轻度哮喘患者在支气管激发试验前后小气道功能及弥散功能的改变  

Changes of small airway function and diffusing capacity in patients with mild asthma before and after bronchial provocation test

作　　者：陈亚红[1] 姚婉贞[1] 柳晓芳[1] 梁岩静[1] 

机构地区：[1]北京大学第三医院呼吸科,北京100083

出　　处：《中国呼吸与危重监护杂志》2007年第1期3-7,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨轻度支气管哮喘(简称哮喘)患者在支气管激发试验(BPT)前后小气道和弥散功能的变化。方法采用前瞻性研究方法,对临床上疑为哮喘的患者(出现发作性喘息、胸闷、咳嗽,胸片正常,基础肺功能在正常范围)行BPT,BPT阳性者为哮喘组,BPT阴性者为对照组。于BPT前后进行肺容量、通气功能及弥散功能检查,比较哮喘组和对照组试验前后肺功能的变化。结果(1)激发前,哮喘组和对照组第1秒用力呼气容积占预计值百分比(FEV1%)、1秒率(FEV1/FVC)、用力肺活量占预计值百分比(FVC%)、肺活量占预计值百分比(VC%)、肺总量占预计值百分比(TLC%)、功能残气量占预计值百分比(FRC%)、残气量占预计值百分比(RV%)和残气量/肺总量(RV/TLC)等指标比较差异无统计学意义(P均>0.05)。激发后,哮喘组FEV1/FVC和FVC%较对照组显著下降(P均<0.01),而FRC%(P<0.05),RV%(P<0.01)和RV/TLC(P<0.01)较对照组显著增加。哮喘组激发前后FEV1/FVC和FVC%下降率显著高于对照组(P均<0.01),TLC%,RV%和RV/TLC增加率显著高于对照组(P均<0.01)。(2)激发前哮喘组最大呼气中期流速(FEF25%-75%)(P<0.05)、在75%肺活量位时的最大呼气流速(V.max75%)(P<0.01)、在50%肺活量位时的最大呼气流速(V.max50%)(P<0.05)均较对照组显著下降。激发后上述指标及在25%肺活量位时的最大呼气流速(V.max25%)较对照组显著降低(P均<0.01)。哮喘组激发前后FEF25%-75%,V.max75%,V.max50%和V.max25%下降率显著高于对照组(P均<0.01)。(3)激发前后哮喘组和对照组一氧化碳弥散功能无显著差异。结论轻度哮喘患者BPT前肺功能虽然在正常范围,但小气道功能较气道反应性正常患者降低;BPT后存在大气道和小气道功能障碍,弥散功能正常。Objective To investigate the changes of small airway function and diffusing capacity in patients with mild asthma before and after bronchial provocation test （BPT）. Methods BPT was performed in suspected asthma patients with chief complaints of paroxysmal wheeze,chest tightness and cough,but with normal chest X-ray and baseline pulmonary function. BPT positive group was regarded as asthma group, while BPT negative group as control group. Lung volume, ventilatory function and diffusing capacity were measured before and after BPT and compared between the asthma and control groups. Results （A） No statistical differences were found in FEV1 %, FEV1/FVC,FVC%, VC%, TLC%, FRC%, RV %, RV/TLC between the asthma and control groups before BPT. FEV1/FVC and FVC% were significantly decreased （all P 〈 0.01）,while FRC% （ P 〈 0.05）,RV% （P 〈0.01） and RV/TLC （P 〈 0.01） increased significantly in the asthma group after BPT compared with the control group. The decline rate of FEV1/FVC and FVC% and the increase rate of TLC%, RV %, RV/TLC were significantly higher in the asthma group than those in the control group （ all P 〈 0.01 ）. （B）Compared with the control group, FEF25%-75% （ P 〈 0.05）, V^·max75% （ P 〈 0.01 ） and V^·max50% （ P 〈 0.05）were significantly lowered before BPT, while the above parameters and V^·max25% were significantly decreased after BPT in the asthma group （ all P 〈 0.01 ）. The decline rate of FEF25%-75%, V^·max75%, V^·max50% and V^·max25% was significantly higher in the asthma group than those in the control group （ all P 〈 0.01 ）. （C） There was no statistical difference in DLCO in both groups before and after BPT. Conclusions Patients with mild asthma had small airways impairment before BPT which further declined after BPT. However, no impairment of diffusion capacity was found before or after BPT.

关 键 词：支气管哮喘 气道高反应性 支气管激发试验 弥散功能 小气道 

分 类 号：R562.25[医药卫生—呼吸系统]