激发试验阳性的慢性咳嗽患者小气道功能特点分析  

Analysis of small airway function in chronic cough patients with positive results in bronchial provocation

作　　者：包婺平[1] 张旻[1] 张鹏宇[1] 张国清[1] 殷俊锋[2] 吕成坚[1] 周新[1] 李群[1] Bao Wuping;Zhang Min;Zhang Pengyu;Zhang Guoqing;Yin Junfeng;Lv Chengjian;Zhou Xin;Li Qun(Department of Respiratory Medicine,Shanghai General Hospital,Shajighai Jiao Tang University,Shanghai 200080,China;School of Mathematical Sciences,Tongji University,Shanghai 200092,China)

机构地区：[1]上海交通大学附属第一人民医院呼吸科,200080 [2]同济大学数学科学学院,上海200092

出　　处：《国际呼吸杂志》2019年第5期326-331,共6页International Journal of Respiration

基　　金：国家自然科学基金面上项目(81470218).

摘　　要：目的分析存在气道高反应性(BHR)的慢性咳嗽成年患者大、小气道功能以及气道炎症特点,并探索小气道功能异常与大气道功能、气道炎症及气道反应性增高程度之间的相关性。方法共纳入96例曾接受肺通气功能检测且乙酰甲胆碱激发试验阳性的慢性咳嗽患者。收集激发试验、肺通气功能、呼气中期流速(FEF25%-75%)以及呼出气一氧化氮(FeNO)结果。按照小气道功能正常与否分组,比较用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1/FVC、呼气峰流速(PEF)、FeNO、激发后FEV1、FEV1下降20%时所吸入的乙酰甲胆碱累计总量(PD20-FEV1)以及FeNO的组间差异,分析小气道功能障碍与上述临床特点之间的相关性。结果激发试验阳性的慢性咳嗽患者中,76.04%存在不同程度的小气道功能障碍。罹患小气道功能障碍的BHR慢性咳嗽患者的FEV1、FEV1/FVC和PEF下降更明显,同时BHR程度更重。FVC和FeNO与小气道功能无明显相关性。结论小气道功能障碍可能参与了慢性咳嗽BHR的发生,且致病机制独立于嗜酸粒细胞性气道炎症。小气道功能联合嗜酸粒细胞性气道炎症的评估能更完善地预测BHR的风险。Objective To analyze the characteristics of small/large airway function and eosinophilic inflammation in adult patients with chronic cough and bronchial hyperresponsiveness (BHR).and to explore if that small airway dysfunction was associated with large airway function,inflammation and BHR.Methods Chronic cough patients (16-80 years) with positive methacholine provocation reactivity and spirometric results were enrolled in this single-center cross-sectional study.Provocation reactivity,spirometric results,forced mid-expiratory flow at 25% to 75% of forced vital capacity (FEF25%-75%) and fractional exhaled nitric oxide (FeNO) were collected.The difference between normal small airway function group and dysfunctional group in forced vital capacity (FVC),forced expiratory volume in one second (FEV1),FEV,/FVC,peak expiratory flow (PEF).FEV after provocation,cumulative dose of mcthacholine provoking a 20% decrease in FEVi from baseline value (PD20-FEV1) and FeNO was investigated.Correlation between small airway dysfunction and the above clinical features were also analyzed.Results Totally 96 patients were enrolled.76.04% of patients with chronic cough and BHR had small airway dysfunction.FEV1 ,FEV1 FVC and PEF decreased significantly in group with small airway dysfunction,companied with more serious increase of BHR.FVC and FeNO had no significant correlation with small airway function.Conclusions Small airway dysfunction may be involved in the development of BHR in patients with chronic cough,independently of airway eosinophilic inflammation.The assessment of small airway function combined with eosinophilic analysis could be considered in prediction of BHR.

关 键 词：哮喘 支气管 呼出气一氧化氮 支气管激发试验 咳嗽 小气道功能障碍 

分 类 号：R56[医药卫生—呼吸系统]