脉冲振荡法在支气管舒张试验中的应用价值

目的 探讨脉冲振荡法(IOS)在气道反应性测定中的价值;研究IOS各值中对支气管哮喘(简称哮喘)诊断有意义的参数.方法 根据入选标准和排除标准共入组38例患者,用常规肺通气法及IOS法进行支气管舒张试验.将舒张前后IOS与肺通气功能各参数进行比较,分析IOS与肺通气功能各参数的相关性,探讨IOS各参数在气道反应性测定中的价值;同时对患者进行随访,使用ROC曲线研究IOS各值中对哮喘诊断有意义的参数,探讨IOS在哮喘诊断中的作用.结果 ①支气管舒张试验无论阳性组还是阴性组,在舒张后R5、R20、R5-20、X5、Fres、Alx及FVC、FEV1、FEV1％pred、PEF、MMEF均较舒张前基础状态有显著差异.②舒张前R5-20、Fres、Alx与FEV1、FEV1％pred、FEV1/FVC％、PEF、MMEF呈显著负相关,与X5呈正相关.舒张后R520、Fres、Alx与FVC、FEV1、FEV1％pred、FEV1/FVC％、PEF呈显著负相关,与X5则呈正相关.③回归分析显示,参数eX5变化倍数与肺通气功能法行舒张试验的结果有回归关系.④ROC曲线说明Alx、X5变化倍数对哮喘的诊断要优于FEV1变化量.2种方法的阳性率差异无统计学意义.结论 IOS可敏感的反映吸入β受体激动剂后气道的舒张变化,其中Alx变化倍数是诊断哮喘最敏感的指标.     

不同控制水平的支气管哮喘患者气道炎症与外周气道功能状态的研究

目的 了解不同临床控制水平的支气管哮喘(简称哮喘)患者的气道炎症状况及外周气道功能,观察哮喘患者诱导痰中的炎症指标能否反映外周气道功能的改变.方法 收集在北京朝阳医院就诊的哮喘患者66例,分为控制组(21例)、部分控制组(28例)、未控制组(17例)以及健康对照组(20名).所有受试者第1天进行哮喘控制测试(ACT)评分,行脉冲振荡肺功能检测气道阻力及肺功能基础值、诱导痰细胞计数和分类以及嗜酸粒细胞阳离子蛋白(ECP)浓度测定;第2天测定呼出气一氧化氮浓度(FE_(NO)),若所测得的FEV_1≥70%预测值则行乙酰甲胆碱激发试验,当气道阻力升高至基础阻力2倍或乙酰甲胆碱达到最大浓度时终止试验,3 min后行气道阻力及通气功能检测;然后嘱受试者行5次深吸气后再复测气道阻力及通气功能.比较4组受试者诱导痰细胞计数和分类、诱导痰中ECP浓度、FE_(NO)水平与ACT评分间的相关性;观察激发后以及深吸气后外周气道阻力的变化与ACT评分、诱导痰中嗜酸粒细胞(EOS)计数、痰ECP水平及FE_(NO)间的关系.结果 (1)哮喘患者诱导痰EOS计数、ECP浓度以及FE_(NO)随着控制水平的下降逐渐增高,且诱导痰EOS计数、ECP浓度均与ACT评分呈负相关(r值分别为-0.43和-0.56,均P<0.01).(2)在健康对照组,乙酰甲胆碱激发后中心气道阻力(R_(20))、外周气道阻力(R_5-R_(20))增高程度间比较差异无统计学意义(F=3.472,P>0.05),而在控制组及部分控制组激发试验后外周气道的反应强于中心气道(F值分别为18.09和14.14,均P<0.01),但激发后R_5-R_(20)的变化与ACT评分、诱导痰EOS计数、ECP、FE_(NO)水平间无相关性.(3)深吸气后,健康对照组R_5-R_(20)由(0.13±0.14)kPa·L~(-1)·s~(-1)降至(0.08±0.09)kPa·L~(-1)·s~(-1)(t=2.84,P<0.05),而控制组、部分控制组R_5-R_(20)分别由(0.24±0.15)、(0.31±0.18)kPa·L~(-1)·s~(-1)>增至(0.30±0.16)、(0.39±0.17)kPa·L~(-1)·s~(-1)(t值分别为3.90、4.68,均P<0.01),但相关分析显示,深吸气后R_5-R_(20)的变化与ACT评分、诱导痰EOS计数、ECP、FE_(NO)水平无相关性.结论 即使在控制水平的哮喘患者,仍存在气道嗜酸粒细胞炎症,且该炎症状态随着疾病控制水平的降低而逐渐加重;哮喘患者深吸气所致的外周气道舒张作用消失;检测诱导痰中的炎症指标并不能反映外周气道功能的改变.     

哮喘支气管舒张试验的新技术研究

目的 以肺通气功能进行支气管舒张试验的方法作为"金标准",探讨脉冲振荡法(IOS)参数在支气管舒张试验中的灵敏度、特异度及阳性标准.方法 对37例急性发作期哮喘患者和30例健康者进行支气管舒张试验,吸药前后均先行IOS测定,再行肺通气功能测定.结果 哮喘组支气管舒张试验阳性率为83.8%,对照组为10%.哮喘组第1秒用力呼气容积(FEV1>)、最大用力呼气峰流量(PEF)及IOS各参数舒张后值和基础值之间均有统计学差异(P<0.01).所有受试者中FEV.均与PEF、IOS各参数呈显著直线相关(除对照组舒张后R5>-R20>外).结论 IOS可作为支气管舒张试验可选择的肺功能方法之一,以Z5>下降≥37.7%、R5>下降≥37.9%作为支气管舒张试验的阳性标准较合理.     

脉冲振荡法与舒张试验结合对支气管哮喘与慢性阻塞性肺疾病鉴别诊断的意义

目的探讨脉冲振荡法(IOS)与舒张试验结合对支气管哮喘与慢性阻塞性肺疾病(COPD)鉴别诊断的意义。方法随机对60例急性期哮喘及78例COPD患者在喷药前后分别进行包括IOS、常规肺通气在内的肺功能检测,比较两组喷药前后IOS测得值及其变化程度的差异。结果喷药前支气管哮喘与COPD组IOS值差异无显著性(P＞0．05),但喷药后支气管哮喘组包括Fres、R5-R20、R5．X5在内的IOS值变化幅度均明显大于COPD组(P均＜0．05)。支气管哮喘组与FEV_(?)增加相关性密切的IOS指标依次为Fres＞R5- R20＞R5＞X5。结论支气管哮喘与COPD患者脉冲振荡结果均显示气道阻力增加与肺顺应性降低,但IOS与舒张试验结合有助于两者鉴别诊断。     

临床控制的支气管哮喘患者外周气道功能状态的研究

外周气道结构和功能的改变在支气管哮喘(简称哮喘)发病机制中发挥着重要作用[1-5].我们利用脉冲振荡技术,以外周气道阻力、外周气道对吸入乙酰甲胆碱的反应性以及深吸气的气道舒张反应作为评价外周气道功能的指标,观察达到临床控制标准的哮喘患者外周气道的功能状态.     

脉冲振荡肺功能在气道反应性测定中的应用

气道高反应性是支气管哮喘(简称哮喘)的主要病理生理特征,临床通过支气管激发试验来测定气道反应性.肺通气功能受患者用力程度的影响,婴幼儿、老年人和有神经肌肉疾病患者难以完成检查.脉冲振荡肺功能(impulseoscillometry,IOS)在平静呼吸时测定,操作简便,适用对象广泛.我们以FEV1作为支气管激发试验的"金标准",探讨IOS参数在支气管激发试验中的敏感性和特异性.     

呼出气一氧化氮与肺功能联合检测对于慢性咳嗽病因的诊断价值

目的探讨呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)、支气管舒张试验及小气道功能检测对于慢性咳嗽病因诊断的临床价值。方法收集2016年4月至2017年4月就诊于我院门诊93例慢性咳嗽患者,均予以Fe NO、肺功能(通气功能、支气管舒张试验、小气道功能)检测,分析FeNO、支气管舒张试验及小气道功能之间的关系。结果支气管舒张试验阳性者48例,阴性者45例,阳性组FeNO水平(47.75±35.22)ppb高于阴性组(27.73±18.13)ppb,两组比较有显著差异(P=0.001,P0.05);支气管舒张试验阳性组患者小气道指标在舒张试验后明显改善,FEV1改善率与舒张试验前小气道指标之间呈负相关;小气道功能减退患者当FeNO水平大于34ppb时,可行支气管舒张试验检查,此时其灵敏度为79.17%,特异度为75.56%。结论 Fe NO水平升高、小气道功能减退的疑似哮喘的慢性咳嗽患者,即使通气功能正常,也应行支气管舒张试验,有助于慢性咳嗽的病因诊断。     

脉冲振荡法在咳嗽变异性哮喘诊断中的应用价值

目的探讨脉冲振荡法(impulse oscillometry system,IOS)在咳嗽变异性哮喘(cough variant asthma,CVA)诊断中的应用价值。方法选择21例BPT试验阳性患者为研究组,20例BPT试验阴性患者为对照组,两组患者均进行IOS各项指标检测,另外对于研究组患者进行支气管舒张试验,并复测IOS指标。结果 CVA患者的R5、R20、Fres及R5实测值/预计值%、R20实测值/预计值%测定值显著高于对照组(P<0.05),提示CVA患者存在不同程度的气道阻力增高;CVA患者经支气管扩张试验后复测的IOS各项指标中R5、R20及Fres均有明显降低(P<0.05),提示CVA患者具有可逆性的气道阻塞。结论 IOS检测简便、安全,具有较好的稳定性及重复性,在慢性咳嗽患者CVA的临床筛选、诊断中具有较好的应用前景。     

支气管舒张试验的舒张时间对支气管哮喘的诊断价值

目的探讨支气管舒张试验的不同舒张时间对支气管哮喘诊断价值。方法对不同程度的支气管哮喘患者,其中轻度30例、中度60例、重度50例,分别于舒张15 min、30 min,重复测定肺通气功能,计算舒张试验的阳性率。结果舒张15min:轻、中及重度支气管哮喘舒张试验的阳性率分别为33.33%、96.67%及62.00%。舒张30 min:轻、中、重度支气管哮喘舒张试验的阳性率分别为36.67%、96.67%及80.00%。结论不同程度的支气管哮喘,支气管舒张试验的阳性率不同,以中度最高,适当延长舒张时间可提高重度支气管哮喘的检出率。     

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。     

无创双水平气道正压通气治疗中重症支气管哮喘临床疗效分析

目的观察无创双水平气道正压通气治疗中重症支气管哮喘的临床疗效。方法将50例患者随机分为两组。两组患者入院后均给予糖皮质激素、氨茶碱、β受体激动剂、祛痰剂、抗感染等对症治疗。治疗组同时使用无创双水平气道正压通气治疗。观察两组临床疗效、症状、体征、肺功能及血气分析的改善情况。结果治疗组临床控制率为76%,总有效率92%,对照组临床控制率为48%,总有效率64%。临床控制率、总有效率两组相比差异有统计学意义(P<0.05)。两组经治疗后日间症状评分、夜间症状评分、FEV1%、PEF%较治疗前有显著的变化(P<0.05)。结论无创双水平气道正压通气治疗中重症支气管哮喘疗效可靠。     

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。     

骨髓间充质干细胞逆转支气管哮喘小鼠气道重塑及其机制的初步研究

目的：探讨骨髓间充质干细胞逆转支气管哮喘(简称哮喘)小鼠气道炎症及对气道重塑的影响。方法采用40只雄性的 BALB/c 小鼠,随机分组为骨髓间充质干细胞对照组、骨髓间充质干细胞治疗组、哮喘模型组、正常对照组。从4周龄雄性小鼠中分离出骨髓间充质干细胞。应用卵白蛋白制备慢性哮喘小鼠模型,采用流式细胞计数法检测小鼠外周血中 CD4+、CD25+调节性 T 细胞的情况,并观察骨髓间充质干细胞抑制之后气道的重塑及气道炎症的情况。结果病理检查可见哮喘模型支气管上皮黏膜有杯状细胞增生,上皮黏膜脱落,部分管腔有大量的炎性细胞浸润,气道平滑肌细胞肥大增生。正常对照组与骨髓间充质干细胞对照组无气道重塑及炎症表现,而骨髓间充质干细胞治疗组有气道炎症并且气道重塑现象明显。哮喘模型组的 CD4+、CD25+调节性 T 细胞比例较骨髓间充质干细胞对照组及正常对照组明显降低(F =12.346、14.528,P 值均<0.05);骨髓间充质干细胞治疗组 CD4+、CD25+调节性 T 细胞比例较哮喘组明显上升(F =9.438,P <0.05);而骨髓间充质干细胞治疗组、骨髓间充质干细胞对照组、正常对照组之间差异无统计学意义。结论骨髓间充质干细胞可逆转哮喘小鼠的气道炎症和气道重塑的程度,是通过上调 CD4+、CD25+调节性 T 细胞的比例发挥作用的。     

Montelukast improves pulmonary function measured by impulse oscillometry in children with asthma (Mio study)

BACKGROUND: Systemic drugs-like oral montelukast can reach lower airways, whose inflammation plays a crucial role in the evolution of asthma, while inhaled drugs hardly reach them. The impulse oscillometry (IOS) technique is useful to evaluate both central and peripheral airways function. OBJECTIVE: To measure the effect of oral montelukast on airways resistance evaluated by oscillometry in children with asthma. METHODS: In an open study, respiratory function in 23 children with mild asthma and a positive bronchodilator response was assessed by spirometry and oscillometry. They took oral montelukast during 4 weeks and were again evaluated. As a control group, 23 similar patients with no preventive treatment underwent the same study. MEASUREMENTS AND MAIN RESULTS: Children on oral montelukast showed improvements (measured in kPa s L(-1)) in all oscillometry parameters: mean 0.20 (22.4%) in total respiratory impedance Zrs5, 0.18 (21.8%) in total airway resistance Rrs5, 0.09 (17.8%) in central airway resistance Rrs20, and 0.09 (28.8%) in distal capacitive reactance Xrs5; the frequency of resonance Fres improved 2.3 Hz (8.7%) (P<0.05 in all cases). No changes were found in the control group. Expiratory flows showed no changes except for a small (0.23 L s(-1), 7.4%) but significant worsening of FEF25-75 in the control group. CONCLUSIONS: Montelukast improves central and especially peripheral airways function in the first month of treatment, as evaluated by IOS, a technique based on tidal breathing analysis which is more sensitive than conventional forced spirometry.     

Comparison of budesonide/formoterol Turbuhaler with fluticasone/salmeterol Diskus for treatment effects on small airway impairment and airway inflammation in patients with asthma

Background

A course of combination therapy with an inhaled corticosteroid (ICS) and a long-acting β₂ agonist (LABA) for asthma can improve lung function, asthma symptoms and reduce exacerbations. Because both medicinal substance and inhalation devices are associated with clinical efficacy, each ICS/LABA combination may have different features. This study aimed to compare the effects of two widely available formulations, budesonide/formoterol (BUD/FM) delivered by a Turbuhaler^®, and fluticasone/salmeterol (FP/SM) delivered by a Diskus^®, on small airway function and airway inflammation.

Methods

Asthmatic patients (n = 40) treated twice daily with FP/SM 250/50 μg with forced expiratory volume in 1 s values controlled above 80% of the predicted normal but with suspected persistent airway inflammation and small airway impairment were enrolled in the study. Patients were randomized into two groups, receiving either twice daily BUD/FM 320/9 μg or FP/SM 250/50 μg, and treatment efficacy was compared after 4 weeks. Outcomes included impulse oscillometry (IOS), fractional exhaled nitric oxide (FeNO), spirometry and Asthma Control Questionnaire (ACQ) scores.

Results

Patients in the BUD/FM group showed significant improvements in their IOS and spirometry parameters of small airway function, FeNO values and ACQ scores, compared with the FP/SM group. There were good correlations between IOS parameters, FeNO and ACQ score changes over the course of the treatment.

Conclusions

BUD/FM twice daily significantly improved small airway impairment and airway inflammation in asthmatic patients, leading to a reduction in asthma symptoms and achievement of good asthma control. In addition, improvement of small airway function may improve airway inflammation and/or lead to better controlled asthma.     

无创双水平气道正压通气治疗中重症支气管哮喘的临床效果观察

目的观察无创双水平气道正压通气(BiPAP)治疗中重症支气管哮喘的临床效果。方法选取2011年4月—2014年2月江西省湘雅萍矿合作医院收治的中重症支气管哮喘患者46例,随机分为对照组和观察组,各23例。对照组采用常规综合治疗,观察组在常规综合治疗基础上加用无创Bi PAP治疗。比较治疗前和治疗72 h后两组患者肺功能指标〔第一秒用力呼气末容积占预计值百分比(FEV1%)和最大呼气流量占预计值百分比(PEF%)〕及血气分析指标(PaO2、PaCO2及SaO2)。结果两组治疗前FEV1%和PEF%比较,差异无统计学意义(P0.05);治疗后观察组FEV1%和PEF%高于对照组(P0.05)。两组治疗前PaO2、PaCO2及SaO2比较,差异无统计学意义(P0.05);观察组治疗后PaO2和SaO2高于对照组,PaCO2低于对照组(P0.05)。结论无创Bi PAP治疗中重症支气管哮喘效果确切,可有效改善患者肺通气功能,迅速纠正低氧及CO2潴留情况。     

Peripheral airways involvement in children with asthma exacerbation

ObjectiveThe literature provides some evidence of peripheral airways key role in the pathogenesis of asthma. However, the extent to which lung periphery including acinar zone contribute to asthma activity and control in pediatric population is unclear. Therefore, the aim of the study was to estimate peripheral airways involvement in children with asthma exacerbation and stable asthma simultaneously via different pulmonary function tests.MethodsChildren with asthma exacerbation (n = 20) and stable asthma (n = 22) performed spirometry, body plethysmography, exhaled nitric oxide, impulse oscillometry (IOS), and multiple‐breath washout (MBW).ResultsPeripheral airway''s function indexes were increased in children with asthma, particularly in group with asthma exacerbation when compared with stable asthma group. The prevalence of abnormal results was significantly higher in asthma exacerbation. All children with asthma exacerbation had conductive ventilation inhomogeneity; 76% had acinar ventilation inhomogeneity. According to IOS measurements, resistance and reactance were within normal range, but other IOS parameters were significantly higher in children with asthma exacerbation compared with stable asthma group. The 36% of children with acute asthma had air trapping.ConclusionSignificant involvement of peripheral airways was observed in children with asthma, particularly in asthma exacerbation, which determine lung periphery as important additional target for therapy and provide new insights into pathophysiological process of pediatric asthma.     

Lungensport bei asthmakranken Erwachsenen

Physical exertion can lead to increased obstruction due to greater loss of bronchial heat and dehydration as a result of increased ventilation. Having experienced exertion-induced dyspnea, asthmatic patients often avoid physical exertion, which leads to deconditioning. Studies in asthmatic patients have shown that the level of physical fitness is not limited by asthma parameters but results from a lack of exercise. Unrestricted training is possible providing that stage-appropriate treatment is provided. Results in an animal model showed that moderate endurance training can reduce allergic inflammation in the respiratory tract. In contrast, strenuous endurance training may exacerbate bronchial hyperresponsiveness and eosinophilic airway inflammation. In comparison with the data available for chronic obstructive pulmonary disease (COPD), few controlled studies have been conducted on the effect of lung exercise in asthmatic patients. Improvements in physical exertion parameters were shown without altering pulmonary function. The best training method for asthma patients has not yet been conclusively established. Physical exercise, e.g. in a lung exercise group, should be recommended to all asthma patients.     

无创双水平正压通气治疗重症支气管哮喘96例临床分析

目的探讨无创双水平正压通气(BiPAP)在重症支气管哮喘治疗中的应用价值。方法观察96例重症支气管哮喘患者(无创通气组)在传统内科治疗基础上运用BiPAP治疗2h后的显效率,并与单用传统内科方法治疗的61例患者(对照组)进行比较。结果治疗后,两组患者的显效率间差异有统计学意义(P<0.05)。结论Bi-PAP是治疗重症支气管哮喘的有效方法,可有效缓解患者的症状,改善通气功能。