支气管哮喘患者小气道阻塞程度及可逆性研究

摘要

目的 探讨支气管哮喘患者激发试验前后及舒张试验前后小气道功能的变化.方法 采用前瞻性研究方法,对31例已确诊为支气管哮喘的患者行支气管激发试验,激发试验阳性患者予以沙丁胺醇气雾剂吸入,15min后再测定患者肺功能.选择同时期条件匹配的28例气道高反应性升高但不能诊断为哮喘的非哮喘患者作为对照,比较两组间激发试验前后及使用支气管舒张剂后小气道功能指标的差异.结果 ①激发前和激发后,哮喘组最大呼气中期流速(MMEF)、用力呼气25％肺活量的瞬间流量(FEF25％)、用力呼气50％肺活量的瞬间流量(FEF50％)和用力呼气75％肺活量的瞬间流量(FEF75％)均显著低于非哮喘组(P＜0.01).舒张后FEF25％和FEF50％在两组间差异有统计学意义(P＜0.05),但MMEF和FEF75％在两组间差异无统计学意义(P＞0.05).②哮喘组激发前后第一秒用力呼气容积占预计值百分比(FEV1％)、MMEF、FEF25％、FEF50％和FEF75％的下降率显著高于非哮喘组(P＜0.01),舒张前后MMEF、FEF25％、FEF50％ 和FEF75％的上升率也显著高于非哮喘组(P＜0.001),而FEV1％的上升率在两组间差异无统计学意义.③哮喘组激发前后及舒张前后MMEF和FEF75％的变异率要显著高于FEV1％(P＜0.01).非哮喘组激发前后MMEF和FEF75％的变异率也要显著高于FEV1％(P＜0.05),但舒张前后变异率差异无统计学意义(P＞0.05).结论 支气管哮喘患者小气道功能要低于其他原因所致的气道高反应性患者,小气道阻塞的可逆性要高于其他原因所致的气道高反应性患者.支气管哮喘患者大、小气道均存在可逆性阻塞,小气道阻塞的可逆程度要高于大气道.%Objective To investigate the changes of small airway function before and after bronchial provocation test (BPT) and bronchial dilation test (BDT) in patients with bronchial asthma. Methods BPT were performed in 31 patients diagnosed as bronchial asthma (the study group) and 28 patients with airway hypcrrcsponsiveness but without asthma (the control group). Those with BPT positive were given salbutamol, and have the small airway function detected. The data before and after BPT and BDT was compared between the two groups. Results Compared with the control group, MMEF, FEF25%, FEF50% and FEF75% before and after BPT in the study group were significantly lower (P<0.01). No statistically significant difference were found in MMEF and FEF75% after BDT between the two groups, while FEF25% and FEF50% increased significantly in the study group after BDT. The decline rate of FEV,%, MMEF, FEF25%, FEF50% and FEF75% after BPT (P<0.01) and the increase rate of MMEF, FEF25%, FEF50% and FEF75% after BDT (P<0.001) were significantly higher in the study group than those in the control group. The variabilities of MMEF and FEF75% after BPT and BDT were significantly higher than that of FEV,% in the study group (P<0.01). The variabilities of MMEF and FEF75% after BPT were significantly higher than that of FEV.% in the control group (P< 0.0S), while no statistically significant differences was found between them after BDT. Conclusion Compared with the patients with airway hyperresponsiveness but without asthma, the small airway function were lower and the small airway reversibility were higher in patients with bronchia asthma. The big and the small airway are all obstructed in the patients with bronchial asthma, but the reversibility of the small airway is higher than of the big airway's.