4年间气道高反应性对慢性阻塞性肺疾病发病影响的随访研究

目的探讨气道高反应性与慢性阻塞性肺疾病(COPD)之间的因果关系.方法1996年6月,从北京市房山区23个自然村筛查出154例COPD患者和154名非COPD者配对对照,以及23名不吸烟正常对照者进行基线调查,以一秒钟用力呼气容积(FEV1)比基线值下降＞20%的乙酰甲胆碱浓度(PC20-FEV1)＜8g/L为支气管高反应性的阳性标准,分为气道反应性阳性组与阴性组,2000年5月进行复查.结果(1)基线病例-对照研究COPD病例组与吸烟非COPD组有良好均衡性.COPD组气道反应性阳性率显著高于对照组(78%和28%,P＜0.0001).(2)前瞻性研究复查241人,复查率为78.2%.基线非COPD者中气道反应性阳性组38名,复查时COPD发病率为23.7%,气道反应性阴性组84名,COPD发病率为9.5%(RR=2.5,P=0.036);基线COPD患者气道反应性阳性组93例,复查时一秒钟用力呼气容积占用力肺活量比值(FEV1/FVC)恢复到正常范围的比率为12.9%,气道反应性阴性组26例,复查时FEV1/FVC恢复到正常范围的比率为30.8%(P=0.031).结论吸烟人群中,气道高反应性导致肺功能下降速度加快,是COPD发病的独立危险因素.

The relationship between bronchial hyperresponsiveness and chronic obstructive pulmonary disease

OBJECTIVE: To explore the relationship between bronchial hyperresponsiveness and chronic obstructive pulmonary disease (COPD). METHODS: 154 smokers with COPD (FEV1/FVC < 70%) served as a study group and 154 smokers without COPD as a control group and 23 never-smokers as a healthy control group from 23 villages in Fangshan Distract, Beijing in June, 1996. The patients with self-reported and doctor-diagnosed asthma were excluded from participants. Those subjects were divided into a positive group and a negative group based on methacholine bronchial responsiveness. All subjects were worked up in May, 2000. RESULTS: (1) Baseline case-control study: The positive rate of bronchial hyperresponsiveness was 78% in the study group, PC20 = (1.4 +/- 1.6) g/L; however 28% of the matched group were positive, PC20 = (2.7 +/- 2.3) g/L, (P < 0.001); (2) Prospective study: Of 154 pairs case-controls 241 subjects were followed up in May 2000. The rate of following up was 78.2%. The incidence of COPD was 23.7% in 38 subjects without COPD with positive hyperresponsiveness, however incidence of COPD was 9.5% in 84 subjects without COPD with negative hyperresponsiveness (P = 0.036), the relative risk (RR) = 2.5. The rate of FEV1/FVC > or = 70% was 12.9% in 93 patients with COPD and positive hyperresponsiveness, however it was 30.8% in 26 patients with COPD and negative hyperresponsiveness (P = 0.031). CONCLUSION: In smoking population, the bronchial hyperresponsiveness lead to more chronic obstructive pulmonary disease and it may be one of the susceptible risk factors for COPD.