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Chest :一种常见但未曾描述过的限制性模式——“复杂限制性”肺功能模式的临床和放射学分析

2017-07-23 MedSci MedSci原创

大多数有肺功能限制的患者均有肺功能模式(PFT),其中肺总量(TLC)、最大肺活量(FVC)和用力呼气量(FEV1)下降到相似的程度。研究人员将这种模式称为“简单”限制(SR)。与此相反,相对于TLCpp,通常可观察到FVC百分比预测(pp)不成比例地减少,研究人员将此模式称为“复杂限制”(CR),并试图描述其临床、放射学和生理特征。

大多数有肺功能限制的患者均有肺功能模式(PFT),其中肺总量(TLC)、最大肺活量(FVC)和用力呼气量(FEV1)下降到相似的程度。研究人员将这种模式称为“简单”限制(SR)。与此相反,相对于TLCpp,通常可观察到FVC百分比预测(pp)不成比例地减少,研究人员将此模式称为“复杂限制”(CR),并试图描述其临床、放射学和生理特征。

研究人员回顾了2009年11月至2013年6月间有肺功能限制的患者的PFTs(TLC < LLN)。研究人员将SR定义为 TLCpp-FVCpp≤10%,基于TLCpp-FVCpp差异将CR分成以下4类:
第一类 CR(TLCpp-FVCpp > 10%且≤15%)
第二类CR(TLCpp-FVCpp > 15%且≤20%)
第三类CR(TLCpp-FVCpp > 20%且≤25%)
第四类CR(TLCpp-FVCpp > 25%)
研究人员随机选择了150例SR患者,并且从每类CR患者中随机选择了50例患者,并回顾了他们的医疗记录。

研究人员发现:在39277个PFTs中,4532名患者(11.5%)有限制,其中,2407例(6.1%)患者为“简单”限制(SR),1614例(4.1%)患者为CR,511例(1.3%)患者为混合模式。“复杂限制”(CR)患者更年轻,且在女性中更多见,而且神经肌肉疾病、体重指数>40或<18.5 Kg/m2、膈肌功能障碍、支气管扩张、CT马赛克样影以及肺动脉高压的患病率较高(p=<0.0001,<0.0001,<0.001,0.004,0.0008,0.002,0.008,0.009,0.053和0.01),但间质性肺疾病的患病率较低(p<0.0001)。

由此可见,复杂限制是一种具有明显临床特征的常见的PFT模式,与肺排空受损相关,如神经肌肉疾病、隐匿性梗阻和胸壁限制。临床医生们应该意识到这种新型PFT模式,以及在鉴别诊断疾病时应考虑到这种情况。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2050787, encodeId=94b02050e870c, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Tue May 08 19:58:00 CST 2018, time=2018-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929388, encodeId=7ea219293889b, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Sat Aug 19 17:58:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385617, encodeId=c0df138561e04, content=<a href='/topic/show?id=b3d05e3382b' target=_blank style='color:#2F92EE;'>#放射学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57338, encryptionId=b3d05e3382b, topicName=放射学)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3bb506, createdName=kkunny, createdTime=Tue Jul 25 09:58:00 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-08-19 Smile2680
  3. [GetPortalCommentsPageByObjectIdResponse(id=2050787, encodeId=94b02050e870c, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Tue May 08 19:58:00 CST 2018, time=2018-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929388, encodeId=7ea219293889b, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Sat Aug 19 17:58:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385617, encodeId=c0df138561e04, content=<a href='/topic/show?id=b3d05e3382b' target=_blank style='color:#2F92EE;'>#放射学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57338, encryptionId=b3d05e3382b, topicName=放射学)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3bb506, createdName=kkunny, createdTime=Tue Jul 25 09:58:00 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-07-25 kkunny
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