活动性肺结核患者化疗疗程中不同时期肺功能监测结果分析

doi:10.3969/j.issn.2096-8493.2020.01.009

摘要/Abstract

摘要：

目的观察活动性肺结核患者治疗前及化疗疗程中不同时期的肺功能变化情况。方法以2018年1月至2019年8月湖南省胸科医院连续住院的活动性肺结核患者628例为监测对象,根据纳入标准和排除标准,最终249例患者纳入研究。观察患者治疗前、治疗1个月末、强化期末、疗程末的肺功能情况,比较4个时期肺功能总体状态评估、肺通气功能、弥散功能、肺容积测定、呼吸阻抗的结果,以及4个时期阻塞性、限制性、混合性通气功能障碍患者情况。结果 249例活动性肺结核患者治疗前肺功能总体状态评估、肺通气功能、弥散功能、肺容积、呼吸阻抗检测结果异常率分别为91.97%(229/249)、67.07%(167/249)、48.19%(120/249)、71.89%(179/249)和34.14%(85/249);随着疗程的进展,到疗程末分别下降至77.11%(192/249)、51.81%(129/249)、30.12%(75/249)、44.18%(110/249)、23.69%(59/249),差异有统计学意义( $χ 趋势 2$ 值分别为25.434、25.255、37.227、60.238、27.153,P值均为0.000)。随着疗程的进展,限制性、混合性通气功能障碍患者分别由治疗前的27.31%(68/249)、12.85%(32/249),减少至疗程末的11.65%(29/249)、6.83%(17/249),差异有统计学意义( $χ 趋势 2$ 值分别为39.222、16.068,P值分别为0.000、0.001);但阻塞性通气功能障碍患者治疗前占26.91%(67/249),疗程末增加至33.33%(83/249),但差异无统计学意义( $χ 趋势 2$ =1.233,P=0.745)。结论肺结核患者常伴肺功能损伤,随着疗程的进展,肺功能损伤有不同程度的好转,但在疗程末肺功能的异常率仍然较高;其中肺通气功能的限制性、混合性通气功能障碍至疗程末明显好转,而阻塞性通气功能障碍持续存在。

关键词: 结核,肺, 药物疗法, 治疗过程片断, 肺功能检测, 功能恢复, 结果与过程评价(卫生保健)

Abstract:

Objective To observe changes of pulmonary function of patients with active tuberculosis as the treatment progresses. Methods Data were collected on 628 patients with active tuberculosis admitted to Hunan Chest Hospital from January 2018 to August 2019. 249 patients were included in the analysis according to inclusion and exclusion criteria. Pulmonary functions of patients were measured before treatment,at the end of the first month, at the end of intensive period and at the end of treatment. Overall lung function, pulmonary ventilation function, diffusing capacity, lung volume, and airway resistance at those four time points were compared. Results The abnormal rate of overall lung function assessment,pulmonary ventilation function, diffusion function, lung volume, respiratory impedance results before treatment were 91.97% (229/249), 67.07% (167/249), 48.19% (120/249), 71.89% (179/249) and 34.14% (85/249) respectively. As the treatment went on, the abnormal rate dropped to 77.11% (192/249), 51.81% (129/249), 30.12%(75/249), 44.18% (110/249), 23.69% (59/249) at the end of the treatment. Differences were statistically significant (χ²=25.434, 25.255, 37.227, 60.238, 27.153, all P=0.000). Patients with restrictive and mixed ventilation dysfunction decreased from 27.31% (68/249) and 12.85% (32/249) before treatment to 11.65% (29/249) and 6.83% (17/249) at the end of treatment, differences were statistically significant ( $χ trend 2$ =39.222, 16.068; P=0.000, 0.001). Patients with obstructive ventilation dysfunction before treatment were 26.91% (67/249), at the end of treatment it increased to 33.33% (83/249), the difference was not statistically significant ( $χ trend 2$ =1.233, P=0.745). Conclusion Pulmonary tuberculosis patients often suffers with lung function damage. With the progress of treatment, lung function damage has been repaired to varying degrees, but the abnormal rate of lung function is still high at the end of the treatment course. The restrictive and mixed pulmonary ventilation dysfunction were improved significantly at the end of treatment, while obstructive ventilation dysfunction persisted.

Key words: Tuberculosis, pulmonary, Drug therapy, Episode of care, Pulmonary function tests, Recovery of function, Outcome and process assessment (health care)

王春婷, 李雅琪, 米艳, 莫念春, 刘红燕, 乐星, 周丽, 吴碧峰, 韩诗云, 白丽琼, 张传芳. 活动性肺结核患者化疗疗程中不同时期肺功能监测结果分析[J]. 结核与肺部疾病杂志, 2020, 1(1): 39-44. doi: 10.3969/j.issn.2096-8493.2020.01.009

WANG Chun-ting, LI Ya-qi, MI Yan, MO Nian-chun, LIU Hong-yan, LE Xing, ZHOU Li, WU Bi-feng, HAN Shi-yun, BAI Li-qiong, ZHANG Chuan-fang. Monitoring of pulmonary function in patients with active tuberculosis during anti-tuberculosis treatment[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(1): 39-44. doi: 10.3969/j.issn.2096-8493.2020.01.009

图/表 3

表1

249例患者不同化疗疗程时期肺功能总体状态评估、肺通气功能、弥散功能、肺容积、呼吸总阻抗异常率比较

疗程	总体状态评估异常
疗程	例数	异常率(%)	例数	异常率(%)	例数	异常率(%)	例数	异常率(%)	例数	异常率(%)
治疗前	229	91.97	167	67.07	120	48.19	179	71.89	85	34.14
1个月末	216	86.75	154	61.85	107	42.97	154	61.85	83	33.33
强化期末	208	83.53	146	58.63	103	41.37	130	52.21	59	23.69
疗程末	192	77.11	129	51.81	75	30.12	110	44.18	59	23.69
$χ 趋势 2$ 值		25.434		25.255		37.227		60.238		27.153
P值		0.000		0.000		0.000		0.000		0.000

表1

表2

249例患者不同化疗疗程时期肺功能检测指标的比较

疗程	FVC (%, $x ˉ$ ±s)	FEV₁ [%, M(Q₁, Q₃)]	FEV₁/FVC [%, M(Q₁, Q₃)]	TLC (%, $x ˉ$ ±s)	RV [%, M(Q₁, Q₃)]	RV/TLC [%, M(Q₁, Q₃)]	D_LCO (%, $x ˉ$ ±s)	Z₅ [%, M(Q₁, Q₃)]	R₅ [%, M(Q₁, Q₃)]	R₂₀ [%, M(Q₁, Q₃)]
治疗前	83.29± 19.19	79.08 (64.85, 92.00)	94.95 (86.51, 102.66)	81.17± 15.26	95.50 (80.10, 115.35)	119.18 (101.49, 137.65)	80.28± 17.21	126.00 (109.50, 149.50)	118.00 (102.50, 141.00)	129.00 (111.50, 149.50)
1个月末	86.67± 17.84^a	84.00 (70.50, 94.00)^b	95.50 (87.10, 103.26)	83.91± 14.81^a	95.20 (82.03, 110.30)	114.11 (100.62, 130.40)	83.05± 17.01^a	118.00 (103.00, 145.00)^b	112.00 (95.00, 135.50)^b	126.00 (106.00, 142.50)^b
强化期末	89.15± 17.01^c,d	86.00 (75.00, 95.00)^e,f	95.55 (87.81, 102.98)	85.65± 12.93^c,d	95.40 (83.15, 112.45)	112.20 (98.68, 126.41)	84.83± 16.35^c,d	117.00 (103.00, 140.00)^e	108.00 (95.00, 132.50)^e	123.00 (106.50, 141.00)^e
疗程末	92.69± 16.41^g,h,i	89.00 (78.65, 98.89)^j,k,l	95.49 (87.13, 102.37)	88.83± 12.98^g,h,i	94.40 (81.60, 108.96)^k,l	106.56 (94.71, 122.22)^j,k,l	89.44± 16.97^g,h,i	114.00 (97.00, 135.00)^j,k,l	105.00 (87.00, 126.50)^j,k,l	116.00 (97.00, 136.50)^j,k,l
统计量	117.122^m	282.263ⁿ	1.100ⁿ	66.400^m	12.372ⁿ	96.118ⁿ	70.413^m	120.459ⁿ	106.438ⁿ	101.474ⁿ
P值	0.000	0.000	0.777	0.000	0.006	0.000	0.000	0.000	0.000	0.000

表2

表3

249例患者不同疗程肺通气功能异常率比较

疗程	阻塞性通气功能障碍		限制性通气功能障碍		混合性通气功能障碍
疗程	例数	异常率(%)	例数	异常率(%)	例数	异常率(%)
治疗前	67	26.91	68	27.31	32	12.85
1个月末	69	27.71	56	22.49	29	11.65
强化期末	76	30.52	52	20.88	18	7.23
疗程末	83	33.33	29	11.65	17	6.83
$χ 趋势 2$ 值		1.233		39.222		16.068
P值		0.745		0.000		0.001

表3

参考文献 18

[1]	MacNeil A, Glaziou P, Sismanidis C, et al. Global epidemiology of tuberculosis and progress toward achieving global targets—2017. MMWR Morb Mortal Wkly Rep, 2019,68(11):263-266. doi: 10.15585/mmwr.mm6811a3. doi: 10.15585/mmwr.mm6811a3 URL pmid: 30897077
[2]	Gupte AN, Paradkar M, Selvaraju S, et al. Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PLoS One, 2019,14(5):e0217289. doi: 10.1371/journal.pone.0217289. doi: 10.1371/journal.pone.0217289 URL pmid: 31120971
[3]	Vashakidze SA, Kempker JA, Jakobia , et al. Pulmonary function and respiratory health after successful treatment of drug-resistant tuberculosis. Int J Infect Dis, 2019,82:66-72. doi: 10.1016/j.ijid.2019.02.039. doi: 10.1016/j.ijid.2019.02.039 URL pmid: 30844519
[4]	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第一部分)——概述及一般要求. 中华结核和呼吸杂志, 2014,37(6):402-405. doi: 10.3760/cma.j.issn.1001-0939.2014.06.002.
[5]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 2017-11-09.
[6]	中华医学会,中华医学会杂志社,中华医学会全科医学分会, 等. 肺结核基层诊疗指南(2018年). 中华全科医师杂志, 2019,18(8):709-717. doi: 10.3760/cma.j.issn.1671-7368.2019.08.002.
[7]	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第二部分)——肺量计检查. 中华结核和呼吸杂志, 2014,37(7):481-486. doi: 10.3760/cma.j.issn.1001-0939.2014.07.001.
[8]	郑劲平. 肺功能学:基础与临床. 广州: 广东科学技术出版社, 2007:61.
[9]	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南——肺弥散功能检查. 中华结核和呼吸杂志, 2015,38(3):164-169. doi: 10.3760/cma.j.issn.1001-0939.2015.03.003.
[10]	朱蕾. 临床肺功能.2版. 北京: 人民卫生出版社, 2014:420.
[11]	Daniels KJ, Irusen E, Pharaoh H, et al. Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley District, South Africa. S Afr J Physiother, 2019,75(1):1319. doi: 10.4102/sajp.v75i1.1319. URL pmid: 31392293
[12]	Fiogbe AA, Agodokpessi G, Tessier JF, et al. Prevalence of lung function impairment in cured pulmonary tuberculosis patients in Cotonou, Benin. Int J Tuberc Lung Dis, 2019,23(2):195-202. doi: 10.5588/ijtld.18.0234. doi: 10.5588/ijtld.18.0234 URL pmid: 30808452
[13]	Chakaya J, Kirenga B, Getahun H. Long term complications after completion of pulmonary tuberculosis treatment: a quest for a Public Health Approach. J Clin Tuberc Other Mycobact Dis, 2016,3:10-12. doi: 10.1016/j.jctube.2016.03.001.
[14]	Amaral AF, Coton S, Kato B, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J, 2015,46(4):1104-1112. doi: 10.1183/13993003.02325-2014. doi: 10.1183/13993003.02325-2014 URL pmid: 26113680
[15]	Mohamed M, Shayo G, Mamuya S, et al. Lung functions among patients with pulmonary tuberculosis in Dar es Salaam-a cross-sectional study. BMC Pulm Med, 2016,16(1):58. doi: 10.1186/s12890-016-0213-5. URL pmid: 27107713
[16]	Marcela MT, Adrian R, Rosella C, et al. Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis. J Bras Pneumol, 2016,42(5):374-385. doi: 10.1590/S1806-37562016000000226.
[17]	de la Mora IL, Martínez Oceguera D, Laniado Laborín R. Chronic airway obstruction after successful treatment of tuberculosis and its impact on quality of life. Int J Tuberc Lung Dis, 2015,19(7):808-810. doi: 10.5588/ijtld.14.0983.
[18]	Jung JW, Choi JC, Shin JW, et al. Pulmonary impairment in tuberculosis survivors: the Korean National Health and Nutrition Examination Survey 2008-2012. PLoS One, 2015,10(10):e0141230. doi: 10.1371/journal.pone.0141230.