支气管哮喘合并慢性阻塞性肺疾病患者的小气道功能变化的研究  

Small-airway function of bronchial asthma with chronic obstructive pulmonary disease

作　　者：赵转华 聂秀红[1] Zhao Zhuanhua;Nie Xiuhong(Department of Respiratory Medicine,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院呼吸内科,北京100053

出　　处：《国际呼吸杂志》2020年第14期1048-1053,共6页International Journal of Respiration

摘　　要：目的探究支气管哮喘(哮喘)合并慢性阻塞性肺疾病(COPD)患者小气道功能变化特点及对患者生活质量的影响。方法2015年10月至2016年11月就诊于首都医科大学宣武医院呼吸内科的哮喘合并COPD的患者,根据患者5 Hz与20 Hz时呼吸黏性阻力之差(R5-R20)的变化,以0.07 kP·L^-1·s^-1作为截点,分为R5-R20≥0.07 kPa·L^-1·s^-1组,即小气道功能异常(SAD)组和R5-R20<0.07 kPa·L^-1·s^-1组,即无小气道功能异常(无SAD)组,比较2组患者的肺功能参数、脉冲震荡参数及SAD对哮喘合并COPD患者生活质量的影响。结果(1)45例哮喘合并COPD患者中,SAD组35例(占77.8%),无SAD组10例(占22.2%)。支气管舒张试验前,有SAD组患者的呼气峰值流速(PEF)低于无SAD组患者(t=2.412,P<0.05),第1秒用力呼气容积(FEV1)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)比较,差异均无统计学意义(t=1.030、0.155,P值均>0.05)。支气管舒张试验后,有SAD组患者的FEV1、FEV1/FVC均高于无SAD组患者(t=2.024、2.663,P值均<0.05)。(2)哮喘合并COPD患者支气管舒张试验前,有SAD组的周边阻力(Rp)、共振频率(Fres)、5 Hz时气道黏性阻力(R5)、R5-R20均高于无SAD组(t=3.679、2.446、2.917、5.15,P值均<0.05),有SAD组周边气道弹性阻力(X5)低于无SAD组(t=3.112,P<0.05)。哮喘合并COPD患者支气管舒张试验后,2组患者中心阻力(Rc)、Rp、Fres、R5、20 Hz时气道黏性阻力(R20)、R5-R20比较,差异均无统计学意义(Z=0.114、0.058,t=0.394、1.439、0.995、1.430,P值均>0.05);SAD组患者Rp、Fres、R5-R20改善值均明显高于无SAD患者(t=3.215、2.495、2.491,P值均<0.05)。(3)哮喘合并COPD患者中,慢性阻塞性肺疾病评估测试(CAT)≥10分的患者有SAD的比例高于CAT<10分的患者(χ^2=7.074,P<0.05),并且哮喘合并COPD患者R5-R20与CAT评分呈正相关(r=0.693,P<0.001)。结论哮喘合并COPD患者中有SAD的患者比无SAD的患者气流受限更为严重,并且使用支气管舒张剂后,有SAD的患者气Objective To explore the characteristics of small-airway function(SAD)in patients with bronchial asthma(asthma)with chronic obstructive pulmonary disease(COPD)and to evaluate the impact of SAD on health status.Methods Asthma with COPD patients in stable condition admitted to department of Respiratory of Xuanwu Hospital of Capital Medical University from October 2015 to November 2016 were recruited as study subjects.According to the fall in resistance from 5 to 20 Hz(R5-R20)≥0.07 kPa·L^-1·s^-1or<0.07 kPa·L^-1·s^-1,the asthma with COPD cohort was categorized in patients with and without SAD,respectively.Two groups′respiratory obstruction indexs tested by pulmonary function device and impulse oscillometry were compared,the impact of SAD on health status was evaluated.Results(1)There were 35 cases with SAD in asthma with COPD patients(77.8%),10 cases without SAD in asthma with COPD patients(22.2%).Before the bronchodilation test,the peak expiratory flow(PEF)in asthma with COPD patients with SAD was significantly lower than those in asthma with COPD patients without SAD(t=2.412,P<0.05).There was no significant difference in other indexs including forced expiratory volume in one second(FEV1),the ratio of FEV1/FVC between the two groups(t=1.030,0.155,both P>0.05).After the bronchodilation test,the parameters including FEV1 and the ratio of FEV1/FVC in asthma with COPD patients with SAD,were significantly higher than those in asthma with COPD patients without SAD(t=2.024,2.663,both P<0.05).(2)Before the bronchodilation test,the IOS parameters,including peripheral resistance(Rp),resonant frequency(Fres),resistance at 5 Hz(R5)and R5-R20 in asthma with COPD patients with SAD,were significantly higher than those in asthma with COPD patients without SAD(t=3.679,2.446,2.917,5.15,all P<0.05).Reactance at 5Hz(X5)in asthma with COPD patients with SAD was significantly lower than that in asthma with COPD patients without SAD(t=3.112,P<0.05).After the bronchodilation test,there were no significant differences in central res

关 键 词：哮喘 肺疾病 慢性阻塞性 小气道功能 肺功能 脉冲震荡法 慢性阻塞性肺疾病评估测试 

分 类 号：R563.9[医药卫生—呼吸系统] R562.25[医药卫生—内科学]