摘要
目的探讨气道黏液栓对支气管哮喘(简称哮喘)患者的影响及管理要点。方法本研究为横断面研究。根据纳入及排除标准,选取2020年1月至2022年6月在北京大学第三医院门诊就诊,确诊哮喘并进行胸部CT检查的患者100例,收集患者病史和一般资料、胸部CT结果、肺功能、呼出气一氧化氮(FeNO)测定、血常规、过敏原总IgE、烟曲霉M3过敏原特异性IgE抗体检测结果等临床资料,根据胸部CT结果将哮喘患者分为有黏液栓组和无黏液栓组,统计气道黏液栓的分布和基于支气管肺段的黏液栓评分,分析气道黏液栓和临床病史、哮喘急性发作、肺功能[包括支气管舒张试验前后用力肺活量占预计值的百分比(FVC%预计值)、第1秒用力呼气容积占预计值的百分比(FEV_(1)%预计值)、FEV_(1)/FVC、呼气峰值流量占预计值的百分比(PEF%预计值)、最大呼气中期流量(MMEF)及剩余25%、50%、75%肺活量时的最大呼气流量占预计值的百分比(MMEF%预计值、MEF_(25)%预计值、MEF_(50)%预计值、MEF_(75)%预计值)]、FeNO、外周血嗜酸性粒细胞(Eos)数量之间的关系,通过logistic回归模型分析气道黏液栓是否是哮喘急性发作的危险因素,并探讨对应的管理策略。结果100例哮喘患者中有黏液栓组24例,无黏液栓组76例。黏液栓组气道黏液栓的分布以双下肺多见(左肺下叶30.53%、左肺上叶9.16%、右肺下叶29.01%、右肺中叶14.50%、右肺上叶16.80%),黏液栓评分(4.42±3.12)分;体重指数(BMI)、入组前1年内因哮喘急性发作就医次数、FeNO、外周血Eos均显著高于无黏液栓组[(24.95±4.34)比(23.22±2.91)kg/m^(2)、0(0,1)比0(0,0)次、97(37,169)比31(18,59)ppb(1 ppb=1×10^(-9))、0.41(0.15,0.70)比0.18(0.09,0.37)×10^(9)/L](均P<0.05);FVC%预计值、FEV_(1)%预计值、FEV_(1)/FVC、PEF%预计值、MEF_(50)%预计值、MEF_(25)%预计值、MMEF%预计值、MEF_(75)%预计值均显著低于无黏液栓组[(87.49±19.32)%比(97.34±14.24)%、(76.49±19.58)%比(91.07±18.33)%、(72.44±10.91)%比(79.48±8.13)%、(82.36±24.46)%比(93.83±18.27)%、(53.03±24.81)%比(75.75±27.15)%、(46.47±22.92)%比(64.09±25.90)%、(50.28±23.73)%比(74.53±26.80)%、(71.30±27.55)%比(89.92±26.82)%](均P<0.05);气道黏液栓评分和患者体重、入组时外周血Eos数量均呈正相关(r=0.413、0.478;均P<0.05),和FVC%预计值、FEV_(1)%预计值呈负相关(r=-0.576、-0.465;均P<0.05)。Logistic回归分析显示,气道黏液栓评分是哮喘急性发作的危险因素(OR=1.269,95%CI:1.031~1.562;P=0.024)。结论哮喘患者具有较高的气道黏液栓发生率,并与Eos炎症水平、体型相关。气道黏液栓可促进患者气流阻塞、哮喘急性发作。临床可针对气道黏液栓制定相应哮喘管理策略,延缓哮喘病情进展,减少急性发作次数。
Objective To explore the influence of airway mucus plugs on patients with bronchial asthma and its management.Methods In this cross-sectional study,from January 2020 to June 2022,100 patients who were diagnosed with asthma and underwent chest CT examination in the Outpatient Department of Peking University Third Hospital were included.The chest CT results and medical history,pulmonary function,fractional exhaled nitric oxide(FeNO),blood routine,total allergen IgE,Aspergillus fumigatus M3 allergen-specific IgE antibody test results were collected.According to the results of chest CT,the asthma patients were divided into group with mucus plugs and those without mucus plugs.Distribution of airway mucus plugs and the mucus plug scores based on lung segments were calculated.The relationships of mucus plugs with medical history,pulmonary function[These included before and after the bronchodilation test,forced vital capacity percent of predicted value(FVC%pred),forced expiratory volume in one second percent of predicted value(FEV_(1)%pred),FEV_(1)/FVC,peak expiratory flow percent of predicted value(PEF%pred),maximal mid-expiratory flow percent of predicted value(MMEF%pred),maximal expiratory flow at 25%,50%,75%of vital capacity remaining percent of predicted value(MEF_(25)%pred,MEF_(50)%pred,MEF_(75)%pred)],FeNO,and peripheral blood eosinophil(Eos)counts were analyzed.The logistic regression model was used to analyze whether airway mucus plug was a risk factor for asthma exacerbation,and the corresponding intervention strategies were explored.Results Among the 100 patients with asthma,24 cases were in the mucus plug group and 76 cases were in the non-mucus plug group.The distribution of mucus plug was more common in the lower lungs(30.53%and 9.16%in the lower and upper lobe of left lung,respectively;29.01%,14.50%and 16.80%in the lower,middle and upper lobe of right lung,respectively).The average score of mucus plug was(4.42±3.12)points.The body mass index(BMI),the number of visits to a doctor due to asthma exacerbations,FeNO,peripheral blood Eos counts in the mucus plug group were higher than those in the non-mucus plug group[(24.95±4.34)vs(23.22±2.91)kg/m^(2),0(0,1)vs 0(0,0),97(37,169)vs 31(18,59)ppb(1 ppb=1×10^(-9)),0.41(0.15,0.70)vs 0.18(0.09,0.37)×10^(9)/L](all P<0.05),and FVC%pred,FEV_(1)%pred,FEV_(1)/FVC,PEF%pred,MEF_(50)%pred,MEF_(25)%pred,MMEF%pred,MEF_(75)%pred were lower than those in the non-mucus plug group[(87.49±19.32)%vs(97.34±14.24)%,(76.49±19.58)%vs(91.07±18.33)%,(72.44±10.91)%vs(79.48±8.13)%,(82.36±24.46)%vs(93.83±18.27)%,(53.03±24.81)%vs(75.75±27.15)%,(46.47±22.92)%vs(64.09±25.90)%,(50.28±23.73)%vs(74.53±26.80)%,(71.30±27.55)%vs(89.92±26.82)%](all P<0.05).In the group with mucus plug,the airway mucus plug score was positively correlated with the patient′s body weight and the number of peripheral blood Eos counts at enrollment(r=0.413,0.478;all P<0.05),and negatively correlated with FVC%pred and FEV_(1)%pred(r=-0.576,-0.465;all P<0.05).Logistic regression analysis showed that airway mucus plug score was a risk factor for acute asthma attack(OR=1.269,95%CI:1.031-1.562;P=0.024).Conclusions Asthma patients have a high incidence of airway mucus plug,which is related to the level of Eos inflammation and body size.Airway mucus plugs can promote airflow obstruction and acute exacerbation of asthma.In clinical practice,appropriate asthma management policies can be formulated for airway mucus plugs to delay the progression of asthma and reduce the number of acute attacks.
作者
刘可欣
葛莹莹
商莹
李美娇
孙丽娜
宋祝
常春
Kexin Liu;Yingying Ge;Ying Shang;Meijiao Li;Lina Sun;Zhu Song;Chun Chang(Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China;Radiology Department,Peking University Third Hospital,Beijing 100191,China)
出处
《中华健康管理学杂志》
CAS
CSCD
2023年第1期29-35,共7页
Chinese Journal of Health Management
基金
国家自然科学基金面上项目(81970028,82170028)
医院队列建设项目(BYSYDL2021020)。
作者简介
通信作者:常春,Email:doudou_1977@163.com。
