支气管哮喘急性发作缓解前后的小气道功能测定

目的肺功能检测在支气管哮喘治疗前后小气道功能的评价作用研究。方法选择31例急性期支气管哮喘患者和30名健康志愿者作为对照,测定其急性期和缓解期肺功能,并加以比较。结果 31例支气管哮喘患者,在哮喘急性发作期测舒张实验全部阳性,哮喘组患者急性发作期和缓解期FEV1占预计值%及FEV1/FVC比较差异有统计学意义(P<0.01);哮喘组患者缓解期和健康对照组受试对象FEV1占预计值%和FEV1/FVC比较差异无统计学意义(P>0.05)。结论急性期哮喘患者均存在大、小气道功能异常,缓解期哮喘患者大气道功能恢复,小气道功能虽有一定恢复,但与正常健康对照组比较仍存在异常。     

50例咳嗽变异型哮喘肺功能临床分析

对比分析典型哮喘患者40例与正常组健康人40例和咳嗽变异型哮喘患者50例的第一秒用力呼气量(FEV1)、用力肺活量(FVC)、第一秒用力呼气量FEV1占FVC比值(FEV1/FVC)、最高呼气流速(PEF)、残气量(RV)及残气量/肺总量(RV/TLC)指标。结果 FEV1、FVC、FEV1/FVC及PEF等肺通气功能指标:正常组最高,咳嗽变异型哮喘次之,而典型哮喘最低,(P0.05),在激发试验前后咳嗽变异型哮喘患者肺功能存在明显可逆性改变。结论咳嗽变异型哮喘存在可逆性气流受限,确诊需要完善肺功能及支气管激发试验(BPT)或支气管舒张试验(BDT)试验。(当患者FEV1≥70%预计值时,可进一步作支气管激发试验;FEV170%预计值提示有气道阻塞时,宜作支气管舒张试验)~([1])     

肺功能及哮喘控制测试(ACT)在哮喘患者管理中的价值

目的探讨肺功能及哮喘控制测试在支气管哮喘患者管理中的价值。方法将肺功能及ACT应用于支气管哮喘患者136例。每月填写1次ACT,在哮喘患者应用ACT前药物治疗时、应用ACT 6个月结束时测定第1秒用力呼气量(FEV1)、FEV1占预计值百分比(FEV1%预计值)和用力肺活量(FVC)、FVC占预计值百分比(FVC%预计值),同时测定ACT评分观察哮喘患者在药物治疗、肺功能检查,应用ACT 6个月末时ACT使用率、治疗的依从性、哮喘控制情况。结果每月1次坚持应用ACT 132例,使用率97%;坚持使用规范的治疗128例,治疗依从性达94%;症状完全控制率达47%,良好控制率达74.2%。ACT评分治疗6个月后较入选时升高,肺功能指标亦有明显改善,FEV1与ACT评分呈正相关(r=0.82,P<0.01)。结论肺功能及ACT用于支气管哮喘患者的管理能提高患者对治疗的依从性和哮喘控制率。     

支气管结核患者的气道高反应性

目的研究支气管结核患者气道高反应性及肺通气功能状况,为早期确诊支气管结核,避免误诊提供客观依据。方法 2002年1月至2005年4月收集24例支气管结核患者,均经纤维支气管镜、胸部 CT、病理等多项检查证实,并进行肺功能测定,且对肺通气功能、气道阻力、气道反应性测定结果进行 t 检验及相关分析。结果高达41.7%的支气管结核患者存在气道高反应性,支气管结核患者还有剧烈咳嗽(100%,24/24)、呼吸困难(54%,13/24)、喘息等症状,而有血痰者仅占21%(5/24),因此极易被误诊为支气管哮喘,特别是咳嗽变异性哮喘。伴有气道高反应性的支气管结核患者的第一秒用力呼气容积占预计值百分比(FEV_1占预计值%)为(80.8±14.1)%,高于未伴有气道高反应性者的(65.8±16.4)%,差异有统计学意义(t=2.345,P<0.05),两组间比较,第一秒用力呼气容积与用力肺活量比值(FEV_1/FVC)、最大呼气中段流量(MMEF)、用力呼出25%肺活量时呼气流量(V_(75%))和气道阻力的差异无统计学意义(t 值为0.506～1.391,P 均>0.05)。伴有气道高反应性的支气管结核患者中,气道高反应性的高低仅与 FEV_1占预计值%呈负相关(r=-0.61,P<0.05),与其他肺功能指标均无明显相关。推测支气管结核患者气道高反应性的形成可能与其气道慢性炎症或刺激受体的暴露有关。结论支气管结核患者的气道高反应性不可忽视,应注意与咳嗽变异性哮喘鉴别。     

支气管舒张试验阴性的哮喘患者呼出气一氧化氮与气道反应性的关系研究

目的 分析支气管舒张试验阴性的哮喘患者呼出气一氧化氮(FeNO)与气道反应性的关系。方法选取2019年3月至2022年3月延安市人民医院和延安市中医医院收治的150例支气管舒张试验阴性的疑似哮喘患者。收集患者的一般资料，测定患者FeNO及肺功能指标[包括第1秒用力呼气容积(FEV₁)占预计值百分比、用力肺活量(FVC)占预计值百分比、FEV₁/FVC比值]。所有患者进行支气管激发试验，记录FEV₁下降20%时吸入乙酰胆碱的累积剂量(PD20-FEV₁)，以PD20-FEV₁<12.8μmol为支气管激发试验阳性，提示气道高反应性，结合临床可诊断为哮喘。根据支气管激发试验结果将患者分为阳性组(n=65)和阴性组(n=85)。支气管舒张试验阴性的哮喘患者FeNO与PD20-FEV₁的相关性分析采用Pearson相关分析。结果 阳性组FeNO、气流受限者占比高于阴性组，FEV₁占预计值百分比和FEV₁/FVC比值...     

支气管哮喘患者气道反应性与可逆性连续测定的临床意义

目的连续测定慢性持续期支气管哮喘(简称哮喘)患者的气道反应性与可逆性,探讨其临床意义。方法98例慢性持续期哮喘患者先进行组胺支气管激发试验,再对激发试验阳性者进行沙丁胺醇支气管舒张试验。结果①基础肺通气功能:用力肺活量(FVC)为(3.19±0.90)L,第1秒用力呼气容积(FEV1)为(2.46±0.71)L,FEV1/FVC为(78.0±8.9)%,基础肺通气功能诊断为小气道功能异常34例,占34.7%,轻度阻塞性通气功能障碍29例,占29.6%,总异常率为68.4%。②支气管激发试验:阳性93例(94.9%)。最大激发剂量时FEV1下降率为(10.1～80.3)%,平均(31.9±11.4)%,其中14.0%(13/93)下降多于40.0%。FEV1较基础值下降20%时的激发剂累计吸入剂量(PD20FEV1)为(0.03～7.72)μmol,平均(1.97±1.68)μmol。气道高反应性分级以轻至中度为主,其中轻度30例,占32.3%,中度42例,占45.2%。③激发后支气管舒张试验结果:FEV1与激发后比较改善率为(56.1±58.9)%,FEV1绝对值增加(0.26～2.26)L,平均(0.78±0.36)L,阳性率为100.0%。激发后最低FEV1与舒张后最高FEV1比较差异有统计学意义(配对t=-22.55,P=0.001),提示吸入舒张剂后FEV1明显升高。结论哮喘患者气道反应性和可逆性连续测定具有重要的临床意义,既可观察哮喘患者阻塞气道的可逆性,指导临床治疗;又可使激发试验诱发的气道痉挛得以舒缓,保证气道反应性测定的安全性。     

胃食管反流病对哮喘患者肺功能影响的研究

目的探讨胃食管反流病对哮喘患者肺功能的影响。 方法收集2015年5月至2017年8月新疆维吾尔自治区人民医院收治并确诊哮喘226例患者的临床资料,根据是否合并有胃食管反流病(GERD)患者分为GERD组102例和非GERD组124例,比较2组患者FEV1占预计值%、FVC占预计值%及FEV1 /FVC%等肺功能指标。 结果GERD发生率45.1%(102/226),GERD组患者FEV1占预计值%、FVC占预计值%及FEV1/FVC%,明显低于非GERD组,差异有统计学意义(P<0.05)。 结论哮喘与GERD密切相关,GERD对哮喘患者肺功能影响大,GERD与哮喘是因果还是伴随关系仍需进一步研究。     

完全控制的支气管哮喘患者186例临床分析

目的探讨获得完全控制的支气管哮喘患者临床特征。方法收集2012年1月至2014年6月深圳市龙岗区人民医院呼吸内科经过规范治疗获得完全控制的支气管哮喘患者186例临床资料与健康对照组进行统计分析。结果完全控制的支气管哮喘患者肺功能指标FEV1%、FEV1/FVC%低于正常对照组,有统计学意义(P0.01),血清总Ig E及外周血EOS显著高于正常对照组(P0.01),获得完全控制的支气管哮喘患者不同剂量药物组之间肺功能检查指标FEV1%、FEV1/FVC%无统计学差别(P0.05)。结论完全控制的支气管哮喘患者肺功能并未恢复正常,仍然存在气道炎症,需要继续抗炎治疗。     

呼出气一氧化氮测定在评价老年人支气管哮喘疗效中的价值

目的探讨检测呼出气一氧化氮(FeNO)检测在评价老年人支气管哮喘疗效中的价值。方法对2011年3～9月因胸闷、喘息、咳嗽就诊于该院门诊,确诊为支气管哮喘并完成随访的42例患者进行研究。患者确诊后嘱其规律吸入沙美特罗/丙酸氟替卡松(50/250)。分别在规律治疗后的1、3、6个月复诊并行肺功能(FEV1/FVC、FEV1/预计值)及FeNO测定。同时以10名健康志愿老年人为对照组,测定上述指标。结果规律吸入治疗1个月后,复查肺功能及FeNO均较前好转,FEV1/FVC(%)达66.87±2.45,FEV1/预计值(%)达76.51±2.48,FeNO(ppb)达21.59±1.79。规律治疗3个月后,患者上述指标较前改善明显,FEV1/FVC(%)达70.44±2.13,FEV1/预计值(%)达80.10±1.89,FeNO(ppb)达19.87±1.33。其中有8名患者肺功能达到正常,但仍有哮喘症状发作(均比治疗前症状减轻)且FeNO值仍高于正常,嘱其继续吸入治疗,余患继续上述治疗。治疗6个月后所有上述指标达正常,FEV1/FVC(%)达74.86±2.01,FEV1/预计值(%)达84.48±1.24,FeNO(ppb)达17.15±0.59。所有患者肺功能及FeNO均达到正常,且无明显哮喘症状发作。结论 FeNO测定比肺功能检测能更好地映应老年人支气管哮喘的疗效。     

支气管反应性与小气道功能及临床缓解时间的关系研究

目的探讨支气管哮喘缓解期患儿的支气管反应性与小气道功能、临床缓解时间的关系。方法选取本院2015年1月-2016年1月收集的94例缓解期支气管哮喘患儿作为研究对象,根据患儿的哮喘缓解时间是否12个月、最大呼气中段流量(MMEF)≥80%进行分组,对比两种分组患儿的支气管激发试验阳性率、肺功能指标。结果 MMEF≥80%组患者的FEV_1、PEF、FEV_1/FVC值均显著的高于MMEF80%组患者,差异具有统计学意义(P0.05);MMEF≥80%组和MMEF80%组患者的吸入激素剂量、激发试验阳性率差异均不具有统计学意义(P0.05);缓解时间12个月患者的FEV_1、PEF、FEV_1/FVC值、吸入激素剂量、激发试验阳性率与缓解时间≤12个月患者比较差异均不具有统计学意义(P0.05)。结论支气管哮喘缓解期患儿仍然存在着气道高反应性及气道阻塞情况,缓解期支气管哮喘患儿的支气管激发阳性率与小气道功能、临床缓解时间关系不显著。     

Exercise provocation test in the diagnosis of bronchial asthma and detection of airway responsiveness]

Exercise provocation test was performed on a bicycle ergometer in 110 asthmatics, 15 allergic rhinitis patients, 10 patients with moderate chronic bronchitis and 22 healthy subjects. 87.5% (21/24) of atypical asthmatics revealed positive exercise induced asthma (EIA), with the overall positive rate of asthmatics being 90% (99/110). There was a close negative linear correlation between the maximal reduction rate in FEV1 induced by exercise (delta FEV1%) and the inhaled histamine dose needed to reduce FEV1 by 20% (PD20FEV1) (r = -0.59, P less than 0.01). None of the healthy subjects, one of 15 allergic rhinitis patients and one of 10 patients with moderate chronic bronchitis showed positive response to exercise test. In contrast, seven of 18 allergic rhinitis patients and all nine patients with moderate chronic bronchitis had positive response to histamine bronchial provocation test. Therefore, exercise provocation test is a reliable method for diagnosing EIA and detecting airway responsiveness and it may possess higher specificity than histamine provocation test in diagnosing bronchial asthma, particularly in atypical bronchial asthma.     

肺功能测定及支气管激发试验对咳嗽变异性哮喘的诊断分析及应用价值

目的探讨在诊断咳嗽变异性哮喘（coughvariantasthma,CVA）过程中支气管激发试验及肺功能测定的效果与应用价值。方法选取我院收治的120例病因不明的慢性咳嗽患者为研究对象,对其实施支气管激发试验检测,并测定呼气峰流速、第1秒用力呼气容积、第1秒用力呼气容积／用力肺活量等各项肺功能指标,对支气管激发检测表现为阳性者吸入糖皮质激素和B。受体激动剂进行治疗,观察治疗前后该组患者症状改善情况。结果本组120例患者中,对其实施支气管激发试验发现其中73例（60．8％）患者检测结果表现为阳性,经吸入糖皮质激素和8：受体激动剂后,59例患者各项肺功能指标与治疗前相比具有显著改善,差异有统计学意义（P〈0．05）。因而确诊为CVA。结论在CVA各项诊断方法中,肺功能测定易于掌握,操作简单,检测费用相对低廉,联合支气管激发试验可有效检出cVA,值得在临床上广泛应用。     

Bronchial hyperresponsiveness is a common feature in patients with chronic urticaria.

BACKGROUND: Chronic urticaria (CU) is a skin disorder characterized by long-lasting release of histamine, and sometimes leukotrienes, from both mast cells and basophils. Although both these substances are potent inductors of contraction of airway smooth muscle, pulmonary function and airway hyperresponsiveness have not been systematically investigated in patients with CU. OBJECTIVE: To assess pulmonary function and airway hyperresponsiveness in patients with CU. METHODS: Twenty-six clinically well-characterized adult patients with CU (M/F 8/18; mean age 47 years) underwent pulmonary function tests and methacholine provocation during a phase of moderate activity of their disease. Twenty-six adult asthmatic patients submitted to methacholine provocation were used as controls. RESULTS: Two patients (8%) had overt asthma on baseline pulmonary function tests. Twenty (77%) patients with a normal baseline pulmonary function showed significant bronchial hyperresponsiveness on methacholine provocation. Altogether, 22/26 (85%) patients had asthma or abnormal bronchial reactivity. Airway hyperresponsiveness was not associated with gender, disease duration, intolerance to NSAID, positive autologous serum skin test or respiratory allergy. On average, asthmatic controls showed a much severer airway hyperresponsiveness than urticaria patients (p < 0.01). CONCLUSION: Patients with CU frequently show bronchial hyperresponsiveness. Prospective studies are needed to assess whether they are at risk for bronchial asthma.     

Reaginic bronchial allergy and the occurrence of reagins against mites in a representative sample of a local Swedish population.

This study involves an investigation of 185 subjects, aged 35--54 years, a representative sample of persons with chronic obstructive lung disease in a local Swedish population. Bronchial asthma was diagnosed in 86 persons, chronic bronchitis in 69 and a combination of bronchial asthma and chronic bronchitis in 30. Reaginic bronchial allergy as a provoking factor was considered as definite when the case history, an intracutaneous test, a bronchial provocation test and a radioallergosorbent test were all positive with regard to one and the same allergen. This was found in 28% of the asthmatics. In 16% of the asthmatics, the diagnosis of reaginic bronchial allergy was not supported by all the four diagnostic criteria used but was considered as probable since the case history or the bronchial provocation test was positive in association with a positive RAST or intracutaneous test with the same allergen. Reaginic (IgE) antibodies in serum to mites (Dermatophagoides pteronyssinus) were found in 20 subjects, 18 of whom also had a positive intracutaneous test for house dust. Four of these 20 subjects had definite and 12 had probable reaginic bronchial allergy. One of the remaining four subjects had chronic bronchitis without asthma. The percentage of definite reaginic bronchial allergy may possibly be increased when reliable bronchial provocations with mite allergen can be performed. Increased IgE levels in serum were found in only eight of the 51 asthmatics with reaginic bronchial allergy and in two of the 65 other asthmatics.     

Airway hyperresponsiveness: the usefulness of airway hyperresponsiveness testing in epidemiology,in diagnosing asthma and in the assessment of asthma severity

The present PhD thesis was conducted at the Respiratory Research Unit at the Pulmonary Department L in Bispebjerg Hospital, Copenhagen, Denmark and describes airway hyperresponsiveness in asthma patients in four studies. The first study concerned risk factors for the development of asthma in young adults in a 12‐year prospective follow‐up study of a random population sample of 291 children and adolescents from Copenhagen, who were followed up from the age of 7–17 years (1986) until the age of 19–29 years (1998). During follow‐up, 16.1% developed asthma, and in these subjects, the most important predictor of asthma development was airway hyperresponsiveness to histamine at baseline. Airway hyperresponsiveness is associated with more severe asthma and a poorer prognosis in terms of more exacerbations and less chance of remission of the disease. The second study described the relation between airway hyper‐responsiveness to methacholine and the quality of life in 691 asthma patients: In asthma patients with airway hyperresponsiveness to methacholine, the quality of life measured with a validated questionnaire (Junipers Asthma Quality of Life Questionnaire) was significantly reduced compared to asthma patients who did not respond to bronchial provocation with methacholine. Airway hyperresponsiveness is not uncommonly observed in non‐asthmatics, and the response to bronchial provocation with methacholine is therefore relatively non‐specific. The mannitol test is a relatively new bronchial provocation test that acts indirectly on the smooth airway muscle cells through the release of mediators from inflammatory cells in the airways; the mannitol could consequently be a more specific test compared with methacholine. The third study showed that out of 16 non‐asthmatics with airway hyperresponsiveness to methacholine, 15 did not respond to bronchial provocation with mannitol Because of the mechanism of action of mannitol, it seems plausible that the response to mannitol is more closely correlated to airway inflammation in asthma compared with the response to methacholine. The fourth study showed that in 53 adult asthma patients, who did not receive treatment with inhaled steroids, there was a positive correlation between the degree of airway inflammation and the degree of airway responsiveness to mannitol as well as to methacholine. The mannitol does, however, have the advantage of being a faster and simpler test to perform, requiring no additional equipment apart from a spirometer. Conclusions: Airway hyperresponsiveness in children and in adolescents without asthma predicts asthma development in adulthood. Asthma patients with airway hyperresponsiveness to methacholine have a poorer quality of life as well as more severe disease and a poorer prognosis compared with asthma patients without airway hyperresponsiveness. Bronchial provocation with mannitol as well as with methacholine were useful for evaluating the severity of asthma and the degree of airway inflammation, and accordingly for determining the need for steroid statement. The mannitol test does, however, have practical advantages over the methacholine test that make it preferable for clinical use.     

呼出气一氧化氮在哮喘诊断中的价值及与肺功能相关性

目的 阐明呼出气一氧化氮（eNO）在不同呼吸系疾病的诊断价值及哮喘患者中eNO与不同肺功能结果的相关性.方法 呼吸系疾病患者共398人,同时检测eNO值、FEV1%预计值、支气管舒张试验.结果 哮喘eNO值明显高于其他呼吸系疾病eNO值.哮喘患者中支气管舒张试验阳性组eNO≥50 ppb占53.8%;支气管舒张试验阴性组eNO＜50 ppb占63.4%.按肺功能严重度分组,各组间eNO值无明显差异.结论 eNO是诊断哮喘可靠的标志物之一;哮喘患者中eNO值与支气管舒张试验结果存在一定相关性,与肺功能严重度无明显关联.     

一磷酸腺苷支气管激发试验的建立

目的 建立一磷酸腺苷(AMP)支气管激发试验的测定方法.方法 由低浓度至高浓度倍增剂量吸入AMP试剂,在吸药前及每次吸药后进行肺功能测定,以PD_(20)FEV_1-AMP<40 mg为判断阳性阈值.对24例健康志愿者(对照组),41例支气管哮喘患者(哮喘组)分别进行AMP支气管激发试验.分析两组的阳性率、PD_(20)FEV_1-AMP、敏感性、特异性、准确度及不良反应.结果 对照组AMP激发试验均为阴性,PD_(20)FEW_1-AMP均>40 mg;哮喘组中38例阳性,阳性率为92.7%,PD_(20)FEV_1-AMP为1.25 mg(6.98 mg).哮喘组的PD_(20)FEV_1-AMP和肺功能变化值△FEV_1、△FVC、APDF的相关系数分别为-0.619(P<0.01)、-0.447(P=0.003)、-0.352(P=0.024).AMP支气管激发试验的灵敏度、特异度和准确度分别为93%、100%和95%,出现喘息、气促、咳嗽和胸闷的哮喘患者分别有78%、29%、29%和10%,但程度较轻,无严重不良反应发生.结论 AMP支气管激发试验的敏感度、特异度、准确度高,可以作为有效诊断哮喘的辅助检查方法,且其安全性良好,本研究成功建立了AMP支气管激发试验的方法.     

A case of combined hypersensitivity pneumonitis and bronchial asthma due to isocyanate (MDI)]

A 29-year-old man was admitted to our hospital complaining of cough, wheezing, dyspnea, and fever one month after handling paint spray containing isocyanate (MDI). Chest HRCT findings showed diffuse ground-glass attenuation in both lung fields. A pulmonary function test revealed restrictive impairment, and the reversibility test was positive. His symptoms, HRCT findings, and pulmonary dysfunction were improved only after the cessation of isocyanate administration. BALF showed lymphocytosis, and the pathological findings of the TBLB specimen revealed cellular alveolitis, but no Masson bodies or epitheloid cell granuloma. As a result of environmental provocation, fever, hypoxia, and reduced peak expiratory flow developed, and the environmental provocation test was positive. The specific antibodies against MDI and TDI were positive in both serum and BALF, and the lymphocyte stimulation test against MDI was positive in peripheral blood. Combined hypersensitivity pneumonitis and bronchial asthma due to isocyanate were therefore diagnosed. Pulmonary dysfunctions due to isocyanate are known to include bronchitis, bronchial asthma, and hypersensitivity pneumonitis. However, case reports of combined hypersensitivity pneumonitis and bronchial asthma due to isocyanate are rare.     

Bronchial Responsiveness During Esophageal Acid Infusion

Among the possible mechanisms explaining the worsening of asthma due to gastroesophageal reflux disease (GERD) is the increase in bronchial hyperresponsiveness. The effects of GERD on bronchial hyperresponsiveness in patients with bronchial asthma have yet to be studied in significant detail. The aim of this study was to determine the effects of esophageal acid perfusion on bronchial responsiveness to bradykinin in patients with both asthma and GERD. In 20 patients with asthma and GERD disease, esophageal pH was monitored with a pH meter and bronchial responsiveness was evaluated by aerosol inhalation of bradykinin during esophageal acid perfusion and, 24 h earlier or later the patients were submitted to another bronchial provocation test without acid infusion. No significant changes were observed in FEV₁, FEF_25-75%, FVC, or PEF during acid perfusion. The response to the bronchial provocation test did not differ between the control day and the day of acid infusion (p = 0.61). The concentration provoking a 20% fall in FEV₁ (geometric mean ± geometric SD) was 1.09 ± 5.84 on the day of acid infusion and 0.98 ± 5.52 on the control day. There is no evidence that acid infusion changes bronchial responsiveness to bradykinin. These findings strongly question the significance of acid infusion as a model to study the pathogenesis of GERD-induced asthma.     

高渗盐水与组胺支气管激发试验在咳嗽变异性哮喘相关性的研究

目的研究探讨高渗盐水与组织胺支气管激发试验在咳嗽变异性哮喘患者中相关性。方法将12名咳嗽变异性哮喘患者分别行组织胺和高渗盐水支气管激发试验,两次试验间隔一周,记录组胺和高渗盐水的累计激发量（PD20）,对其行相关性分析研究。结果两者之间相关系数为0．794,有显著性统计学意义（P〈0．05）。结论两者在咳嗽变异性哮喘中有较强的相关性。