哮喘患者气道高反应性特点及其日间差异性研究  

Iurnal Variability of Airway Hyperresponsiveness in Asthma Patients

作　　者：虞欣欣[1] 郑劲平[1] 高怡[1] 谢燕清[1] 安嘉颖[1] 刘文婷[1] 钟丽萍[1] 吴仲平[1] 朱政[1] YU Xinxin;ZHENG Jinping;GAO Yi;XIE Yanqing;AN Jiaying;LIU Wenting;ZHONG Liping;WU Zhongping;ZHU Zheng(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第一医院,广东省广州市510000

出　　处：《中国全科医学》2022年第11期1351-1356,共6页Chinese General Practice

基　　金：国家重点研发计划(2018YFC1311900,2016YFC1304603);国家科技支撑计划(2015BAI12B10);广东省基础与应用基础研究基金项目(2020A1515110007);广州市科技计划项目(202102010347);广东省钟南山医学基金会(ZNSA-2020003,ZNSA-2020013)。

摘　　要：背景哮喘患者呼气峰值流量(PEF)、第1秒用力呼气容积(FEV_(1))等肺功能指标存在昼夜变异的特点,评估药物治疗对哮喘患者肺功能和气道高反应性影响的研究均要求患者在1 d中的相同时间点进行肺功能检测,而哮喘患者气道高反应性是否存在日间差异尚不清楚。目的探讨哮喘患者气道高反应性特点及日间变异性。方法收集2018年1月至2020年9月在广州医科大学附属第一医院呼吸科就诊的202例哮喘患者资料并进行统计分析。患者均完成乙酰甲胆碱支气管激发试验,根据其进行支气管激发试验的时间分为上午检测组(上午组)81例和下午检测组(下午组)121例;根据患者的病程分组,病程≤6个月为初诊组98例,>6个月为复诊组104例,其中初诊组和复诊组又根据检测时间分为初诊上午组、初诊下午组和复诊上午组、复诊下午组;参照中国肺功能指南气道高反应性分级,根据使FEV_(1)下降20%的累积激发剂量(PD20-FEV_(1))将患者分为极轻度组、轻度组、中度组和重度组。比较各组间气道高反应性特点及主要肺功能指标〔用力肺活量(FVC)占预计值百分比(FVC%pred)、FEV_(1)占预计值百分比(FEV_(1)%pred)、呼气峰值流量(PEF)占预计值百分比(PEF%pred)、最大呼气中段流量(MMEF)占预计值百分比(MMEF%pred)、50%肺容量位的用力呼气流量(MEF50%)占预计值百分比(MEF50%pred)、25%肺容量位的用力呼气流量(MEF25%)占预计值百分比(MEF25%pred)〕及下降20%的累积激发剂量(PD20)〔使FVC下降20%的累积激发剂量(PD20-FVC)、PD20-FEV_(1)、使PEF下降20%的累积激发剂量(PD20-PEF)、使MMEF下降20%的累积激发剂量(PD20-MMEF)、使MEF25%下降20%的累积激发剂量(PD20-MEF25%)、使MEF50%下降20%的累积激发剂量(PD20-MEF50%)〕。结果上午组和下午组患者主要肺功能指标及PD20比较,差异无统计学意义(P>0.05)。初诊组FEV_(1)%pred及PD20-PEF均高于复诊组(P<0.05);初诊组�Background There are daytime variability in pulmonary function indexes such as peak expiratory flow(PEF)and forced expiratory volume in 1 second(FEV_(1))in asthma patients.Studies evaluating the effects of drug therapy on lung function and airway hyperresponsiveness(AHR)in asthma patients all required patients to perform spirometry and bronchial challenge test in the same time point of the days.However,whether there is a daily diurnal AHR variability is still not clear.Objective To explore the characteristics and diurnal variability of AHR in asthma patients.Methods The data of 202 patients with asthma who consulted in respiratory department of the First Affiliated Hospital of Guangzhou Medical University from January 2018 to September 2020 were included for statistical analysis.All patients completed the methacholine bronchial provocation tests,they were divided into the morning detection group(morning group)with 81 cases and the afternoon detection group(afternoon group)with 121 cases;according to the disease course,98 cases were divided into the initial diagnosis group if the disease course was≤6 months,and 104 cases were divided into the follow-up group if the disease course was>6 months.The initial diagnosis group and the follow-up group were divided into the initial diagnosis morning group,the initial diagnosis afternoon group,the follow-up morning group,and the follow-up afternoon group according to the detection time;according to the AHR,the patients were divided into very mild,mild,moderate and severe groups.The characteristics of AHR and the main pulmonary function indexes including FVC%pred,FEV_(1)%pred,PEF%pred,MMEF%pred,MEF50%pred,MEF25%pred,PD20-FEV_(1),PD20-PEF,PD20-MMEF,PD20-MEF25%,PD20-MEF50%of these groups were analyzed and compared.Results There were no significant differences of the math pulmonary function indexes and PD20 between morning and afternoon groups(P<0.05).FEV_(1)%pred and PD20-PEF were significantly higher in initial diagnosed group than follow-up group(P<0.05).There was no signi

关 键 词：哮喘 呼吸功能试验 肺功能 气道高反应性 支气管激发试验 

分 类 号：R562.25[医药卫生—呼吸系统]