慢性咳嗽患者小气道功能的改变及其临床价值

目的 初步评价肺功能检测中反映小气道功能的指标对慢性咳嗽患者鉴别诊断的临床价值.方法 对109例慢性咳嗽患者进行常规肺功能检测和支气管激发试验,观察支气管激发试验阳性患者与阴性患者小气道功能指标的差异,以及小气道功能异常与正常患者肺功能指标差异和支气管激发试验的阳性率.结果 109例患者中支气管激发试验阳性60例,阴性49例.支气管激发试验阳性患者峰值呼气流速、最大呼气中期流速75/25、呼气中段流速(FEF)25、FEF50、FEF75较阴性患者低,差异有统计学意义(P<0.05),肺活量、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量百分比两者比较差异无统计学意义.109例患者中有48例提示小气道功能异常,其中39例支气管激发试验阳性,占81.2%;而小气道功能正常的6l例患者中,有21例支气管激发试验阳性,占34.4%,两者阳性率比较差异有统计学意义(P<0.01).结论 肺功能中反映小气道功能的指标能预测气道高反应性,对于大量不能开展支气管激发试验的基层医院,有助于发现早期咳嗽变异型哮喘患者,尤其对于合并小气道病变的年轻患者更重要.

The clinical value of changes in small airway function in patients with chronic cough

Objective To evaluate the clinical value of small airway function indexes in lung function in the differential diagnosis of patients with chronic cough. Methods One hundred and nine patients with chronic cough were managed with conventional pulmonary function testing and bronchial provocation test. The difference of small airway function between bronchial provocation test positive and negative indicators, and the difference of lung function and the positive rate of bronchial provocation test between small airway dysfunction and normal small airway function was observed. Results Sixty cases in 109 patients had positive bronchial provocation test and 49 eases were negative. Peak expiratory flow (PEF),maximal midexpiratory flow rate (MMEF)75/25, forced expiratory flow of vital capacity (FEF)25, FEF50,FEF75 were lower than those in negative eases (P<0.05 ), ventilatory capacity, forced vital capacity( FVC ),forced expiratory volume in one second (FEV_1, FEV_1/FVC had no significant differences. Forty-eight eases had small airway dysfunction. There were 39 cases with positive bronchial provocation test, and the positiverate was 81.2%. In 61 cases without small airway function, there were 21 cases with positive bronchial provocation test(34.4%). There was significant difference in positive rate of bronchial provocation test between them (P <0.01). Conclusions Small airway function indexes in lung function can predict airway hyperresponsiveness. In a large number of primary hospital where bronchial provocation test can not carry out,it helps to identify patients with early cough variance asthma. In particular, it is more important in young patients with small airway disease.