小气道功能与气道敏感性和反应性  

Relationship of small airway function with airway sensitivity and reactivity

作　　者：陈亚红[1] 梁岩静[1] 柳晓芳[1] 姚婉贞[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》2008年第3期177-181,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究小气道功能与气道敏感性和反应性的关系,探讨气道高反应性(AHR)变异的影响因素。方法采用前瞻性研究,收集北京大学第三医院2005年1月～2006年4月期间支气管激发试验(BPT)阳性疑诊支气管哮喘的患者,气道敏感性以引起第1秒用力呼气容积(FEV1)下降≥20%的乙酰甲胆碱(Mch)累积量表示(PD20);气道反应性以Mch剂量反应曲线斜率(DRS)表示,以FEV1下降率除以Mch累积量。以log10DRS作为因变量,以在50%肺活量位时的最大呼气流速(Vmax50%)和在25%肺活量位时的最大呼气流速(Vmax25%)反映小气道功能,建立小气道功能指标与log10DRS之间的简单线性回归模型。以log10DRS作为因变量,根据年龄、身高、FEV1%pred建立多元回归模型,得出决定系数(r2)。将小气道功能指标加入此模型,重新计算r2,二者差异代表小气道功能指标在气道反应性中的作用。分别对不同性别和年龄组进行分析。结果共入选184例患者,男70例,女114例。PD20越低,Vmax50%和Vmax25%越低,反之亦然。PD20与log10DRS呈显著负相关(r=-0.874,P<0.01)。简单线性回归分析发现,FEV1%pred、Vmax50%、Vmax25%分别与log10DRS显著相关(r2值分别为0.062、0.097和0.085,P均<0.01)。与年龄、身高、FEV1%pred进行多元线性回归分析,Vmax50%、Vmax25%引起气道反应性的变异程度分别占3.9%和2.6%。不论男性还是女性患者,Vmax50%与log10DRS显著相关,并且男性r2值高于女性。年龄≤25岁者女性Vmax50%、Vmax25%与log10DRS显著相关,r2值高于男性。而年龄在25～45岁患者男性Vmax50%、Vmax25%与log10DRS显著相关,r2值高于女性。当年龄>45岁时男性和女性患者Vmax50%、Vmax25%与log10DRS均无明显相关性。结论小气道功能下降导致气道敏感性和反应性增加。Objective To investigate the relationship of small airway function with airway sensitivity and reactivity and assess the factors influencing airway hyperresponsiveness（AHR）.Methods Data of consecutive subjects with suspected asthma who had a ≥20% reduction in FEV1 after ≤12.8 μmol/L cumulative doses of methacholine were analyzed from January 2005 to April 2006.Airway sensitivity was assessed by the cumulative dose of methacholine required to cause 20% reduction in FEV1（PD20）.Airway reactivity was analyzed using the slope of the dose-response curve（DRS）.The DRS was defined as the reduction in FEV1 from baseline after the final dose of methacholine inhaled divided by the cumulative dose inhaled.Because of their highly skewed distribution,DRS was logarithmically transformed（log10） for all analysis.Results A total of 184 consecutive subjects aged 16 to 80 years was enrolled.There were 70 male（38.0%） and 114 female（62.0%） subjects.Subjects with higher airway sensitivity,indicated by lower PD20,also had a lower Vmax50% and Vmax25%,and vise versa.PD20 was negatively correlated with log10DRS（r=-0.874,P〈0.01）.In a simple linear regression model,log10DRS was significantly correlated with FEV1%pred,Vmax50% or Vmax25% respectively（the determinant r^2 were 0.062,0.097 and 0.085,respectively,all P〈0.01）.In a multiple linear regression model that included age,height and FEV1%pred,Vmax50% and Vmax25% accounted for 3.9% and 2.6%,respectively,of variability in airway reactivity.The association between Vmax50% and log10DRS was significant in both male and female subjects.The r^2 was higher in male subjects.The subjects were divided into three age groups and the association between Vmax50% or Vmax25% and log10DRS was higher in female than in male for age ≤25 years,higher in male than in female for age 25-45 years.No association was found for age〉45 years in both male and female.Conclusion Impaired small airway function is associated with higher airway sensitivity and reactivity to methach

关 键 词：气道高反应性 小气道 气道敏感性 

分 类 号：R562.25[医药卫生—呼吸系统] R725.622.5[医药卫生—内科学]