慢性咳嗽患者小气道功能与气道高反应的相关性分析

Correlation between small airway function and airway hyper responsiveness in patients with chronic cough

  • 摘要: 目的 探讨小气道功能对气道高反应的预测价值。 方法 收集疑似存在气道高反应且通气功能和支气管舒张试验均正常的慢性咳嗽患者194例,分析小气道功能指标与气道反应性和敏感性指标间的相关关系。 结果 本组支气管激发试验阳性率72.68%,阳性组与阴性组比较,25%,50%,75%肺活量位的用力呼气流速(FEF 25%、FEF 50%、FEF 75%)和最大呼气中期流速(MMEF75/25)显著下降(P<0.01),而肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气量(FEV1)、最大呼气流量(PEF)无统计学差异。小气道功能异常发生率为39.18%,异常组激发试验阳性率为92.11%,正常组为60.17%,两组阳性率差异有统计学意义。小气道功能正常组和异常组比较,基础呼吸阻力(Rrs)、基础呼吸传导率(Grs)、反应阈值(Dmin)和PD35的差异有统计学意义,传导率下降斜率(SGrs)的差异无统计学意义。小气道功能指标与气道反应性和敏感性指标相关(r值最高为0.47)。FEF 25%、FEF 50%、FEF 75%、MMEF 75/25与PD35、Dmin多元回归分析的负相关系数分别为0.472 1和0.459 1(P值均<0.05)。Logistic回归分析显示:小气道功能异常对激发试验结果有显著影响(P=0.000 3,OR值为6.19)。 结论 支气管激发试验阳性患者与阴性患者相比小气道功能有统计学差异,小气道功能下降对气道高反应有一定的预测价值。

     

    Abstract: Objective To study the value of small airway function for predicting airway hyper responsiveness. Methods One hundred and ninety-four patients with chronic cough who had suspected airway hyper responsiveness with normal ventilation function and bronchial dilation testing were enrolled in this study.Correlation between small airway function,airway reactivity and sensitivity was analyzed. Results The positive rate for bronchial challenge testing was 72.68% in these patients.The forced expiratory flow(FEF) rate was 25%,50%,and 75%,respectively.The maximal mid-expiratory flow(MMEF) rate was significantly lower in patients receiving positive challenge testing than in those receiving negative challenge testing(P<0.01).No significant difference was observed in vital capacity(VC),forced VC(FVC),forced expiratory volume 1(FEV1),and peak expiratory flow(PEF).The incidence of small airway dysfunction was 39.18%.The positive challenge testing rate was 92.11% in abnormal group and 60.17% in normal group(P<0.05).A significant difference was found in Rrs,Grs,Dmin,and PD35 but no significant difference was observed in SGrs between normal and abnormal small airway function groups.The small airway function was correlated with the airway reactivity and sensitivity(r=0.47).Multiple regression analysis showed that the FEF was 25%,50% and 75%,respectively,while the coefficient for MMEF of PD35 and Dmin was 0.472 1 and 0.459 1,respectively(P<0.05).Logistic regression analysis displayed that the abnormal small airway function exerted a significant effect on the challenge testing(P=0.000 3,OR=6.19). Conclusion Small airway function in patients receiving positive bronchial challenge testing is significantly different from that in those receiving negative bronchial challenge testing.Decreased small airway function is of a certain value for predicting the airway hyper responsiveness.

     

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