支气管舒张试验前后小气道功能的研究
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摘要
目的本研究旨在通过比较支气管舒张试验前后支气管哮喘和慢性阻塞性肺疾病(COPD)病人大小气道肺通气功能参数的变化情况,来明确两组疾病小气道的变化规律以及小气道和大气道变化程度的差别和相关性,并明确支气管哮喘患者支气管舒张试验后各参数阳性率的敏感性。
方法本研究选用82例确诊的支气管哮喘病人、88例确诊的COPD病人和41例符合COPD病史支气管舒张试验阳性病人为研究对象。三组病例分别吸入沙丁胺醇气雾剂行支气管舒张试验,记录试验前后的FVC、FEV_1、PEF、MEF50%、MEF25%、MMEF值。采用SPSS11.5统计软件进行数据处理。
结果
1.支气管哮喘、慢性阻塞性肺疾病、符合COPD病史支气管舒张试验阳性患者支气管舒张试验后大气道和小气道参数均较试验前有明显改善(P＜0.01),且支气管哮喘患者的改善程度大于慢性阻塞性肺疾病患者(P＜0.01)。
2.支气管哮喘患者舒张试验前后FEV_1变异率、MEF50%变异率、MEF25%变异率、MMEF变异率分别为22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%,它们之间的差异有统计学意义(F=7.031,P＜0.01),且小气道参数较大气道参数的变异率明显(MEF50%、MMEF同FEV_1的变异率比较,t值分别为2.583、2.773,P值分别为0.011、0.007),而慢性阻塞性肺疾病病人和符合COPD病史支气管舒张试验阳性病人大小气道参数的变异率没有统计学意义(P＞0.05)。
3.在支气管哮喘病人中支气管舒张试验后FEV_1、MEF50%、MEF25%、MMEF的阳性率分别为60.98%、75.61%、58.54%、76.83%。小气道参数的阳性率较大气道参数的阳性率敏感(χ~2=10.352,P=0.016),且同支气管哮喘的严重程度有关,哮喘严重程度越大,小气道参数阳性率越敏感(P＜0.01)。
4.在支气管哮喘、慢性阻塞性肺疾病和符合COPD病史支气管舒张试验阳性病人中MEF50%变异率同FEV_1变异率成正相关(其中哮喘组r=0.788,P=0.000;COPD组r=0.717,P=0.000;符合COPD病史支气管舒张试验阳性组r=0.710,P=0.000),但MMEF同FEV_1变异率变异率不相关(其中哮喘组r=0.234,P=0.136;COPD组r=0.182,P=0.225;符合COPD支气管舒张试验阳性组r=0.208,P=0.191)。
结论支气管哮喘和COPD患者支气管舒张试验后小气道功能均较试验前有所改善,支气管哮喘改善程度较COPD明显。支气管哮喘和COPD支气管舒张试验后小气道的扩张规律不同,前者为逐步扩张并持续较长时间,后者扩张后迅速回缩。支气管哮喘病人中支气管舒张试验后大小气道舒张,但小气道舒张程度较大气道舒张程度明显,慢性阻塞性肺疾病病人中支气管舒张试验后大小气道扩张,但扩张程度没有差别。支气管哮喘病人支气管舒张试验后小气道参数的阳性率较FEV_1敏感,能够进一步提高诊断哮喘的阳性率。支气管舒张试验后支气管哮喘和COPD小气道的扩张程度和大气道的扩张程度呈正相关。
Objective.The bronchial asthma and chronic obstructive pulmonary disease are the most common diseases in the world.The feature of those diseases is airway obstruction.We study the changes of the lung function about the bronchial asthma and COPD after bronchial dilation test and describe the regularity of the dilatation of the small airway.We also explore the difference and the correlation between the big airway and the small airway in order to identify the two diseases.
Methods:We chose 82 patients with asthma and 88 patients with COPD and 41 patients with COPD but the bronchial dilation test is positive.We record the numbers of the FVC,FEV_1,PEF,MEF50%,MEF25%,MMEF before and after the bronchial dilation with the salbutamol.Throgh those numbers,we compare the changes between the small airway and the big airway.We also compare the sensitivity of the positive rate about the small airway function.
Results:The small airway lung function and the big airway lung function improved after the bronchial dilation test in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＜0.01).The lung function of the patients with asthma was better than the patients with the COPD(P＜0.01).The variance rate in FEV_1,MEF50%,MEF25%,MMEF are 22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%.There are statistical significance between those numbers(F=7.031,P＜0.01).The change of small airway of the patients with asthma was high than that before the test(P＜0.01).There was no difference in the variance rate between the test before and the test after in the other two groups(P＞0.05).In the patients with asthma the positive rate of FEV_1、MEF50%、MEF25%、MMEF was 60.98%,75.61%,58.54%,76.83%.The positive rate ofMMEF, MEF50%was more sensitive than the rate of FEV_1(x~2=10.352,P=0.016)and correlate with the Severity of the asthma.The more severe the asthma is,the more sensitive the positive rate of the lung function of the small airway is(P＜0.01).The variance rate in MEF50%correlates with the one in FEV_1 in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＜0.01).The variance rate in MMEF does not correlates with the one in FEV_1 in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＞0.05).
Conclusions:The big and the small airway are all dilated in the patients with asthma,but the dilatation of the small airway is more than the big airway's.In the same time,the positive rate of the small airway lung function is more sensitive than the big airway's.The big and the small airway are all dilated in the patients with COPD.The dilatation of the small airway is no difference with the big airway's.And the positive rate is low in the patients with COPD.The regular about the small airway is convenient to identify asthma and COPD.
方法本研究选用82例确诊的支气管哮喘病人、88例确诊的COPD病人和41例符合COPD病史支气管舒张试验阳性病人为研究对象。三组病例分别吸入沙丁胺醇气雾剂行支气管舒张试验,记录试验前后的FVC、FEV_1、PEF、MEF50%、MEF25%、MMEF值。采用SPSS11.5统计软件进行数据处理。
结果
1.支气管哮喘、慢性阻塞性肺疾病、符合COPD病史支气管舒张试验阳性患者支气管舒张试验后大气道和小气道参数均较试验前有明显改善(P＜0.01),且支气管哮喘患者的改善程度大于慢性阻塞性肺疾病患者(P＜0.01)。
2.支气管哮喘患者舒张试验前后FEV_1变异率、MEF50%变异率、MEF25%变异率、MMEF变异率分别为22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%,它们之间的差异有统计学意义(F=7.031,P＜0.01),且小气道参数较大气道参数的变异率明显(MEF50%、MMEF同FEV_1的变异率比较,t值分别为2.583、2.773,P值分别为0.011、0.007),而慢性阻塞性肺疾病病人和符合COPD病史支气管舒张试验阳性病人大小气道参数的变异率没有统计学意义(P＞0.05)。
3.在支气管哮喘病人中支气管舒张试验后FEV_1、MEF50%、MEF25%、MMEF的阳性率分别为60.98%、75.61%、58.54%、76.83%。小气道参数的阳性率较大气道参数的阳性率敏感(χ~2=10.352,P=0.016),且同支气管哮喘的严重程度有关,哮喘严重程度越大,小气道参数阳性率越敏感(P＜0.01)。
4.在支气管哮喘、慢性阻塞性肺疾病和符合COPD病史支气管舒张试验阳性病人中MEF50%变异率同FEV_1变异率成正相关(其中哮喘组r=0.788,P=0.000;COPD组r=0.717,P=0.000;符合COPD病史支气管舒张试验阳性组r=0.710,P=0.000),但MMEF同FEV_1变异率变异率不相关(其中哮喘组r=0.234,P=0.136;COPD组r=0.182,P=0.225;符合COPD支气管舒张试验阳性组r=0.208,P=0.191)。
结论支气管哮喘和COPD患者支气管舒张试验后小气道功能均较试验前有所改善,支气管哮喘改善程度较COPD明显。支气管哮喘和COPD支气管舒张试验后小气道的扩张规律不同,前者为逐步扩张并持续较长时间,后者扩张后迅速回缩。支气管哮喘病人中支气管舒张试验后大小气道舒张,但小气道舒张程度较大气道舒张程度明显,慢性阻塞性肺疾病病人中支气管舒张试验后大小气道扩张,但扩张程度没有差别。支气管哮喘病人支气管舒张试验后小气道参数的阳性率较FEV_1敏感,能够进一步提高诊断哮喘的阳性率。支气管舒张试验后支气管哮喘和COPD小气道的扩张程度和大气道的扩张程度呈正相关。
Objective.The bronchial asthma and chronic obstructive pulmonary disease are the most common diseases in the world.The feature of those diseases is airway obstruction.We study the changes of the lung function about the bronchial asthma and COPD after bronchial dilation test and describe the regularity of the dilatation of the small airway.We also explore the difference and the correlation between the big airway and the small airway in order to identify the two diseases.
Methods:We chose 82 patients with asthma and 88 patients with COPD and 41 patients with COPD but the bronchial dilation test is positive.We record the numbers of the FVC,FEV_1,PEF,MEF50%,MEF25%,MMEF before and after the bronchial dilation with the salbutamol.Throgh those numbers,we compare the changes between the small airway and the big airway.We also compare the sensitivity of the positive rate about the small airway function.
Results:The small airway lung function and the big airway lung function improved after the bronchial dilation test in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＜0.01).The lung function of the patients with asthma was better than the patients with the COPD(P＜0.01).The variance rate in FEV_1,MEF50%,MEF25%,MMEF are 22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%.There are statistical significance between those numbers(F=7.031,P＜0.01).The change of small airway of the patients with asthma was high than that before the test(P＜0.01).There was no difference in the variance rate between the test before and the test after in the other two groups(P＞0.05).In the patients with asthma the positive rate of FEV_1、MEF50%、MEF25%、MMEF was 60.98%,75.61%,58.54%,76.83%.The positive rate ofMMEF, MEF50%was more sensitive than the rate of FEV_1(x~2=10.352,P=0.016)and correlate with the Severity of the asthma.The more severe the asthma is,the more sensitive the positive rate of the lung function of the small airway is(P＜0.01).The variance rate in MEF50%correlates with the one in FEV_1 in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＜0.01).The variance rate in MMEF does not correlates with the one in FEV_1 in the patients with asthma COPD and COPD but the bronchial dilation test is positive(P＞0.05).
Conclusions:The big and the small airway are all dilated in the patients with asthma,but the dilatation of the small airway is more than the big airway's.In the same time,the positive rate of the small airway lung function is more sensitive than the big airway's.The big and the small airway are all dilated in the patients with COPD.The dilatation of the small airway is no difference with the big airway's.And the positive rate is low in the patients with COPD.The regular about the small airway is convenient to identify asthma and COPD.
引文
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[1]Tashkin DP.The role of small airway inflammation in asthma.Allergy Asthma Proc,2002,23:233-242.
[2]Corsico A,Milanese M,Baraldo S,et al.Small airway morphology and lung function in the transition from normality to chronic airway obstruction.Journaal of applied physiology,2003,95:441-447.
[3]Brown LK,Millre A,Pilipski M,et al.Forced midexpiratory time reference value and the effect of cigarette smoking.Lung,1995,173:35-37
[4]Babb TG,Rodarte JR.Mechanism of reduced maximal expiratory flow with ageing.Journaal of applied physiology,2000,89(2):505-507.
[5]Currie GP,Jackson CM,Lec DK.Determinants of airway hyerresponsivenseein mild asthmaJ.Ann Allergy Asthma Immunol,2003,90:560-566.
[6]Wang JP,Wang CZ.Multiple index of bronchial dilatete test for asymptomatic patients with asthma.Acta Academiae Medicinae Militaris Tertiae,2000,22:184-187.
[7]Ward C,Johns DP,Bush R,et al.Reduced airway distensibility,fixed airflow limitation,and airway wall remodeling in asthma.Am J Respir Crit Care Med,2001,164:1718-1721.
[8]吕波,周鸿,黄勤欢等.哮喘病人支气管舒张反应曲线的研究.中国实验诊断学,2006.10:58-62.
[9]Taguchi O,Hida W,Nogami H,et al.Possible site of bronchodilation due to inhaled procaterol aerosol in asthmatic patients.Eur J Clin Pharmacol.1988,34:433-435.
[10]李银环,高艳,张生山等.支气管舒张试验小气道指标对哮喘的诊断价值.宁夏医学院学报,2006,28:329-330.
[11]宋玉,佟振月,刘刚等.哮喘病人舒张试验多项指标的比较及临床意义.中国医科大学学报,2003,32:242-243.
[12]吕波,黄瑾,曾红科等.慢性阻塞性肺疾病与支气管哮喘患者支气管舒张反应曲线的比较.Chinese Journal of Practical Internal Medicine,2007,27:1670-1673.
[13]杨生岳,冯恩志,沈君礼等.高原地区慢性阻塞性肺疾病与支气管哮喘患者气道阻塞可逆性对比研究.西北国防医学杂志,2005,26:170-172
[14]陈宇清,周新,蔡映云.吸入沙丁胺醇对慢性阻塞性肺疾病患者呼气流速受限的影响.中华老年多器官疾病杂志,2002,1:193-195.
[15].王洪武,赖利芬,聂舟山等.舒喘灵扩张试验对支气管哮喘和慢性喘息性支气管炎患者小气道功能的影响.天津医药,1998,26:87-89.
[16]蒋雷服.支气管舒张试验中各项评定指标敏感性比较.江苏医药,1997,23:668-669
[17]Maselli R,Paciocco G.Asthma:pathophysiology of the bronchial obstruction.Allergy,2000,61:49-51.
[18]Carroll N,Cooke C,James A,et al.The distribution of eosinophils and lymphocytes in the large and small airways of asthmatics.Eur Respir J,1997,10:292-300.
[19]Roberts CR.J.Chest,1995,107:111-117.
[20]Roche WR.J.AmJ Respir Crit Care Med,1998,157:191-194.
[21]茅培英,崔德健,张进.哮喘小气道及肺组织的病理和生理变化.国外医学呼吸系统分册,2005,25:703-708.
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[23]许浒,熊密,黄庆华等.细菌感染导致慢性阻塞性肺疾病大鼠模型的讨论[J].中华结核与呼吸杂志,1999,22(12):739-742.
[24]James AL,Hogg JC,Dumm LA,et al.The use of the internal perimeter to compara airway size and to calculate smooth muscle shortening[J].Am Rev Respir Dis,1988,138(1):136-139.
[25]Peter J,Barnes.COPD疾病中的小气道问题[J].中国处方药,2004,33:34-35.
[26]陈平,蔡珊,朱应群.肺泡巨噬细胞在慢性阻塞性肺疾病气道炎症中的作用[J].中华内科杂志,2001,40(40):232-235.
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