吴玲芳　尉理梁　李永兴　陶学芳

[摘要] 目的 探討慢性阻塞性肺疾病急性发作患者呼出气冷凝液炎症因子检测对患者预后的指导价值。 方法 选择2018年7月至2019年10月本院收治的慢性阻塞性肺疾病急性发作患者40例，搜集所有患者的冷凝液，比较治疗前后机体氧代谢指标及肺功能指标，统计治疗前后炎症相关因子水平，及治疗前、治疗后3 d、7 d炎症因子变化趋势，并分析超敏-C反应蛋白（hs-CRP）水平与氧摄取率及第1秒用力肺活量（FEV1）的相关性。 结果 治疗后机体氧摄取率高于治疗前（P<0.05），动脉血氧含量高于治疗前（P<0.05），治疗后FEV1高于治疗前（P<0.05），1 s用力呼气容积/用力肺活量（FEV1/FVC）水平大于治疗前（P<0.05），治疗后hs-CRP及白细胞介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）水平均显著低于治疗前（P<0.05），随着时间的推移，患者炎症因子hs-CRP水平、IL-1水平及TNF-α水平均呈下降趋势（P<0.05），hs-CRP水平与氧摄取率及FEV1值呈负相关。 结论 慢性阻塞性肺疾病急性发作者行呼出气冷凝液检测，可通过冷凝液中炎症因子水平变化对患者预后进行预测。

[关键词] 慢性阻塞性肺疾病;急性发作;呼出气冷凝液;炎症因子;预后评估

[中图分类号] R563.1          [文献标识码] B          [文章编号] 1673-9701（2021）06-0053-04

Value of the detection of inflammatory factors in exhaled breath condensate of the patients with acute attacks of chronic obstructive pulmonary disease for the prognostic assessment

WU Lingfang1   WEI Liliang2   LI Yongxing1   TAO Xuefang1

1.Department of Respiratory Medicine， Affiliated Hospital of Shaoxing University， Shaoxing   312000， China; 2.Department of Traditional Chinese Medicine， Affiliated Hospital of Shaoxing University， Shaoxing   312000， China

[Abstract] Objective To explore the guiding value of the detection of inflammatory factors in exhaled breath condensate（EBC） of the patients with acute attacks of chronic obstructive pulmonary disease （COPD） for the prognosis of the patients. Methods A total of 40 patients with acute attacks of COPD admitted to and treated in our hospital from July 2018 to October 2019 were selected. EBC of each of the selected patients was collected; the indexes of oxygen metabolism of the whole body and pulmonary function parameters before and after treatment were compared; the levels of inflammation-related factors before and after treatment and the changing trend of inflammatory factors before，3 d and 7 d after treatment were counted; the correlation between the level of high sensitivity C-reactive protein（hs-CRP） and the extraction rate of oxygen （ERO2） and that between the level of hs-CRP and the forced expiratory volume in the first second（FEV1） were analyzed. Results After treatment， the ERO2 of the whole body was higher than that before treatment（P<0.05）， and the oxygen content of arterial blood（CaO2） was higher than that before treatment （P<0.05）. After treatment，the FEV1 level was higher than that before treatment（P<0.05）， and the level of the forced expiratory volume in the first second/forced vital capacity （FEV1/FVC） was higher than that before treatment（P<0.05）. After treatment，the levels of hs-CRP，interleukin-1（IL-1）， tumor necrosis factor-α （TNF-α） were all significantly lower than those before treatment（P<0.05）. With time， the levels of hs-CRP， IL-1 and TNF-α of inflammatory factors in the patients showed a downward trend（P<0.05）. The level of hs-CRP was negatively correlated with ERO2 and the FEV1 value. Conclusion The detection of the changes in the levels of inflammatory factors in the EBC of the patients with acute attacks of COPD can help to predict the prognosis of the patients.

[Key words] Chronic obstructive pulmonary disease; Acute attacks; Exhaled breath condensate; Inflammatory factors; Prognostic assessment

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）在我国为呼吸内科最常見的疾病之一，其病理生理改变主要为肺部通气功能障碍，该病病程长，反复发展，治疗效果不理想，且随着年龄增长及病程的延长而严重程度加重[1]。晚期患者多出现呼吸衰竭而危及生命。目前临床针对稳定期COPD者以预防为主，结合提高患者免疫能力及抵抗力进而减少本病急性发作[2]。故如何有效延缓疾病发展，降低患者病死率及致残率，提高患者生活质量是治疗重点[3]。

Hogman等[4]研究认为慢性阻塞性肺疾病急性发作（Acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者机体炎症相关因子水平显著升高，尤其在呼出气冷凝液中其水平显著升高。目前针对呼出气冷凝液水平的检查为无创安全可重复的一种检测技术，已经广泛应用于临床[5]。但目前极少有文献针对冷凝液水中炎症因子变化与AECOPD治疗效果评估的相关性研究。……