胃食管反流与慢性阻塞性肺疾病急性加重的关系探讨

目的观察慢性阻塞性肺疾病（COPD）患者是否存在诱发胃食管反流（GER）因素并分析其相关性，以及GER是否影响COPD急性加重次数。方法观察2003年11月-2005年9月因COPD急性加重人院治疗的50例患者。让入选患者回答胃食管反流标准问题答卷，其中13／50患者近1年有明确的烧心、反酸、胃部不适症状，并经胃镜检查证实存在程度不同的胃酸反流性食管炎表现，为GER阳性组，其余37例患者为GER阴性组。结果两组问在年龄、性别、体重指数（BMI）、血浆白蛋白、吸入支气管舒张剂或激素、茶碱使用等方面无显著差异。第1秒用力呼气容积占预计值百分比（FEW1％pred）（37％比38．3％，P=0．608），肺残气量占预计值百分比（RV％pred）（123．4％比137．8％，P=0．222），残气／肺总量（RV／TLC）（139．4％比141．5％，P=0．798），两组间差异均无统计学意义。但两组间COPD每年急性加重发作次数有显著差异（4．5次／年比1．3次／年，P=0．006）。结论肺内气流阻塞和肺过度膨胀的严重程度与发生GER无明显相关性，但GER阳性组COPD患者每年急性加重发作次数较GER阴性患者明显增加，应重视诊断和积极治疗GER。

Gastroesophageal reflux is associated with incresead exacerbation of chronic obstructive pulmonary disease

Objective To investigate the prevalence and predisposing factors of gastroesophageal reflux(GER) in patients with chronic obstructive pulmonary disease(COPD) and its impacts on the frequency of COPD exacerbations.Methods 50 patients with acute exacerbation of COPD were enrolled in the study.All patients filled a modified version of clinically validated standardized Mayo Clinic GER questionnaire.Pulmonary function tests(PFT),body mass index(BMI),serum albumin,and medications were recorded.The patients were divided into GER group(13 patients with GER symptoms longer than one year and diagnosed GER by gastroscope) and non-GER group(37 patients without GER symptoms).Results There were no significant differences in the BMI,serum albumin,use of inhaled steroids and theophylline between the two groups.Forced expiratory volume in one second as a percentage of the predicted value(FEV1%pred)(37% vs 38.3%,P=0.608),residual volume % predicted(123.4 % vs 137.8%,P=0.222),and residual volume to total lung capacity(139.4% vs 141.5%,P=0.798) were not significantly different between the two groups.The number of COPD exacerbations per year was significantly higher in patients with GER compared to patients without GER(4.5 vs 1.3,P=0.006).Conclusions The severity of airflow obstruction and the hyperinflation is unlikely to contribute to the development of GER.Patients with GER experience significantly more exacerbations per year when compared to patients without GER,suggesting more highlight warrant in treatment of GER in COPD patients.