肺泡蛋白沉着症肺功能检查特点:附27例分析

目的 肺泡蛋白沉着症(PAP)在临床上极为罕见,其肺功能检查特点的报道也极少,本研究目的在于探讨肺功能检查在PAP诊断和治疗中的价值.方法 回顾性分析本院呼吸疾病研究所经肺组织病理(过碘酸雪夫反应阳性)确诊的27例PAP患者的临床资料.全部病例均给予肺通气和弥散功能测试,其中12例进行了肺容积测试.比较了10例行支气管肺泡灌洗(BAL)治疗的患者在灌洗前、后肺功能的改变情况.结果 27例患者入院后的基础通气肺功能情况:用力肺活量(FVC):(79.67±16.21)%;第1秒用力呼气容积(FEV1):(83.94±16.07)%,一秒率(FEV1/FVC):(89.20±5.50)%;最大呼气流量(PEF):(107.64±17.73)%;肺一氧化碳弥散量(DLCO):(49.27±21.83)%;DLCO与肺泡通气量比值(DLCO/VA):(69.92±20.11)%.肺总量(TLC):(80.60±19.56)%;残气容积(RV):(86.03±38.10)%;残总比(RV/TLC):(32.73±9.48)%;功能残气量(FRC):(84.91±28.08)%.27例患者基础肺功能下降的异常率:FVC:55.6%(15例);FEV1:44.4%(12例);FEV1/FVC:0%(0例);PEF:3.7 %(1例);DLCO:88.9%(24例);DLCO/VA:70.4%(19例).12例患者肺容积的异常率:TLC下降者占50%(6例);RV下降者占41.7%(5例),升高者占16.7%(2例);RV/TLC升高者占50%(6例);FRC下降者占33.3%(4例).10例进行BAL治疗的患者术后肺功能改善率:FVC:5.47%;FEV1:5.50%;DLCO:31.07%;DLCO/VA:20.35%.灌洗前后DLCO及DLCO/VA差异有统计学意义(t=-3.551,-3.159;P=0.006,0.012).结论 PAP的肺功能检查以肺限制性通气功能障碍及肺弥散功能障碍为常见,尤其为弥散功能障碍.PAP经BAL治疗后肺弥散功能有显著性改善.     

肺泡蛋白沉积症十例临床分析及全肺灌洗治疗体会

目的总结肺泡蛋白沉积症（PAP）的临床资料以及全肺灌洗的疗效和安全性,丰富PAP的诊治经验.方法10例PAP患者,经支气管肺活检（TBLB）和支气管肺泡灌洗液（BALF）过碘酸夫雪（PAS）染色检查确诊,均行全肺灌洗治疗.结果10例PAP患者均表现为渐进性呼吸困难.肺部高分辨率CT有特征的毛玻璃样改变,全肺灌洗治疗后临床症状、肺功能、动脉血气及高分辨率CT等指标均显著改善.结论渐进性呼吸困难和毛玻璃样在高分辨率CT改变是PAP患者的最重要临床特征,大容量全肺灌洗治疗PAP安全有效.     

全肺灌洗治疗9例肺泡蛋白沉着症后的总结与思考

目的 探讨大容量全肺灌洗治疗肺泡蛋白沉着症(pulmonary alveolar proteinosis,PAP),并观察其疗效.方法 对9例确诊PAP患者在全麻下行大容量全肺灌洗治疗,同时测定术前及术后1个月肺功能、血气分析、6分钟步行试验、Borg呼吸困难评分.结果 经全肺灌洗治疗后,8例患者的临床症状减轻,肺功能(FVC、FEV1、DLCO、MVV)、血气(PaO2、SaO2％)、6分钟步行试验、Borg呼吸困难评分均有显著改善;89％患者胸部高分辨率CT病灶有吸收.结论 全肺灌洗是目前治疗PAP安全有效的方法.     

狼疮性肾炎患者肺功能损害特征及其相关因素分析

目的　探讨狼疮性肾炎患者肺功能损害的特征及其相关因素。方法　测定 40例狼疮性肾炎患者的肺容量、通气功能、小气道功能、弥散功能和血红蛋白、BUN及血压。结果　肺活量 (VC)、残气容积与肺总量之比值 (RV/TLC)、第一秒肺活量 (FEV1)、最大通气量 (MVV)、一氧化碳弥散量 (DLCO)、每升肺泡通气量之CO弥散量 (DLCO/VA)与对照组比较 ,差异有显著性 (P <0 .0 5 ) ,其中 30 %的患者呈现肺气肿现象 ,30 %的患者肺通气功能减低 ,小气道阻塞和可疑小气道阻塞者高达 6 0 % ,更有高达 85 %的患者弥散功能减退 ;相关因素分析表明 ,DLCO与TLC明显正相关关系 (r =0 .42 ,P <0 .0 5 )。结论　狼疮性肾炎患者肺功能损害以弥散功能减退为主 ,限制性通气障碍与阻塞性通气障碍并存 ,且以限制性通气障碍为主要发展趋势 ,与其他结缔组织疾病一样弥散功能障碍先于肺X线表现 ,但其呼吸困难症状几乎与弥散功能同步出现 ,则与其他结缔组织疾病有所不同     

不同阶段2型糖尿病患者肺功能分析

目的通过对不同阶段2型糖尿病患者的肺功能进行分析,以明确糖尿病患者是否存在肺功能损害。方法对60例2型糖尿病患者(初发糖尿病患者30例,合并不同并发症患者30例)和60例健康志愿者分别进行肺功能检测,检测其用力肺活量(FVC)、1秒钟用力呼气容积(FEVI)、1秒率(FEVl/FVC)、肺一氧化碳弥散(DLCO)及单位肺泡一氧化碳弥散量(DLCO/VA)肺功能指标数据,采用SPSS17.0软件进行统计学处理,分析不同阶段2型糖尿病患者的肺功能变化。结果糖尿病组FVC、DLCO及DLCO/VA低于健康对照组,差异有统计学意义(P0.05);且有并发症组较无并发症组以上各项指标进一步下降,差异有统计学意义(P0.05)。结论糖尿病患者肺功能减退,且以弥散功能下降显著,且随疾病进展,糖尿病出现并发症的患者肺弥散功能更加减退,积极控制血糖,延缓并发症的产生,可进一步减缓肺功能的减退。     

常规肺功能的测定仪器和测定原理

测定肺功能的仪器统称为肺功能检查仪,简称肺功能仪,有肺量计(spirometer)、体容积描记仪和脉冲振荡仪等.根据测定方法可将肺功能参数分为直接测定参数和间接测定参数,前者可通过密闭式肺量计或流量计直接测定.受检者呼吸气量的多少为容积,包括潮气容积(VT)、补吸气容积(IRV)、深吸气量(IC)、补呼气容积(ERV)、肺活量(VC)等静态容积参数和FVC、FEV1等反映通气功能的各种动态容积参数;呼吸气量进出的快慢显示为流量.但部分参数不能通过呼气或吸气直接测定,如残气容积(RV)和包含RV的功能残气量(FRC)、肺总量(TLC),需通过气体分析法等间接测定.一氧化碳弥散量(DLCO)和每升肺泡容积的一氧化碳弥散量(DLCO/VA)也需要间接测定.     

结节病患者肺功能与支气管肺泡灌洗液细胞学关系的研究

目的 探讨结节病患者不同影像分期之间肺功能指标、支气管肺泡灌洗液细胞学的改变以及两者的相关性.方法 回顾性调查71例结节病患者肺功能以及支气管肺泡灌洗液检查的资料.结果 在结节病患者不同影像分期之间肺功能指标用力肺活量(FVC)占预计值%、第1秒用力呼气容积(FEV1)占预计值%、肺总量(TLC)占预计值%以及肺一氧化...     

298例2型糖尿病对肺功能的影响

目的 分析糖尿病患者的肺功能,研究肺是否为糖尿病损害的靶器官.方法 回顾性298名糖尿病患者肺功能(包括通气功能和弥散功能),以一氧化碳弥散量(DLCO)作为肺弥散功能的指标.对照组为年龄性别匹配的300名健康志愿者.分析糖尿病病程及合并高血压对肺功能的影响.结果 糖尿病组患者中所有肺通气功能指标均低于对照组,但两组之间的差异均无统计学意义(P＞0.05).糖尿病患者DLCO平均值为91.4±16.7％,明显低于对照组(104.1±7.9％)(P＜0.001).结论 糖尿病患者肺弥散功能受损,提示肺脏是糖尿病慢性病变的靶器官之一.     

老年高血压患者肺功能的研究

目的 研究老年高血压患者肺功能的变化。方法 本研究设高血压病组68人,对照组46人,高血压病组根据WHO／ISH分类分为3组,其中1级22人,2级28人,3级18人。检测检测肺活量（VC）、用力肺活量（FVC）、一秒钟用力呼气容积（FEV1）、FEV1／FVC、肺一氧化碳弥散量（DLCO）、单位肺泡容积的一氧化碳弥散量（DLCO／VA）、最大通气昔（MVV）、呼出25％啼活量时最大呼气流量（FEF25）、呼出50％肺活量时最大呼气流量（FEF50）、呼出75％肺活量时最大呼气流苗（FEF75）等肺功能指标,采用SPSS11．5软件进行统计学处理,比较各组间肺功能各指标间的差异,结果高血压病组患者VC、FEV1／FVC、MVV、FEF25、FEF50、FEF75,低于对照组,差异有统计学意义（P〉0．05）．两组间FEV1、DLCO、DLCO／VA差异无统计学意义（P〉0．05）。高血压病3级患者VC、FEV1／FVC、MVV、FEFn、FEF50、FEF75低于1级,高血压病2级患者FEF25,低于1级,差异有统计学意义（P〈0．05）。三组间FEV1、DLCO、DLCO／VA差异无统计学意义（P〉0．05）。结论高血压病患者存在以通气功能为主的肺功能损伤,且通气功能的损伤稃度与高血压的进展及严重程度相关。     

利拉鲁肽对2型糖尿病肺功能影响

40例糖化血红蛋白〉9％的2型糖尿病患者随机分为胰岛素组和利拉鲁肽组（n=20）,22例为对照,采用肺功能仪测定肺通气功能指标和DLCO（一氧化碳肺弥散功能）。结果与对照组相比,2型糖尿病患者的肺通气功能指标（VC、FVC、FEVl、TLC、MVV）和DLCO明显下降（P〈0．05）。12周后胰岛素组肺通气功能指标轻度增加,但无统计学意义,而弥散功能指标DLCO明显增加（P〈0．05）。利拉鲁肽组肺通气功能指标及弥散功能指标均明显高于胰岛素组（P值均〈0．05）。结论2型糖尿病血糖控制不良患者肺功能明显降低,与胰岛素比较,利拉鲁肽可明显改善2型糖尿病患者肺功能。     

Quantitative assessment of pulmonary function in lymphangioleiomyomatosis patients using high-resolution computed tomography and pulmonary function tests

BackgroundTo explore the feasibility of using quantitative high-resolution computed tomography (HRCT) to evaluate pulmonary function in patients with pulmonary lymphangioleiomyomatosis (PLAM).MethodsPulmonary function tests (PFTs) were performed in 30 patients with pathologically confirmed PLAM with the use of HRCT. These results were correlated with quantitative HRCT in 21 patients.ResultsThere were significant correlations between the HRCT parameters for lung function and PFT parameters. Among these parameters, emphysema volume (EV), pulmonary volume with a pixel index less than the trigger threshold (−950 HU) to account for a proportion of total lung volume [PI-950 (%)] and forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC (%)] had the strongest correlations, reaching values between −0.71 and −0.68. HRCT lung function might therefore also be helpful for predicting changes in lung function before and after treatment.ConclusionsHRCT is helpful for the assessment of pulmonary function in PLAM patients and can assist in the clinical evaluation of lung function and treatment response in patients with this disease.     

Mixed infiltrative and obstructive disease on high-resolution CT: differential diagnosis and functional correlates in a consecutive series

Fourteen of 400 consecutive patients having high-resolution computed tomography (HRCT) with expiratory images showed findings of infiltrative lung disease on inspiratory HRCT and air trapping on expiratory CT. Diagnoses included hypersensitivity pneumonitis, sarcoidosis, atypical infection, and pulmonary edema. The extent of infiltrative abnormalities and air trapping were correlated with pulmonary function tests (PFT) in 11 patients. PFT indicated a mixed pattern in five, an obstructive pattern in three, and a restrictive pattern in three. Forced expiratory volume (FEV) in 1 second/forced vital capacity (FVC) correlated significantly with the extent of air-trapping (r = 0.60; p = 0.05). The extent of infiltrative abnormalities correlated significantly and negatively with forced vital capacity (r = -0.82, p = 0.002), FEV1 (r = -0.59, p = 0.05), total lung capacity (TLC) (r = -0.67, p = 0.05), and DLCO (r = -0.75, p = 0.02). Findings of lung infiltration on inspiratory HRCT scans and air trapping on expiratory CT correlated respectively with PFT measures of restrictive and obstructive lung disease.     

肺纤维化合并肺气肿综合征八例并文献复习

目的 探讨肺纤维化合并肺气肿(CPFE)综合征的临床、肺功能及影像学特点.方法 结合文献对北京协和医院2006-2009年确诊的8例CPFE综合征患者的临床、肺功能及影像学特点进行分析.结果 8例均为男性,7例为吸烟者,年龄59～75岁,中位数为65岁,7例有活动后呼吸困难,4例有杵状指,6例有双下肺爆裂音.肺功能结果[中位数(范围)]:FVC占预计值%为73%(51%-92%),FEV1/FVC为76%(60%-86%),肺总量占预计值%为80%(59%～114%),DLCO占预计值%为44%(16%-65%).胸部高分辨率CT示双上肺为主的肺气肿及肺大疱,双下肺为主的网格影、蜂窝肺及牵张性支气管扩张.其中6例有肺动脉高压,肺动脉收缩压的中位数为49 mm Hg(1 mm Hg=0.133 kPa),范围为35-101 mm Hg.结论 胸部高分辨率CT是诊断肺纤维化合并肺气肿综合征的重要手段,其特点为同时存在上肺野肺气肿和下肺野纤维化.肺功能表现为肺容积相对正常而弥散能力显著下降,是该综合征的突出特点.肺动脉高压发生率较高.肺纤维化合并肺气肿综合征能否作为一种独立的综合征,其发病机制、治疗及预后仍有待进一步研究.     

The relationship between pulmonary function tests, thorax HRCT, and quantitative ventilation-perfusion scintigraphy in chronic obstructive pulmonary disease

We have evaluated the relationship between pulmonary function tests (PFT), thorax high resolution computed tomography (HRCT) images and quantitative ventilation-perfusion (V/Q) scintigraphic studies in 16 male patients (mean age 65.6 +/- 5.5 years) with chronic obstructive pulmonary disease (COPD). The mean forced vital capacity (FVC) value of the patient group was 2352 +/- 642 mL (65.4 +/- 15.8%), whereas mean forced expiratory volume in one second (FEV(1)) was found to be 1150 +/- 442 mL (40.8 +/- 14.9%). The ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) was 3.17 +/- 0.88 mL/min/mmHg/L, and the mean partial oxygen (PaO(2)) and carbon dioxide (PaCO(2)) pressures were 68.5 +/- 11.04 mmHg and 38.9 +/- 5.8 mmHg respectively. For each patient, thorax HRCT and V/Q scintigraphic images of both lungs were divided into upper, mid and lower zones during examination. Visual scoring for the assessment of emphysema on thorax HRCT were used and images were graded from mild to severe (< or = 25% - > or = 76%). Emphysema scores were found to be higher on upper zones with accompanying lowest V/Q ratios. DLCO/VA, DLCO, total emphysema scores, and individual emphysema scores of the upper, mid and lower zones were found to be correlated. As a conclusion, it can be stated that emphysematous changes in COPD patients are more apparent in the upper lung zones, which also have the lowest V/Q ratios.     

Pulmonary function testing prior to reduced intensity conditioning allogeneic stem cell transplantation in an unselected patient cohort predicts posttransplantation pulmonary complications and outcome

Pretransplant pulmonary function tests (PFTs) have been checked mostly in myeloablative allogeneic stem cell transplantation (Allo-SCT). Their value in the setting of reduced intensity conditioning Allo-SCT (Allo-RIC) has been less explored. We retrospectively evaluated the predictive value of PFTs on posttransplant pulmonary complications (PPC) and outcomes in 195 consecutive Allo-RIC patients, based on fludarabine plus busulphan or melphalan. PFT parameters included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, total lung capacity (TLC), residual volume, and diffusion capacity for carbon monoxide (DLCo) corrected for the hemoglobin levels. Pretransplant PFTs abnormalities were observed in 130 patients (66%). The most frequent abnormalities were abnormal DLCO (n = 83, 44%), followed by FEV1/FVC (n = 75, 38%) and FVC (n = 47, 24%). The abnormalities were severe in 25 (13%) patients, moderate in 65 (33%) and mild in 40 patients (21%). Multivariate analysis showed that TLC was significantly associated with PPC, nonrelapse mortality and overall survival (OS), (HR 4.2, 95% CI. 2-8.5; HR 3.8, 95% CI. 1.7-8.5; HR 2.3, 95% CI. 1.3-4.1, respectively, P = 0.01), while abnormal FVC had a negative impact on PPC and OS (HR 1.8, 95% CI. 0.98-3.6, P = 0.06 and HR 1.7, 95% CI. 1.1-2.6, P = 0.008). This study emphasizes the valuable role of PFTs in identifying patients at risk for PPC, NRM, and lower OS in the Allo-RIC setting.     

64层螺旋CT肺功能研究及HRCT在肺间质疾病的应用

目的 评价高分辨力CT(HRCT)对肺间质性疾病诊断的作用,并探讨MSCT肺容积指标与肺功能(PFT)指标之间的相关性.方法 选择50例临床诊断为间质性肺疾病的患者为病例组,对照组为22例CT胸部体检且肺功能正常者,对比两者间各种指标的差异.同时观察所有对象肺HRCT的细微结构的改变.结果 HRCT易于发现肺部间质性病变的网状阴影、小结节阴影、磨玻璃样阴影、肺气肿和细支气管病变.CT肺容积指标中,最大呼气末容积(Vex)与残气量(RV),最大吸气末容积(Vin)与肺总量(TLC),容积差(Vin-Vex)与用力肺活量(FVC),容积比(Vin/Vex)与残气量及肺总量比(RV/TLC),存在着较好的相关性,r值分别为0.91、0.87、0.65、0.65,P＜0.01.结论 HRCT对诊断ILD有很高的价值,MSCT肺容积与PFT容积指标有显著相关性,MSCT肺容积指标能用于临床评价肺功能.     

The Relationship Between Severity of Liver Cirrhosis and Pulmonary Function Tests

Pulmonary complications, mainly hepatopulmonary syndrome (HPS), are frequently observed in liver cirrhosis. In this study, the aim was to investigate the frequency of hypoxemia and impairment of pulmonary function tests (PFT) in patients with liver cirrhosis and to examine the relationships of these impairments with liver failure. A total of 39 patients with cirrhosis, 24 males and 15 females, were included in our study. The mean age of the patients was 47.5 +/- 17.2 years. Arterial blood gases, PFT, and carbon monoxide diffusion tests (DLCO) were performed in all patients. Out of 39 cirrhotic patients, 21 (53.8%) had ascites, whereas 18 (46.2%) did not. Seven patients were in the Child-Pugh A group, 21 in the Child-Pugh B group, and 11 patients were in the Child-Pugh C group. Hypoxia was found in 33.3% of the patients. Although the PaO2 and SaO2 values of patients with ascites were lower compared to those without ascites (P < 0.05), no statistically significant difference was determined in the comparison of hypoxia between the groups (P > 0.05). Among the PFT parameters, FEV1/FVC and FEF25-75% values were found to be lower in patients with ascites than those without (P < 0.05). No differences were established between these two groups of patients in terms of DLCO (P > 0.05). While no differences were found in comparison of the DLCO values in between the groups (P > 0.05), there was a statistically significant difference in the ratio of DLCO to the alveolar ventilation (DLCO/VA) in between the groups (P < 0.05). On the other hand, a negative correlation was found between the DLCO/VA and Child points when the relationship between the Child-Pugh score and PFT parameters were investigated (r = -0.371, P < 0.05). Consequently, a relationship was established between the severity of liver failure and diffusion tests showing pulmonary complications invasively. We believe diffusions tests should be performed in addition to the PFT in order to determine pulmonary involvements particularly in patients who are candidates for liver transplantation.     

Abnormal pulmonary function in adults with sickle cell anemia

RATIONALE: Pulmonary complications of sickle cell anemia (Hb-SS) commonly cause morbidity, yet few large studies of pulmonary function tests (PFTs) in this population have been reported. Objectives: PFTs (spirometry, lung volumes, and diffusion capacity for carbon monoxide [DLCO]) from 310 adults with Hb-SS were analyzed to determine the pattern of pulmonary dysfunction and their association with other systemic complications of sickle cell disease. METHODS: Raw PFT data were compared with predicted values. Each subject was subclassified into one of five groups: obstructive physiology, restrictive physiology, mixed obstructive/restrictive physiology, isolated low DLCO, or normal. The association between laboratory data of patients with decreased DLCO or restrictive physiology and those of normal subjects was assessed by multivariate linear regression. MEASUREMENTS AND MAIN RESULTS: Normal PFTs were present in only 31 of 310 (10%) patients. Overall, adults with Hb-SS were characterized by decreased total lung capacities (70.2 +/- 14.7% predicted) and DLCO (64.5 +/- 19.9%). The most common PFT patterns were restrictive physiology (74%) and isolated low DLCO (13%). Decreased DLCO was associated with thrombocytosis (p = 0.05), with hepatic dysfunction (elevated alanine aminotransferase; p = 0.07), and a trend toward renal dysfunction (elevated blood urea nitrogen and creatinine; p = 0.05 and 0.07, respectively). Conclusions: Pulmonary function is abnormal in 90% of adult patients with Hb-SS. Common abnormalities include restrictive physiology and decreased DLCO. Decreased DLCO may indicate more severe sickle vasculopathy characterized by impaired hepatic and renal function.     

慢性阻塞性肺疾病合并肺纤维化的肺动脉压力变化及其与肺功能和生活质量关系的研究

目的探究慢性阻塞性肺疾病(COPD)合并肺纤维化患者的肺动脉压力变化及其与肺功能、生活质量的关系。方法 回顾性对比分析天津医科大学总医院2009年7月至2011年3月诊断的20例COPD合并肺纤维化及随机抽取同期30例单纯COPD患者的肺动脉收缩压、肺功能、Medieal Research Council dyspne...