脉冲振荡技术在COPD与支气管哮喘鉴别诊断中的价值

目的探讨脉冲振荡法(IOS)对COPD、支气管哮喘(哮喘)的鉴别诊断价值。方法 102例受试者(其中AECOPD40例,哮喘急性发作期36例,以及健康者26例)完成脉冲振荡法检查、肺通气功能(PFT)。比较三组间肺通气功能参数、脉冲振荡的全呼吸相阻抗以及吸气-呼气相阻抗的差别。结果 (1)肺通气功能结果:COPD组、哮喘组均表现为阻塞性通气功能障碍,FEV1%pred、FEV1/FVC、PEF%pred差异无统计学意义。(2)哮喘组代表中心气道阻力的指标R20高于COPD组(P<0.01)。(3)COPD组、哮喘组、健康组吸气-呼气相阻抗比较:仅COPD组的呼气相R5-20大于吸气相R5-20、呼气相X5小于吸气相X5(P值分别为0.041、0.017)。另外COPD组的吸气-呼气相的R5-20变化值(ΔR5-20)、X5变化值(ΔX5)大于哮喘组(均P<0.01)。结论脉冲振荡法有助于支气管哮喘与AECOPD的鉴别诊断。

Value of impulse oscillometry in the differential diagnosis between bronchial asthma and chronic obstructive pulmonary disease

Objective To explore the value of impulse oscillometry（IOS） in the differential diagnosis between chronic obstructive pulmonary disease（COPD） and bronchial asthma（asthma）.Methods 102 subjects,which included 40 acute COPD patients,36 acute asthma patients and 26 healthy volunteers,were all performed with impulse oscillometry and pulmonary ventilation function test（PVF）.The parameters of PVT,whole-breath impedance and inspiratory-expiratory impedance were compared among the three groups.Results（1） There was no statistical significance in FEV1% pred,FEV1/FVC,PEF%pred between the COPD group and the asthma group.（2） R20 was obviously higher in the asthma group than in the COPD group（P0.01）.（3） Only in COPD group,expiratory R5-20 was larger than inspiratory R5-20（P=0.041）,and expiratory X5 was significantly smaller than inspiratory X5（P=0.017）.Additionally,inspiratory-expiratory variations in X5（ΔX5） and inspiratory-expiratory variations in R5-20（ΔR5-20） were larger in the COPD group than in the asthma group（P0.01）.Conclusion Impulse oscillometry is helpful in the differential diagnosis between asthma and chronic obstructive pulmonary disease.