糖尿病引起肺功能损害的早期改变

目的　探讨糖尿病导致肺功能损害的早期改变。方法　采用日本产ChestGraphHZ 70 1型体积容积描记肺功能仪检测 68例糖尿病患者的肺功能。结果　糖尿病组的肺通气功能有明显改变 ,肺活量、用力肺活量、一氧化碳弥散量和每升肺泡通气量与对照组比较均有显著性差异(P <0 .0 1)。结论　糖尿病患者引起肺功能的早期改变以弥散功能损害为主     

免疫和结缔组织疾病

,52肚。风湿性疾病3。例肺功能测定/张沪生…//中华内科杂志一1994,35(12)一837~838 此组sLE12例,类风湿关节炎(RA)5例,混合性结缔组织病(MCTD)6例,原发性干燥综合征(SS)4例.系统性硬化症(PSS)2例.多发性肌炎(PM)1例。病程2个月~19年。以16例正常女性为对照组。结果患者组肺通气功能和弥散功能均低于正常对照组;患者病程<和>5年者,其肺功能无显著性差异;有胸片改变者(11例)的肺通气和弥散功能低于无胸片改变者。故认为即使胸片正常,肺功能检查仍可作为风湿性疾病肺部受累早期的诊断标准,并为早期治疗提供依据。表2(李伟成) 95281145…     

136例结缔组织疾病患者的肺功能表现

为探讨结缔组织疾病（ＣＴＤ）患者肺功能变化特点，我们测定１３６例ＣＴＤ患者的肺容量，通气、弥散功能和动脉血气分析，并分析胸部Ｘ线改变和病程的关系。对象　１９８８年～１９９８年在我院肺功能室检查的ＣＴＤ患者，男２４例，女１１２例，年龄２０～７３岁，病程２周～２０年。其中系统性红斑狼疮患者５１例，类风湿关节炎患者１９例，系统性硬化症患者９例，混合性结缔组织疾病患者２６例，皮肌炎或多发性肌炎患者２３例，干燥综合征患者６例，白塞氏病患者２例。所有病例均行常规胸部Ｘ线检查，排除其他原发性肺部疾病患者。另选…     

风湿性疾病相关性间质性肺病患者的临床特点分析

目的分析风湿性疾病相关性间质性肺病(RD-ILD)患者的临床特点,提高临床对该病的认识。方法选择2013年1月—2014年6月在广西医科大学第四附属医院风湿免疫科确诊的风湿性疾病(RD)患者513例,统计其间质性肺病(ILD)发生情况,回顾性分析RD-ILD患者原发病、胸部高分辨率CT检查结果、肺功能检查结果及血气分析结果。结果本组513例RD患者发生ILD 87例(占17.0%)。原发病:系统性硬化34例(占39.0%)、类风湿关节炎21例(占24.1%)、干燥综合征16例(占18.4%)、系统性红斑狼疮8例(占9.2%)、肌炎/皮肌炎5例(占5.7%)、其他3例(占3.4%)。胸部高分辨率CT检查结果显示,25例(28.7%)为普通型间质性肺炎(UIP),62例(71.3%)为非UIP,其中类风湿关节炎患者UIP发生率最高,为42.9%。肺功能检查结果显示,肺功能正常16例(占18.4%),限制性通气功能障碍47例(占54.0%),阻塞性通气功能障碍2例(占2.3%),混合性通气功能障碍4例(占4.6%),弥散功能障碍60例(占69.0%)。血气分析结果显示,正常42例(占48.2%)、低氧血症27例(占31.3%)、Ⅰ型呼吸衰竭15例(占17.2%)、Ⅱ型呼吸衰竭3例(占3.4%)。结论 RD患者ILD发生率较高,其中以系统性硬化、类风湿关节炎及干燥综合征患者多见,RD-ILD患者肺功能障碍主要表现为弥散功能障碍和限制性通气功能障碍,常伴有低氧血症及Ⅰ型呼吸衰竭。     

糖尿病肺损伤的研究进展

研究表明,肺是糖尿病攻击的靶器官之一,其损害主要涉及肺功能及病理学改变,糖尿病患者肺功能损害主要表现为通气功能障碍、小气道功能减退和弥散功能异常,而糖尿病肺组织病理学改变主要表现为基底膜增厚和细胞外基质增生以及超微结构的改变.积极控制血糖水平及胰岛素等药物治疗可能改善糖尿病患者的肺功能.深入研究糖尿病肺部病变,有可能在防治糖尿病血管并发症方面提出新的思路.     

类风湿关节炎患者合并左心室舒张功能不全的临床研究

目的:评估我国类风湿关节炎患者中合并左心室舒张性心功能不全的发病情况.方法:随机选取76例类风湿关节炎患者(组)及65例正常对照组,采用多普勒超声检测左心室舒张功能,分析两组指标之间的差异,病程与左心室舒张功能之间的关系.结果:左心室舒张功能指标比较:类风湿关节炎组与正常对照组比较,二尖瓣口血流频谱舒张晚期峰速、二尖瓣口血流频谱舒张早期峰速/二尖瓣环运动频谱舒张早期峰速、E波减速时间3项指标升高,差异均有统计学意义(P＜0.05);而二尖瓣口血流频谱舒张早期和舒张晚期峰值比、二尖瓣环运动频谱舒张早期和舒张晚期峰速比、二尖瓣环运动频谱舒张早期峰速类风湿关节炎组与正常对照组比较下降,差异均有统计学意义(P＜0.05).相关性分析发现类风湿关节炎组患者的二尖瓣环运动频谱舒张早期峰速和病程呈负相关(r=-0.5936,P＜0.01).结论:类风湿关节炎患者中有较高的左心室的舒张功能不全发生率;病程与左心室舒张功能(二尖瓣环运动频谱舒张早期峰速)之间存在负相关.     

类风湿关节炎心脏损害34例临床分析

目的；探讨类风湿关节炎心脏损害的特征及其临床与病理联系和早期诊断方法。方法：分析１３０例类风湿关节炎中出现心脏损害３４例的临床资料，结果：心脏损害发生率２６．２％，其中心律失常１４例（４１．２％）心肌炎９例（２６．５％），心包炎７例（２０．６％）瓣膜病变４例（１１．８％）心脏损害与原发病的活动密切相关，治疗原发病后的民脏损害减轻或消失，ＵＣＧ可早期检获心包炎及瓣膜病变，结论：类风湿关节炎累及心脏损     

糖尿病肺损害

大量研究表明,肺脏是糖尿病攻击的“靶器官”之一,其损害主要涉及肺功能及病理学改变。糖尿病患者肺功能损害主要表现为限制性通气功能障碍、小气道功能减退和弥散功能异常。而糖尿病肺组织病理学改变主要表现为基底膜增厚和细胞外基质增生以及超微结构的改变。积极控制血糖水平及胰岛素和噻唑烷二酮类药物治疗可能改善糖尿病患者的肺功能。深入研究糖尿病肺部病变,有可能在防治糖尿病血管并发症方面提出新的思路。     

COPD并发肺癌患者的肺功能检测分析

目的探讨COPD并发肺癌患者的肺功能改变。方法采用意大利COSMED公司生产QuarkPFT4肺功能检测仪分别对32例COPD并发肺癌与58例COPD患者以及30例正常对照实施肺功能检测。结果COPD并发肺癌及单纯COPD患者肺功能均较正常对照损伤严重,而COPD并发肺癌患者的小气道功能及弥散功能较COPD患者下降明显(P0.05)。结论动态观察COPD肺功能情况,在肺功能下降的基础上,发现弥散功能下降明显,应考虑并发肺癌可能。     

糖尿病肺损害

大量研究表明，肺脏是糖尿病攻击的“靶器官”之一，其损害主要涉及肺功能及病理学改变。糖尿病患者肺功能损害主要表现为限制性通气功能障碍、小气道功能减退和弥散功能异常。而糖尿病肺组织病理学改变主要表现为基底膜增厚和细胞外基质增生以及超微结构的改变。积极控制血糖水平及胰岛素和噻唑烷二酮类药物治疗可能改善糖尿病患者的肺功能。深入研究糖尿病肺部病变，有可能在防治糖尿病血管并发症方面提出新的思路。     

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.     

Diffusing capacity for nitric oxide and carbon monoxide in patients with diffuse parenchymal lung disease and pulmonary arterial hypertension

BACKGROUND: The passage of carbon monoxide (CO) through the alveolocapillary membrane and into the plasma and intraerythrocytic compartments determines the diffusing capacity of the lung for CO (DLCO) as defined by the Roughton and Forster equation. On the other hand, the single-breath diffusing capacity of the lung for nitric oxide (DLNO) is thought to represent the true membrane diffusing capacity because of its very high affinity for hemoglobin (Hb) and its independence from pulmonary capillary blood volume. Therefore, the DLNO/DLCO ratio can be used to differentiate between thickened alveolocapillary membranes (both DLNO and DLCO are decreased, and the DLNO/DLCO ratio is normal) and decreased perfusion of ventilated alveoli (the DLNO less decreased than the DLCO; therefore, the DLNO/DLCO ratio is high) in patients with pulmonary disease. STUDY DESIGN: We measured the combined values of DLCO and DLNO in 41 patients with diffuse parenchymal lung disease (DPLD), 26 patients with pulmonary arterial hypertension (PAH), and 71 healthy subjects. RESULTS: The DLCO (corrected to the standard Hb value) was lowered in the DPLD group (64% of predicted) and in the PAH group (64% of predicted), and was normal in the control group (105% of predicted). The DLNO/DLCO ratio in patients with PAH (4.98) was significantly higher than that in patients with DPLD (4.56) and in healthy subjects (4.36). CONCLUSION: The DLNO/DLCO ratio is significantly higher in patients with PAH than in healthy subjects, although this ratio cannot be applied as a screening test to discriminate between patients with DPLD and PAH as the overlap between these groups is too large.     

类风湿性关节炎的肺胸膜表现56例临床分析

目的了解并分析类风湿性关节炎（rheumatoid arthritis，an）对呼吸系统的影响。方法选择符合诊断标准的RA患者110例。对有肺部表现的56例根据其一般临床表现，呼吸系统症状和体征、胸部X线检查和肺功能检查进行分析。结果110例中56例有明显肺部表现，占50．9％。呼吸系统症状和体征主要为干咳、胸痛、呼吸困难、水泡音。可发生肺间质纤维化。肺功能损害为限制性通气障碍、弥散功能障碍和小气道通气障碍。胸部X线检查表现为肺间质纤维化、胸腔积液、胸膜肥厚、肺结节、肺纹理增多和肺部渗出性病变。结论RA对呼吸系统的影响较常见。应引起重视。     

Lung function in survivors of childhood acute lymphoblastic leukemia

STUDY OBJECTIVES: To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. DESIGN: Cross-sectional study conducted at least 3 years after cessation of therapy. SETTING: Outpatient pneumology department of the University Hospital. PATIENTS: Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). MEASUREMENTS: A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. RESULTS: No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). CONCLUSIONS: Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.     

Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume

The volume dependence of single breath carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) was determined in 24 healthy subjects. The change in DLCO [fraction of DLCO measured at total lung capacity (TLC)] to change in alveolar volume [fraction of alveolar volume (VA) at TLC] closely fitted a simple linear regression and matched a theoretical model. As VA decreased, DLCO fell linearly and KCO increased as expected from the relation of DLCO to VA. The equations for adjustment of predicted DLCO and KCO for alveolar volume are: DLCO/DL COtlc = 0.58 + 0.42 VA/VAtlc, KCO/KCOtlc = 0.42 + 0.58/(VA/VAtlc). DLCO and KCO were evaluated in 2313 patients. Subgroups of patients with asthma, emphysema, extrapulmonary lung disease, interstitial lung disease and lung resection were identified. Unadjusted DLCO and KCO percent predicted values showed large differences and much variability, so can be misleading. As expected, KCO and DLCO percent predicted values adjusted for alveolar volume were nearly identical. Subgroups have characteristic patterns of VA and unadjusted and adjusted DLCO and KCO. Changes in DLCO and KCO with alveolar volume are relevant for accurate interpretation of diffusion in patients with low lung volumes. Adjusting predicted DLCO and KCO for alveolar volume provides a better assessment of lung function.     

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.     

Predictors of oxygen desaturation during submaximal exercise in 8,000 patients.

STUDY OBJECTIVES: To determine predictors of oxygen desaturation during submaximal exercise in patients with various lung diseases. Design and setting: This retrospective case series used pulmonary function laboratory results from all patients referred to a major tertiary-care center. Patients and measurements: All patients > or = 35 years old who underwent spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), lung volumes, and pulse oximetry during 3-min submaximal step-test exercise during 1996 were included (4,545 men and 3,472 women). Logistic regression models, correcting for gender, age, and weight, determined the odds ratios (ORs) for oxygen desaturation of > or = 4% during exercise for each category of lung function abnormality (compared to those with entirely normal lung function). RESULTS: Approximately 74% of the patients had airways obstruction, while only 5.6% had restriction of lung volumes. One third of those with obstruction had a low DLCO, compared to 56% with restriction, while 2.7% had a low DLCO without obstruction or restriction. The risk of oxygen desaturation during submaximal exercise was very high (OR, 34) in patients with restriction and low DLCO (as in interstitial lung disease) and in patients with obstruction and low DLCO (as in COPD; OR, 18), intermediate (OR, 9) in patients with only a low DLCO, and lowest in those with a normal DLCO (OR, 4 if restricted; OR, 2 if obstructed). A cut point of DLCO < 62% predicted resulted in 75% sensitivity and specificity for exercise desaturation. No untoward cardiac events occurred in any patients during or following the submaximal exercise tests. CONCLUSIONS: The risk of oxygen desaturation during submaximal exercise is very high in patients with a low DLCO. Submaximal exercise tests are safe, even in elderly patients with heart and lung diseases.     

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.     

Small airways function in nonsmokers with rheumatoid arthritis

To evaluate the possible relationship between rheumatoid arthritis (RA) and airways dysfunction independent of cigarette smoking, we studied 19 lifetime nonsmokers with RA and 47 healthy nonsmokers. Ten tests of small airways function were administered to the subjects. In addition, diffusing capacity and static lung compliance were measured, and upstream airway conductance at mid-to-low lung volumes was calculated. Mean values were not significantly lower in the RA group than in the control group in any of the tests of small airways function. Three of the 19 (16%) patients with RA versus 15 of the 47 (32%) control subjects had abnormal findings on greater than 2 tests of small airways function (P greater than 0.1). Although mean diffusing capacity and static lung compliance were both within normal limits in each group, the former tended to be lower, while the latter was significantly lower, in the RA subjects. We conclude that airways dysfunction in RA, if present, is probably related to factors other than the underlying disease; if an association between RA and small airways abnormality is present in some patients, its prevalence is too small to have been detected in our sample.