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目的在重度COPD的患者中,吸烟与否对其运动心肺功能、运动耐力是否造成差异,国内外仍缺乏相关研究报道。本研究通过比较吸烟组、戒烟组及未吸烟组稳定期重度COPD患者的相关肺功能指标及心肺运动试验结果,探讨吸烟对COPD患者运动心肺功能的影响。方法将121例处于稳定期的重度COPD男性患者分为3组:吸烟组(n=47,组1),戒烟组(戒烟时间≥6月,n=46,组2)及未吸烟组(n=28,组3),并分别进行常规肺功能检测(PFT)及心肺运动试验(CPET),测定相关肺通气功能参数、心肺运动功能参数,并将三组间数据进行方差分析。结果 (1)3组的PFT测定结果显示,FEV1、FEV1%pred、FEV1/FVC、TLC、DLCO三组间比较无统计学差异(P>0.05),而组1的IC值[(1.43±0.5)L]显著低于组2[(1.51±0.6)L]与组3[(1.64±0.6)L](P<0.05),组1的RV、RV/TLC[(4.43±1.5)L,57.2±9.8%]显著低于组2[(4.1±1.3)L,54.3±7.6%]与组3[(3.4±1.2)L,51.5±7.9%](P<0.05)。(2)CPET测定结果显示,三组间peak Load无统计学差异(P>0.05),组1的VO2/Kg、peak VE、dO2/dW1、Peak O2 pulse、VD/VT[(15.4±4.6)mL/min/kg,(33.1±7.6)L/min,(8.1±0.8)mL/min/watt,(8.0±2.4)mL/beat,(39.4±7.0)%]与组2[(17.2±4.8)mL/min/kg,(34.3±79.1)L/min,(8.7±0.7)mL/min/watt,(9.8±2.7)mL/beat,(35.1±6.7)%]、组3[(18.7±4.0)mL/min/kg,(38.6±7.7)L/min,(9.1±1.5)mL/min/watt,(10.8±2.7)mL/beat,(32.4±6.1)%]比较,有统计学差异(P<0.05);组1的peak VO2、peak VO2%pred、LowestVE/VCO2[(876.6±384.3)mL/min,(54.3±15.6)%,(32.5±3.2)]与组2[(1086.9±305.1)mL/min,(63.4±18.4)%,(30.3±3.4)]、组3[(1299.5±284.8)mL/min,(71.1±17.6)%,(28.8±2.9)]间比较具有显著统计学差异(P<0.01)。(3)吸烟指数与IC、TLC、peakVO2、Peak VO2/Kg、peak VE呈负相关(P<0.01);与peakVO2、peak VE、LowestVE/VCO2、VD/VT呈正相关(P<0.01)。结论吸烟能明显影响COPD患者运动心肺功能,降低运动耐量,且其影响程度与吸烟量的多少相关。戒烟对于COPD患者仍有较大意义。
Objectives In patients with severe COPD, smoking or not on their exercise cardiopulmonary function, exercise tolerance caused by differences, the lack of relevant research reports at home and abroad. This study compared the smoking group, smoking cessation group and non-smoking group stable COPD patients with COPD related to lung function and cardiopulmonary exercise test results to explore the smoking on COPD patients with exercise cardiopulmonary function. Methods 121 patients with severe COPD were divided into three groups: smoking group (n = 47, group 1), smoking cessation group (smoking cessation time ≥ 6 months, n = 46, group 2) and non-smoking group = 28 and group 3), and routine pulmonary function tests (PFT) and cardiopulmonary exercise tests (CPET) were performed respectively. Relevant pulmonary ventilatory function parameters and cardiopulmonary motor function parameters were measured. ANOVA was performed among the three groups. Results (1) The results of PFT in 3 groups showed that there was no significant difference between FEV1, FEV1% pred, FEV1 / FVC, TLC and DLCO group (P> 0.05) ) L] was significantly lower in group 1 than in group 2 [(1.51 ± 0.6) L] vs group 3 [(1.64 ± 0.6) L] (P < ± 9.8%] was significantly lower than those in group 2 [(4.1 ± 1.3) L, 54.3 ± 7.6%] and group 3 [(3.4 ± 1.2) L, 51.5 ± 7.9%] (P <0.05). (2) The peak load of VO2 / Kg, peak VE, dO2 / dW1, Peak O2 pulse and VD / VT [(15.4 ± 4.6) (8.1 ± 0.8) mL / min / watt, (8.0 ± 2.4) mL / beat, (39.4 ± 7.0)%] and group 2 [(17.2 ± 4.8) mL / (18.7 ± 0.7) mL / min, (34.3 ± 79.1) L / min, (8.7 ± 0.7) mL / min / There were significant differences between the two groups (P <0.05), 4.0 mL / min / kg, 38.6 ± 7.7 L / min, 9.1 ± 1.5 mL / min / watt, 10.8 ± 2.7 mL / beat, (P <0.05). Peak VO2, peak VO2% pred, LowestVE / VCO2 [(876.6 ± 384.3) mL / min, (63.1 ± 18.4)% and (30.3 ± 3.4)] in group 3 [(1299.5 ± 284.8) mL / min, (71.1 ± 17.6)% and (28.8 ± 2.9) Learning difference (P <0.01). (3) The smoking index was negatively correlated with ICV, TLC, peakVO2, Peak VO2 / Kg and peak VE (P <0.01), but positively correlated with peakVO2, peak VE, LowestVE / VCO2 and VD / VT. Conclusion Smoking can significantly affect cardiopulmonary function and reduce exercise tolerance in patients with COPD, and the degree of influence is related to the amount of smoking. Smoking cessation is still significant for patients with COPD.