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目的分析哮喘和慢性阻塞性肺病(COPD)患者主要临床特征与肾上腺皮质功能之间的关系。方法37例哮喘患者分为有夜间症状组(NA组)和无夜间症状组(NNA组),根据控制情况分为部分控制组和未控制组。33例COPD患者根据病情严重程度分轻~中度组与重~极重度组,对所有患者进行肺功能测定并分别测定上午8时与下午4时血浆皮质醇水平。结果上午8时皮质醇水平哮喘组较COPD组显著下降,NA组较NNA组显著下降,差异均有高度统计学意义(分别P<0.001和<0.01);未控制组与部分控制组、重~极重度组COPD患者与轻~中度组相比,差异均无统计学意义(均P>0.05)。下午4时皮质醇水平除NA组较NNA组明显下降,差异有统计学意义(P<0.05)外,其余哮喘组与COPD、未控制组与部分控制组、重~极重度组与轻~中度组的差异均无统计学意义(均P>0.05)。COPD患者上午8时平均皮质醇水平显著高于下午4时,差异有高度统计学意义(P<0.01),哮喘组患者上午8时与下午4时的平均皮质醇水平接近甚至倒置。结论哮喘患者较COPD患者可能存在更明显的肾上腺皮质功能障碍和昼夜节律的紊乱,哮喘夜间症状的发生可能与此有关。
Objective To analyze the relationship between the main clinical features of asthma and chronic obstructive pulmonary disease (COPD) and adrenocortical function. Methods 37 asthmatic patients were divided into nocturnal symptomatic group (NA group) and nocturnal symptomatic group (NNA group), which were divided into partial control group and uncontrolled group according to the control situation. Thirty-three patients with COPD were divided into mild-moderate group and severe-severe group according to the severity of the illness. Pulmonary function tests were performed on all patients and plasma cortisol levels were determined at 8:00 am and 4:00 pm, respectively. Results The level of cortisol in asthma group was significantly lower than that in COPD group at 8 AM, and significantly decreased in NA group compared with NNA group (P <0.001 and <0.01, respectively) Compared with mild to moderate severe COPD patients, the difference was not statistically significant (all P> 0.05). The level of cortisol in NA group was significantly lower than that in NNA group at 4:00 (P <0.05), and the levels of cortisol in COPD group, uncontrolled group, partial control group, heavy-severe group and mild-moderate group There was no significant difference between the two groups (all P> 0.05). The mean cortisol level in COPD patients at 8 AM was significantly higher than that at 4 PM (P <0.01). The average cortisol level in patients with asthma at 8 AM and 4 PM was close to even or inverted. Conclusion Asthma patients may have more obvious adrenocortical dysfunction and circadian rhythm disorders than COPD patients. The occurrence of nighttime asthma symptoms may be related to this.