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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (01) : 78 -82. doi: 10.3877/cma.j.issn.1674-6902.2024.01.015

论著

慢性阻塞性肺疾病与获得性免疫缺陷综合征共病的临床特征分析
周恩竹1, 刘敏1, 万秋1, 刘静文1, 唐莉歆1,†()   
  1. 1. 400030　重庆，西南大学附属重庆市公共卫生医疗救治中心呼吸老年科
  • 收稿日期:2023-12-28 出版日期:2024-02-25
  • 通信作者: 唐莉歆
  • 基金资助:
    重庆市科卫联合面上项目(2022MSXM033)

Clinical characteristics of acquired immunodeficiency syndrome complicated with chronic obstructive pulmonary disease

Enzhu Zhou1, min Liu1, Qiu Wan1, Jingwen Liu1, Lixin Tang1,†()   

  1. 1. Department of Respiratory Medicine and Geriatrics, Southwest University Affiliated Chongqing Public Health Medical Center, Chongqing 400030, China
  • Received:2023-12-28 Published:2024-02-25
  • Corresponding author: Lixin Tang
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引用本文：

周恩竹, 刘敏, 万秋, 刘静文, 唐莉歆. 慢性阻塞性肺疾病与获得性免疫缺陷综合征共病的临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 78-82.

Enzhu Zhou, min Liu, Qiu Wan, Jingwen Liu, Lixin Tang. Clinical characteristics of acquired immunodeficiency syndrome complicated with chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 78-82.

目的

分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)与获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)共病的临床特征。

方法

选择2021年6月至2022年10月我院收治的COPD患者98例，COPD伴有AIDS共病35例为观察组，COPD 63例为对照组，分析两组临床特征。

结果

两组性别，吸烟史，体质量，合并高血压、糖尿病、冠心病，CO2分压，心脏超声右心房及右心室大小、肺动脉压，胸部CT提示支气管扩张及肺部感染差异无统计学意义(P>0.05)。观察组较对照组平均年龄小[(58.72±16.86)岁vs. (68.92±7.87)岁](P<0.05)、CD4＋ T细胞计数低[(137.55±88.32)vs. (319.82±119.78)]，CD8＋ T细胞计数高[(408.79± 209.66)vs. (269.74±412.06)](P<0.05)、氧合指数低[(320.48±86.27)vs. ( 345.78±68.16)](P<0.05)，影像学肺气肿征象明显(77.14% vs. 15.87%)(P<0.05)。观察组肺功能Vcmax[(2.02±0.68)vs.(2.56±0.75)]、TLC[(68.99±17.29)vs. (97.10±22.57)]、RV%[(110.46±38.61)vs. (137.13±40.18)]、FVC[(1.92±0.67)vs. (2.58±0.83)]、FEV1[(1.05±0.49)vs. (1.32±0.57)]、FEV1%[(41.42±14.58)vs. (54.79±19.63)]、PEF%[(22.69±9.83)vs. (42.78±17.64)]、DLCO[(3.26±1.98)vs. (5.65±1.38)]、VA[(0.87±0.46)vs. (1.02±0.26)]低于对照组(P<0.05)，弥散功能中重度障碍88.57%高于对照组12.70%(P<0.05)；观察组FEV1/FVC[(62.65±3.67)vs. (50.23±11.97)]、MVV[(108.24±17.63) vs. (36.79±21.37)]、MMEF75/25% [(20.12±14.83)vs. (18.98±7.26)]高于对照组(P<0.05)。

结论

COPD伴有AIDS共病患者年轻，氧合指数低，外周血CD8＋ T细胞计数升高加速COPD进展；AIDS加重以弥散障碍及限制性通气障碍为主的肺功能损害，弥散障碍不完全可逆，抗反转录病毒治疗(antiretroviral therapy, ART)或治疗机会性感染改善通气功能障碍。早期规律ART、预防及治疗肺部机会性感染，可逆转COPD伴有AIDS共病肺功能持续损害。

关键词: 获得性免疫缺陷综合征, 肺疾病，慢性阻塞性, 临床特征, 肺功能
Objective

To analyze the clinical characteristics of acquired immunodeficiency syndrome(AIDS) complicated with chronic obstructive pulmonary disease (COPD).

Methods

The clinical data of 98 COPD patients who were admitted to Chongqing Public Health Medical Center during the period from June 2021 to October 2022 were reviewed retrospectively. According to pulmonary function tests, 35 COPD+ AIDS patients were divided into observation group, 63 COPD patients were divided into control group, and analyzed the differences of clinical characteristics between the two groups.

Results

Patient sex, smoking history, body weight, hypertension, diabetes, coronary heart disease, partial pressure of carbon dioxide in arterial blood, right atrium and right ventricle measurements, pulmonary artery pressure, bronchiectasis, lung infection did not show significant differences between the two groups (P>0.05). In observation group, patients had younger age[(58.72±16.86)vs. (68.92±7.87)](P<0.05), lower CD4+ T cell count[(137.55±88.32)vs. (319.82±119.78)]and higher CD8+ T cell count[(408.79± 209.66)vs. (269.74±412.06)](P<0.05), lower oxygenation index[(320.48±86.27)vs. (345.78±68.16)](P<0.05), more obviously emphysema(77.14% vs.15.87%)than patients in control group(P<0.05). In observation group, patients had significantly lower Vcmax[(2.02±0.68)vs.(2.56±0.75)], TLC[(68.99±17.29)vs. (97.10±22.57)], RV%[(110.46±38.61)vs. (137.13±40.18)], FVC[(1.92±0.67)vs. (2.58±0.83)], FEV1[(1.05±0.49)vs. (1.32±0.57)], FEV1%[(41.42±14.58)vs. (54.79±19.63)], PEF%[(22.69±9.83)vs. (42.78±17.64)], DLCO[(3.26±1.98)vs. (5.65±1.38)], VA[(0.87±0.46)vs. (1.02±0.26)]and worse dispersion function(88.57% vs. 12.70%) than control group (P<0.05). In observation group, had significantly higher FEV1/FVC[(62.65±3.67)vs. (50.23±11.97)], MVV[(108.24±17.63) vs. (36.79±21.37)], MMEF75/25%[(20.12±14.83)vs. (18.98±7.26)]than controlgroup(P<0.05).

Conclusions

AIDS+ COPD patients who are younger have lower oxygenation index, the increased CD8+ cell count accelerated the develop of COPD. AIDS lead to more severe lung function impairment especially in diffusion disorder and restrictive ventilation disorder. Diffusion disorder is not completely reversible while ventilation dysfunction might be improved by antiretroviral therapy(ART) or treatment of opportunistic infections. Considering of the treatment of AIDS complicated with COPD, early regular ART, prevention and treatment of various lung opportunistic infections are expected to reverse the sustained impairment of lung function in patients to a certain extent.

Key words: Acquired immunodeficiency syndrome, Chronic obstructive pulmonary disease, Clinical characteristics, Pulmonary function
表1 两组患者临床资料比较(±s)
临床资料 观察组(n＝35) 对照组(n＝63) χ2/t值/Z值 P值
基础疾病        
高血压 8(22.86) 17(26.98) 0.38 0.54
糖尿病 3(8.57) 8(12.70) 0.30 0.55
冠心病 6(17.14) 12(19.05) 0.08 0.88
CD4＋ T细胞数量(μl) 137.55±88.32 319.82±119.78 －6.85 0.00
CD8＋ T细胞数量(μl) 408.79±209.66 269.74±412.06 －2.96 0.00
动脉血气分析        
氧合指数(mmHg) 320.48±86.27 345.78±68.16 －2.35 0.04
二氧化碳分压(mmHg) 43.12±9.89 44.63±9.13 －0.79 0.51
超声心动图        
肺动脉压力(mmHg) 24.92±3.23 22.78±2.16 －1.98 0.06
右心房(mm) 31.87±3.23 32.54±1.98 －0.26 0.87
右心室(mm) 20.45±0.99 19.23±1.04 －1.29 0.18
胸部CT        
支气管扩张 5(14.29) 15.00(23.38) 1.12 0.36
感染 25.00(71.43) 60(95.24) 1.95 0.11
肺气肿 27.00(77.14) 10.00(15.87) 58.96 0.00
表2 两组患者肺功能指标比较(±s)
肺功能指标 观察组(n＝35) 对照组(n＝63) χ2/t值/Z值 P值
VCmax(L) 2.02±0.68 2.56±0.75 －4.13 0.00
TLC% 68.99±17.29 97.10±22.57 －7.12 0.00
RV% 110.46±38.61 137.13±40.18 －5.09 0.00
FVC(L) 1.92±0.67 2.58±0.83 －4.74 0.00
FEV1(L) 1.05±0.49 1.32±0.57 －3.75 0.00
FEV1% 41.42±14.58 54.79±19.63 －4.24 0.00
FEV1/FVC(%) 62.65±3.67 50.23±11.97 －4.19 0.00
MVV(L) 108.24±17.63 36.79±21.37 －9.32 0.00
MMEF75/25% 20.12±14.83 18.98±7.26 －2.14 0.00
PEF% 22.69±9.83 42.78±17.64 －5.92 0.00
DLCO(ml/mmHg/min) 3.26±1.98 5.65±1.38 －5.84 0.00
VA(L/min) 0.87±0.46 1.02±0.26 －2.78 0.00
弥散障碍[n(%)]     67.52 0.00
正常＋轻度 4(11.43) 54(85.71)    
中度＋重度 31(88.57) 8(12.70)    
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