD patients experience more pronounced chest pain and night sweats, and have impaired pulmonary function and immune function.It is suggested to establish a comprehensive clinical analysis and give anti-tuberculosis treatment in time to promote the recovery of pulmonary function and improve the immune level.

HTML全文

参考文献(0)

施引文献

资源附件(0)