对慢性喘息型支气管炎气道反应性特点及其本质的探讨  

A study about airway reactivity and nature of chronic asthmatic bronchitis

作　　者：黄克武[1] 翁心植[1] 柯以恕[1] 李征征[1] 张洪玉[1] 王辰[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院

出　　处：《中华内科杂志》1999年第6期383-386,共4页Chinese Journal of Internal Medicine

摘　　要：目的研究慢性喘息型支气管炎对乙酰甲胆碱和运动激发试验的气道反应性特点，并对其本质进行初步探讨。方法对诊断明确的支气管哮喘患者（４２例）、单纯型慢性支气管炎患者（２９例）及慢性喘息型支气管炎患者（２７例）分别进行乙酰甲胆碱吸入激发试验和运动激发试验，观察血嗜酸粒细胞计数、血ＩｇＥ水平并测定慢性喘息型支气管炎患者血清嗜酸细胞阳离子蛋白（ＥＣＰ）含量。结果慢性喘息型支气管炎患者对乙酰甲胆碱吸入激发试验阳性率为７７．８％，介于支气管哮喘患者（１０００％）和单纯型慢性支气管炎患者（４１．４％）之间。运动试验阳性的慢性喘息型支气管炎患者中无１例乙酰甲胆碱试验阴性，而运动试验阴性者中有６例乙酰甲胆碱试验为阴性，且阳性者的１秒钟用力呼气容积降低２０％所需乙酰甲胆碱药物累积量的中位数显著低于阴性者，并与支气管哮喘患者很接近。另外，慢性喘息型支气管炎阳性者中血清总ＩｇＥ水平与支气管哮喘患者差异无显著性，但高于阴性者，阳性者中血清ＥＣＰ也明显高于阴性者。结论慢性喘息型支气管炎的气道反应性特点介于支气管哮喘和单纯型慢性支气管炎之间，不同的患者其本质可能有所不同。Objective To observe the airway reactivity with methacholine provocation and exercise challenge of chronic asthmatic bronchitis and to assess preliminarily the nature of chronic asthmatic bronchitis. Methods 42 patients with bronchial asthma, 29 with simple chronic bronchitis and 27 with chronic asthmatic bronchitis were selected. The study protocol consisted of inhalation challenge with methacholine and exercise challenge. Count of blood eosinophil cells and level of blood total IgE were studied. Serum eosinophil cationic protein (ECP) concentration was measured in the asthmatic bronchitis group. Results The positive ratio to methacholine response was 77.8% in chronic asthmatic bronchitis group, whereas the ratios were 100.0% and 41.4% in bronchial asthma and simple chronic bronchitis groups respectively. According to the response to exercise challenge, patients with chronic asthmatic bronchitis were divided into positive and negative groups. The cumulative dose of methacholine producing a 20% fall in FEV1(PD20FEV1) was different between the two groups. In the positive group (9 patients), none was negative with methacholine response and PD20FEV1 being similar to the bronchial asthma group. The blood total IgE and ECP levels were significantly higher in the positive than in the negative group. Conclusion The characteristics of airway reactivity in chronic asthmatic bronchitis are midway between bronchial asthma and simple chronic bronchitis. The nature of chronic asthmatic bronchitis may be different in different patients.

关 键 词：支气管炎 气道反应性 病理 

分 类 号：R562.210.2[医药卫生—呼吸系统]