哮喘患者气道阻塞可逆性测定的临床意义

１３４例哮喘患者，以舒喘灵定量吸入进行气道阻塞可逆性试验。结果表明：气道阻塞可逆程度及其阳性检出率与患者的基础ＦＥＶ１呈显著负相关。提示评价药物疗效时应严格选择基础气道阻塞程度相近的对照组与之对比。虽然小气道功能指标的阻塞可逆幅度较大，但其变异大，特异性差。以ＦＥＶ１的改善率为最佳考核指标。本试验尚有助于鉴别形成哮喘气道阻塞的两大成因，并用以指导治疗。     

支气管哮喘缓解期患者气道反应性测定

支气管哮喘是一种嗜酸性粒细胞、肥大细胞和其他多种细胞参与反应而引起的慢性、持久性的炎症疾病 ,可逆性气道阻塞、气道炎症和气道高反应性是哮喘的三大特征。我们对 2 0例缓解期支气管哮喘患者进行气道反应性测定 ,并与对照组进行比较 ,为缓解期支气管哮喘的诊治提供依据。对象与方法1.对象 :( 1)缓解期组 :缓解期支气管哮喘患者 2 0例 ,年龄19～ 3 5岁 ,吸入激素抗炎治疗 1～ 10个月 ,经过治疗症状、体征消失 ,肺功能恢复到急性发作前水平 ,并维持 4周以上。 ( 2 )对照组 :2 0例 ,为无过敏性疾病 ,皮肤过敏原检查阴性的健康者。2 .方法 …     

支气管哮喘与气道炎症和支气管高反应性

现已普遍认为支气管哮喘是一种气道炎症（ＡＩ）疾病，支气管高反应性（ＢＨＲ）是其重要特征。本探讨了哮喘与ＡＩ和ＢＨＲ的关系，进而阐述哮喘的可能发病机制。     

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...     

哮喘患者小气道功能与气道高反应性的关系探讨

目的探讨哮喘患者小气道功能与气道高反应性的关系。方法选取可疑哮喘患者164例进行肺通气功能测定及支气管激发试验(BPT),依据激发试验结果分为AHR阴性组(n=34)、轻度组(n=53)、中度组(n=43)及重度组(n=34),收集临床资料,检测FVC%pred、FEV_1%pred、FEV_1/FVC、PEF%pred、FEF25%pred、FEF50%pred、FEF75%pred、FEF25-75%pred水平,分析患者基础小气道功能与气道高反应性之间的相关性,利用受试者工作特征(ROC)曲线分析小气道功能指标在预测气道反应性中的价值。结果 (1)基础FVC%pred、FEV_1%pred、FEV_1/FVC、PEF%pred、FEF25%pred、FEF50%pred、FEF75%pred、FEF25-75%pred从AHR阴性组、轻度组、中度组到重度组,数值依次递减,差异均有统计学意义(P0.05)。(2)小气道功能障碍的发生率从AHR阴性组、轻度组、中度组到重度组依次递增,差异有统计学意义(P0.001)。(3)以基础FEF25%pred、FEF50%pred、FEF75%pred、FEF25-75%pred作ROC曲线,曲线下面积(AUC)分别为0.80、0.873、0.833、0.879,均大于0.5,差异有统计学意义(P0.001)。结论哮喘患者基础小气道功能指标与气道高反应性密切相关,且对气道反应程度较低或无反应状态的患者有一定的预测价值。     

支气管哮喘妇女月经周期气道反应性的改变

通过对120例支气管哮喘妇女于月经周期利用组织胺为激发剂进行非特异性激发试验,以激发浓度PC_(20)-PEF、激发阈值PD_(20)-PEF、24小时波动率为观察指标,观察月经前期(月经前1周)、月经期、月经期后(月经后1周)的变化,发现支气管哮喘妇女月经期间PC_(20)-PEF、PD_(20)-PEF均低于月经前期及月经期后,月经前期低于月经期后,24小时PEF于月经期间波动率最大,其中有36例(30%)临床上有哮喘症状出现,通过观察说明妇女月经期间气道反应性增强,月经周期和支气管哮喘有密切关系。     

支气管哮喘干预措施对气道反应性的影响

气道高反应性（AHR）是支气管哮喘（哮喘）的重要特点,多种哮喘干预措施可影响气道反应性。吸入糖皮质激素可明显降低AHR,白三烯调节剂降低AHR的作用弱于吸入糖皮质激素。吸入短效β2受体激动剂对AHR有不利影响,而长效β2受体激动剂对AHR无明显影响。避免过敏原能明显改善职业性哮喘患者的AHR。某些免疫治疗方法可减轻部分哮喘患者的AHR。     

小气道功能与气道高反应性的相关性分析

目的：分析小气道功能与气道高反应的相关性。方法选取2012年10月至2013年5月于北京友谊医院及北京房山区良乡医院呼吸科门诊就诊的符合纳入及排除标准的临床怀疑哮喘的患者110例,用肺通气功能进行支气管激发试验(BPT),比较 BPT 阳性组与阴性组肺通气肺功能参数及小气道异常率,使用受试者工作特征曲线(ROC 曲线)评估 FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC 在 BPT 前后的变化量(△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC)对气道高反应的诊断准确性、敏感度及特异度,对阳性组 PD20-FEV1累积量与△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC进行相关性分析。结果 BPT 前后阳性组 FEV1、FEV1/FVC、FEF25、FEF50、FEF75、MMEF、FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC与阴性组比较,差异均有统计学意义(P <0.05)。BPT 前后阳性组小气道异常率与阴性组相比,差异均有统计学意义(χ2=22.482,P =0.000;χ2=25.852,P =0.000)。△FEF25/FVC的曲线下面积(AUC)为0.792[95%CI (0.703~0.881)](P =0.000),△FEF50/FVC的 AUC 为0.767[95%CI (0.677~0.858)](P =0.000),△MMEF/FVC 的 AUC 为0.667[95%CI (0.563~0.771)](P =0.004)。△FEF50/FVC、△MMEF/FVC 与 PD20-FEV1呈正相关(r=0.360,P=0.007;r=0.271,P=0.035)。结论存在气道高反应的患者大小气道功能均明显低于气道反应性正常的患者,存在小气道功能异常的患者BPT可能更易出现阳性结果,小气道功能在激发试验前后的变化可以反映气道高反应性的严重程度。     

检后支气管舒张试验对咳嗽变异性哮喘的诊断价值

目的探讨检后支气管扩张试验对咳嗽变异性哮喘（CVA）的诊断价值。方法选取48例气道反应性增高的慢性咳嗽患者,采用两种方法进行诊断：一种是检后支气管舒张试验,另一种盐酸丙卡特罗诊断试验。判断检后支气管舒张试验的诊断价值。结果48例患者接受检后支气管舒张试验,FEV,增加3％～46％,平均22．8％±8．8％。盐酸丙卡特罗诊断试验显示,48例患者中,阳性38例,占受检人数的79．2％,阴性10例,占20．8％。检后支气管舒张试验诊断CVA的灵敏度为84．2％,特异度80％,阳性预测值94．1％,阴性预测值57．1％。诊断的正确率为83．3％。结论检后支气管舒张试验可以缩短诊断时间,对CVA具有较好的诊断价值。     

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。     

HRCT在支气管哮喘气流受限可逆性评估中的应用价值

目的评估肺部高分辨CT(HRCT)在支气管哮喘气流受限可逆性的应用价值。方法用HRCT在支气管舒张试验前后扫描支气管哮喘患者,测出D、L、T/D及WA%在肺功能舒张试验前后的变化,分析HRCT测量指标与肺功能试验结果在支气管舒张试验前后FEV1变化量的定量关系,判断WA%变异率与FEV_1变异率相关性等研究。结果全部36例、支气管舒张试验阳性和支气管舒张试验阴性患者各18例。支气管舒张试验前后,CT测量前后L、D、T、T/D、WA%测量结果均有统计学差异,支气管舒张试验阳性组与阴性组舒张试验前后各组数据差值均无统计学差异。WA%变异率与FEV_1变异率呈负相关,△L与△FEV1呈正相关。结论 HRCT可通过测定气道壁厚、面积等及其支气管舒张试验前后变化,评估支气管哮喘急性发作患者气流受限的可逆性。     

Damage of the airway epithelium and bronchial reactivity in patients with asthma

We measured bronchial reactivity to inhaled histamine and prepared electron micrographs from bronchial biopsies from 8 asthmatic patients who never smoked (2 females, 6 males, 18 to 62 yr of age). Judging from their clinical histories and the need for medication and long-term follow-up of PEF values, 2 of them had mild asthma, 3 moderately severe, and 3 severe asthma. They had not experienced respiratory infections for at least 2 months prior to the study. The result, obtained from the cumulative dose-response curve, was expressed as the provocative dose (PD20) of histamine producing a 20% fall in forced expiratory volume in one second (FEV1). In 5 patients, the PD20 varied from 0.049 mg to 2.234 mg. In the sixth patient, only PD15 could be measured (5.187 mg). In 2 patients, the low initial FEV1 values, because of severe, partly irreversible obstruction, prevented the measurement of bronchial reactivity. Bronchial biopsies were taken with rigid tube bronchoscopy from 3 levels: (1) at the carina of the right upper lobe, (2) at the opening of the right middle or lower lobe, and (3) inside the right lower lobe. The specimens were prepared for both light and electron microscopy. Fresh biopsies showed that asthma patients can have epithelial destruction at all levels of the airways. The ciliated cells appeared to be the most destroyed cell type in the epithelium. Intraepithelial nerves and mast cells were seen. Epithelial destruction in the respiratory tract of the asthma patients with mild to severe bronchial hyperresponsiveness was prominent enough to expose the epithelial nerves for specific or nonspecific stimuli.     

慢性阻塞性肺疾病与支气管哮喘患者的气道可逆性分析

肺功能检测是判断气流受限重复性较好的客观指标,也是慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）诊断的核心标准,在COPD的诊断、严重程度评价、疾病进展、预后及治疗反应等方面具有重要意义。支气管舒张试验,反映了气道的“可逆性”,曾经是作为诊断支气管哮喘的重要指标,通常用于支气管哮喘和COPD的鉴别。但随着临床上对该检查方法的深入研究,     

完全控制的支气管哮喘患者肺功能和气道高反应性测定

目的检测完全控制的支气管哮喘患者肺功能和气道反应,探讨其临床意义。方法选择71例完全控制的支气管哮喘患者,测定肺功能和气道反应性。选择30名急性发作期支气管哮喘患者和15名健康老年人作为对照。结果71例完全控制的支气管哮喘患者中,49例(84.5%)支气管激发试验阳性,9例(15.5%)支气管激发试验阴性。完全控制哮喘组和哮喘组患者FEV1占预计值%和FEV1/FVC分比较差异有统计学意义(P0.01);完全控制哮喘组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(P0.05)。结论完全控制的支气管哮喘患者多数存在气道高反应性,测定患者气道反应性有助于指导哮喘治疗。     

支气管哮喘的炎症表型及其临床意义

支气管哮喘（bronchialasthma,简称哮喘）是由多种炎症细胞（如嗜酸性粒细胞、肥大细胞、淋巴细胞、中性粒细胞等）、组织结构细胞（如上皮细胞、平滑肌细胞等）及其细胞组分参与的慢性气道炎症性疾病。这种慢性炎症导致气道高反应和可逆的气流受限。临床上表现为反复发作性的喘息、呼吸困难、咳嗽和胸闷等症状。近年的研究证实哮喘具有明显的异质性,根据其发病年龄、发病诱因、呼吸道炎症、     

Correlation between reversibility of airway obstruction and exhaled nitric oxide levels in children with stable bronchial asthma

Recent trials measuring exhaled nitric oxide (eNO) concentrations have suggested that it may be a useful measure of ongoing airway inflammation in patients with asthma. The purpose of this study was to examine the relationship between eNO levels and baseline as well as postbronchodilator spirometry, a measurement commonly used in the clinical setting to determine the severity of asthma and as a guide to therapeutic decisions. Forty-nine patients between the ages of 5-16 years with physician-diagnosed asthma who attended the pediatric pulmonary clinic for a routine asthma visit with spirometric evaluation were recruited for the study. eNO levels prior to spirometry were obtained before and after receiving inhaled beta(2) agonist. eNO samples were collected in impermeable bags (Tedlar) and assayed within 24 hr by chemiluminescence. Regression analysis was used to assess the relationships between pre- and postbronchodilator eNO and spirometric variables. eNO was also compared in patients receiving and not receiving inhaled corticosteroids (ICS), as well as those whose therapy had been increased after evaluation by a pediatric pulmonologist or allergist. We found no significant difference between the levels of eNO before and after inhalation of beta(2) agonist (P = 0.60 paired t-test). Positive correlation was found between eNO vs. percentage change in FEV(1) (r = 0.35, P = 0.01) and percentage change in FEF(25-75% )(r = 0.29, P = 0.04). A negative correlation was found between prebronchodilator FEV(1) and eNO (r = -0.29, P = 0.03). Patients on ICS had lower mean eNO levels (29.9 vs. 47.6 parts per billion (ppb), P = 0.053) than those not receiving ICS. Patients whose ICS therapy was increased had higher mean eNO levels (47.2 vs. 26.9 ppb, P = 0.018) than those not having ICS therapy increased. We suggest that eNO levels could be a clinically useful measurement of asthma severity and could be used as an adjunct to spirometry to determine appropriate treatment plans. Longitudinal clinical trials are needed to determine if eNO can enhance therapeutic decisions for asthmatic children.     

支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点及意义

目的探讨支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点,以便为临床诊断提供依据。方法采用日本产ＡＳＴＯＧＡＰＨＴＣＫ６０００ＣＶ气道反应测定仪,以乙酰甲胆碱为气道激发剂,观察６０例支气管哮喘、５８例咳嗽变异性哮喘及３７例急性支气管炎患者气道反应性变化。结果支气管哮喘和咳嗽变异性哮喘病人气道激发试验均为阳性,哮喘病人的气道反应阈值（Ｄｍｉｎ）低于咳嗽变异性哮喘病人（Ｐ＜００５）。急性支气管炎病人中,气道激发试验３３例阴性,占８９％,４例阳性,占１１％。４例阳性急性支气管炎患者的气道反应性曲线与哮喘组及咳嗽变异性哮喘组明显不同,其Ｄｍｉｎ也显著高于哮喘组（Ｐ＜００１）及咳嗽变异性哮喘组（Ｐ＜００５）。结论气道反应性测定对于不同类型哮喘及急性支气管炎的鉴别和指导治疗具有很好的临床应用价值。     

Usefulness of bronchial reactivity analysis in the diagnosis of bronchial asthma in patients with bronchial hyperresponsiveness

We examined the usefulness of some bronchial reactivity indices to identify bronchial asthma in patients with airway hyperresponsiveness. Eighty-eight consecutive patients with positive response to histamine bronchial challenge (> or = 20% fall in FEV1) were included in the study. Dose-response curves were characterised by their sensitivity (PD20) and reactivity. Dose-response slope, continuous index of responsiveness (CIR) and bronchial reactivity index (BRI) with respect to baseline and post-diluent baseline values were determined as reactivity indices. The clinical diagnosis remaining in the case history 2 years after the bronchial challenge was considered the definitive diagnosis. Asthmatic patients had higher baseline BRI (12.121+/-0.412 vs. 11.615+/-0.201; P<0.001) and post-diluent baseline BRI (12.054+/-0.368 vs. 11.563+/-0.531; P = 0.003) than other subjects. Area beneath their receiver operating characteristic (ROC) curve was 82.68% (standard error: 0.77) for the baseline BRI and 81.73 (standard error: 0.76). By multiple logistic regression analysis, baseline BRI was the only independent variable identified as a predictor for diagnosis of bronchial asthma (r = 0.387, P = 0.0007). A cut-off of 11.76 for baseline BRI reached an 87.2% sensitivity and an 80% specificity for bronchial asthma diagnosis. In conclusion, BRI calculated with respect to baseline FEV1 should be useful in identifying asthmatic patients among subjects with airway hyperresponsiveness.     

哮喘患者氧化/抗氧化系统的变化及意义

为探讨支气管哮喘(哮喘)患者体内氧化/抗氧化系统的变化及其与哮喘的相关性,选择40例非急性发作期哮喘患者、20例健康人(对照组),用放射免疫法和分光光度法测定血清超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性及丙二醛(MDA)含量,同时测定1秒种用力肺活量实测值和预计值百分比(FEV1%).结果显示,哮喘患者SOD、CAT活性低于对照组(P＜0.01,P＜0.05);MDA含量高于对照组(P＜0.01);哮喘患者MDA含量与FEV1%呈显著负相关(P＜0.01);哮喘患者吸入沙丁胺醇治疗后MDA含量减低(P＜0.05),沙丁胺醇 必可酮吸入治疗者较单独吸入沙丁胺醇治疗者SOD活性升高(P＜0.05),MDA含量下降(P＜0.05).表明氧化/抗氧化系统失衡是哮喘发病的重要机制之一,应用β2-受体兴奋剂及吸入糖皮质激素均可减少氧化物的产生.     

支气管哮喘合并变应性鼻炎上下气道共治的临床观察

目的探讨上、下气道共治方法治疗支气管哮喘合并变应性鼻炎的临床效果及其安全性。方法 90例支气管哮喘合并常年变应性鼻炎的患者,按照数字随机表法分为A组(n=30)、B组(n=30)和C组(n=30),A组患者应用沙美特罗替卡松粉吸入剂,B组患者应用布地奈德鼻喷雾剂,C组应用沙美特罗替卡松粉联合布地奈德喷雾剂;对比临床治疗效果。结果治疗12周后,C组的哮喘症状记分、第1秒用力呼气容积、外周嗜酸粒细胞百分比(EOS%)、痰EOS%改善明显优于A组和B组,差异均有统计学意义(P<0.05);三组均未出现严重不良反应。结论沙美特罗替卡松粉吸入剂联合布地奈德喷雾剂治疗支气管哮喘合并变应性鼻炎疗效显著、安全,能够全面地控制上、下气道炎症,具有临床推广价值。