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。

Bronchial hyperreactivity in endobronchial tuberculosis

Objective To investigate the bronchial hyperreactivity(BHR)and pulmonary function in patients suffering from endobronchial tuberculosis(EBTB),and therefore to provide clues for early and correct diagnosis of EBTB.Methods Twenty-four patients with EBTB,proved by fiberoptic bronchoscopy, chest computerized tomography and biopsy,received measurements of pulmonary ventilatory function,airway resistance(Raw),and bronchial responsiveness test.The results were analyzed by t test and correlations. Results As many as 41.7% of the patients with EBTB were found to have BHR,which had never been recognized before.The patients with EBTB usually had severe cough(100%,24/24),shortness of breath (54%,13/24),and wheezing,but bloody sputum was found in only 21%(5/24),and so the patients tended to be misdiagnosed as having asthma,especially cough variant asthma.FEV_1% in the group of EBTB with BHR was significantly higher than that in the group of EBTB without BHR(t=2.345,P<0.05).But there was no significant difference of FEV_1/FVC%,MMEF%,V_(75%)and Raw between the two groups.In the group of EBTB with BHR,FEV_1% showed a negative correlation with BHR(r=-0.61,P<0.05),but there was no remarkable correlation between the other pulmonary function parameters with BHR.Conclusion BHR is present in a considerable number of patients with EBTB,and therefore attention should be paid to the differential diagnosis of EBTB and cough variant asthma.