小气道功能检测对气道高反应性预测价值的初步探讨  

Preliminary study of the predicting value of small airway function examination for airway hyperresponsiveness

作　　者：林岚[1] 陶晓南[1] 彭毅[1] 付薇[1] 向敏[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院呼吸内科,武汉430022

出　　处：《临床内科杂志》2008年第11期753-756,共4页Journal of Clinical Internal Medicine

摘　　要：目的初步评价肺功能测定中反映小气道功能的指标对气道高反应性的预测价值。方法对126例可疑气道高反应性患者行肺功能测定和支气管激发试验,观察分析小气道功能病变与气道高反应性的相关性。结果(1)126例患者中,支气管激发试验阳性率为50.79%(64/126);阳性组FEV1/VC、FEF25%、FEF50%、FEF75%、MMEF75/25等基础肺功能基指标与阴性组比较,差异有非常显著性(P<0.01)。(2)小气道功能异常发生率为42.06%(53/126),异常组激发试验阳性率为73.58%(39/53),明显高于正常组(34.25%,25/73),P<0.01。FEF75%、FEF50%和MMEF75/25与激发试验阳性率密切相关,≥80%预计值组的阳性率显著低于<80%预计值组(P<0.01)。(3)FEF 75%、FEF 50%、MMEF 75/25的阳性预测值分别为62.07%、72.73%、69.86%;各指标的ROC曲线下面积分别为0.713、0.771和0.768,均大于0.7,诊断准确性达到中等。串联应用时阳性预测值有所提高,达73.58%。结论肺功能测定中反映小气道功能的指标能很好地预测气道高反应性,对症状不典型气道高反应性患者的早期筛查有重要价值。Objective The purpose of this study is to evaluate the predicting value of small airway function examination for airway hyperresponsiveness. Methods Pulmonary function tests and bronchial provocation tests were performed in 126 medical outpatients with suspect airway hyperresponsiveness. The incidences of small airway disfunction and airway hyperresponsiveness were observed. And then made a further analysis of the correlation between them. Results ①There are 50.79% of total 126 patients with positive bronchial provocation tests. And there is a significant difference in pulmonary function tests index （FEV,/VC,FEF 25% ,FEF 50% ,FEF 75% ,MMEF 75/25） between positive group and negative group （P 〈 0. O1 ）. ②The incidence of small airway disfunction is 42.06% （53/126）. The incidence of positive bronchial provocation tests in 53 patients （73.58%）with small airway disfunction is significantly higher than that in 73 patients （34.25 % ）without it （P 〈 0.01 ）. In addition, FEF 75 % ,FEF 50% and MMEF 75/ 25 correlate closely with the bronchial provocation tests. The positive incidence in the group of more than 80% predicted value is obviously lower than that of less than 80% predicted value. ③The area under the ROC is 0. 713,0. 771 and 0.768 respectively（P 〈 0.01 ）, and all of them are larger than 0.7 which means that the diagnostic accuracy rating reaches moderate degree. Serial test of small airway function index can improve the positive predictive value. Conclusion The indexes which reflex small airway disfunction can predict airway hyperrespinsiveness very well. They have important value for screening early BHR patients.

关 键 词：小气道功能 气道高反应性 肺功能 支气管激发试验 

分 类 号：R56[医药卫生—呼吸系统]