摘要
目的探讨咳嗽变异性哮喘(CVA)患者肺通气功能的特点及其与气道反应性的关系,增强临床医师对CVA的认识。方法收集2017年1月至11月山西医科大学第一医院呼吸与危重症医学科门诊初诊的哮喘患者132例。根据症状将其分为CVA组与典型哮喘组,又将CVA组根据使第1秒用力呼气容积(FEV1)较基线下降20%时累积吸入激发剂的剂量(PD20-FEV1)分为不同气道反应性亚组,比较CVA组与哮喘组以及CVA各亚组呼气流速指标的差异,并分析年龄、体质量指数(BMI)、呼吸流速指标与气道激发试验各指标的相关性。结果CVA组与哮喘组小气道功能障碍发生率分别为30.9%(21例)和26.6%(17例),2组差异无统计学意义(χ^2=0.3,P>0.05);CVA组FEV1/FVC、最大呼气中期流量(FEF25%-75%)、用力呼出25%肺活量时的瞬间呼气流量(FEF25%)、用力呼出50%肺活量时的瞬间呼气流量(FEF50%)及呼吸峰值流量(PEF)均高于哮喘组,差异有统计学意义(t=2.239、2.374、3.785、3.088、2.261,P值均<0.05)。CVA极轻度组FEV1/FVC、FEF25%-75%及FEF75%与轻度组及中度组比较总体差异有统计学意义(F=7.586、7.403、7.646,P值均<0.05);极轻度组FEF50%及FEF25%高于中度组(t=3.13、2.25,P值均<0.05),轻度组FEF25%高于中度组(t=2.10,P<0.05)。反应阈值、PD20-FEV1与FEV1/FVC呈正相关;初始气传导率、传导率下降斜率与BMI呈负相关。结论CVA也可发生小气道功能障碍,但其大、小气道病变程度均较典型哮喘轻。CVA患者气道反应性越高,呼气流速指标越差。肥胖可增加CVA患者气道敏感性与气道反应性。
Objective By exploring the characteristics of pulmonary ventilation function and airway reactivity in patients with cough variant asthma (CVA), to enhance the cognition of CVA by clinicians. Methods We collected 132 patients who were first diagnosed with asthma in the department of respiratory and critical diseases of the First Hospital of Shanxi Medical University from January to November 2017.They were divided into CVA group and typical asthma group according to symptoms, and the former was further divided into extreme mild group, mild group and moderate group based on the methacholine provocative dose causing a 20% fall in FEV1(PD20-FEV1). Then we compared the differences in respiratory velocity in the CVA group, asthma group and each subgroup of the CVA group, and the correlation of age, body mass index (BMI), respiratory velocity and airway stimulation test was also analyzed. Results The incidence rate of small airway dysfunction in the CVA group and the asthma group was 30.9%(21 cases) and 26.6%(17 cases), respectively.There was no significant difference between these groups (χ^2=0.3, P>0.05). FEV1/FVC, forced expiratory flow at 25%-75%(FEF25%-75%), forced expiratory flow at 25%(FEF25%), forced expiratory flow at 50%(FEF50%) and peak expiratory flow (PEF) in CVA group were higher than those in asthma group, with statistically significant differences (t=2.239, 2.374, 3.785, 3.088, 2.261, all P<0.05). The overall differences of FEV1/FVC, FEF25%-75%and FEF75% between the extremely mild group, the mild and moderate groups of CVA were statistically significant(F=7.586, 7.403, 7.646, all P<0.05). FEF50% and FEF25% in the extremely mild group were greater than the moderate group (t=3.13, 2.25, all P<0.05), and FEF25% in the mild group was higher than the moderate group(t=2.10, P<0.05). The cumulative dose of methacholine until the resistance of respiratory system began to increase (Dmin) and PD20-FEV1 were positively correlated with FEV1/FVC.The conductance of respiratory system at control and the declining slop of the Grs were negatively correlated with BMI. Conclusions Small airway dysfunction can also occur in CVA, but its large and small airway lesions are lighter than typical asthma.The higher the airway reactivity, the worse the index of expiratory flow.Obesity may increase airway sensitivity and reactivity in CVA patients.
作者
冉博文
杨铭心
候飞飞
樊芳芳
张潍
胡晓芸
Ran Bowen;Yang Mingxin;Hou Feifei;Fan Fangfang;Zhang Wei;Hu Xiaoyun(Department of Respiratory and Critical Care Medicine,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Health Management Center,Shandong Provincial Qianfoshan Hospital,Qianfoshan 250014,China)
出处
《国际呼吸杂志》
2019年第7期495-499,共5页
International Journal of Respiration
关键词
哮喘
呼吸功能试验
支气管高反应性
Asthma
Respiratory function tests
Bronchial hyperreactivity
作者简介
通信作者:胡晓芸。Email:huxiaoyunly@sina.com.
