常规肺功能与脉冲振荡肺功能测定在间质性肺疾病病人中的应用

目的探讨常规肺功能与脉冲振荡(IOS)肺功能检测在间质性肺疾病病人中的应用价值。方法单纯肺间质纤维化病人38例,慢性阻塞性肺疾病(COPD)合并肺间质纤维化病人18例和健康人35例分别测定常规肺功能,包括肺活量(VC)、1秒量(FEV1.0)、1秒率(FEV1。0/FVC%);呼气峰流速(PEF)、50%用力呼气流速(FEF50);25%用力呼气流速(FEF25)和一氧化碳弥散量(DLCO)。IOS肺功能测定指标包括脉冲频率5Hz、20Hz下的气道黏性阻力(R5、R20)、呼吸总阻抗(ZrS)、中央气道阻力(Rc)、周围气道阻力(Rp)、脉冲频率5Hz时的弹性阻力及惯性阻力(X5)、共振频率(Fres)。结果单纯肺间质纤维化病人常规肺功能与健康人比较有十分显著性差异(P<0.01),FEV1.0/FVC%与健康人比较无显著性差异(P>0.05);IOS肺功能与健康人比较无显著性差异(P>0.05)。COPD合并肺间质纤维化病人常规肺功能与健康人比较有十分显著性差异(P<0.01);IOS肺功能与健康人比较有显著性差异(P<0.01或P<0.05)。结果显示常规肺功能检查,单纯肺间质纤维化病人存在限制性肺通气功能障碍、小气道功能障碍、肺换气功能障碍;COPD合并肺间质纤维化病人存在混合性通气功能障碍、小气道功能障碍、肺换气功能障碍。IOS肺功能检查提示单纯肺纤维化病人各值均在正常范围;COPD合并肺纤维化患者IOS各值均有所升高。结论常规肺功能检查对于单纯肺间质纤维化及COPD合并肺间质纤维化的诊断、病情评估,仍不失为一项重要敏感指标;IOS肺功能检查在COPD合并肺间质纤维化病人中有一定的临床意义,可以间接反映气道黏性阻力、弹性阻力、中央气道阻力、周围气道阻力、呼吸总阻抗的增高程度,而对单纯肺间质纤维化病人不敏感。

Application of Routine and Impulse Oscillometry Pulmonary Function Tests in Patients with Interstitial Lung Diseases

Objective To assess the role of different methods-routine and impulse oscillometry (IOS) pulmonary functional tests in normal subjects and patients with interstitial lung diseases. Methods Routine and impulse oscillometry pulmonary function tests,including VC%,FVC% FEV1.0,FEV1.0/FVC%,PEF,FEF50,FEF25 and diffusing capacity of CO(DLCO%),were conducted in 35 normal subjects,38 patients with pulmonary fibrosis(Group 1) and 18 patients suffering from chronic obstructive pulmonary disease(COPD) and pulmonary fibrosis(Group 2). Impulse oscillometry(ISO) pulmonary functional test measured airway resistance at 5 Hz and 20 Hz impulse frequency(R5,R20),respiratory impedance(ZrS),central airway resistance(Rc),peripheral airway resistance(Rp),capacitance and inertance at 5Hz frequency(X5),and resonant frequency(Fres). Results Compared with normal subjects,patients of the two groups showed significant difference(P < 0.01 ) in routine pulmonary function except for FEV1.0/FVC% . For ISO pulmonary functional test,no difference was observed between the normal subjects and patients of Group 1(P > 0.05),while Group 2 showed higher values when compared with the normal subjects (P < 0.01). The results showed that patients with interstitial lung diseases had restrictive ventilation disorder,small airway disorder and gas-exchange disorder while patients with COPD and interstitial lung disease had mixed ventilation functional disorder,small airway disorder and gas-exchange disorder. Conclusion Routine pulmonary function test is a sensitive method to diagnose and assess patients with interstitial lung disease,while IOS is only useful for patients with COPD and pulmonary fibrosis by reflecting different airway resistances.