南方医科大学学报

南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (03): 330-.

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典型哮喘与咳嗽变异性哮喘的小气道功能差异分析

陈树煜，方泽葵，方思，沈其晓，何熹，王翠兰，于化鹏   

  • 出版日期:2017-03-20 发布日期:2017-03-20

Comparison of functional parameters of small airways between patients with typical asthma and cough-variant asthma

  • Online:2017-03-20 Published:2017-03-20

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摘要： 目的对比典型哮喘、咳嗽变异性哮喘（CVA）患者的小气道功能指标及临床特征差异，为延缓咳嗽变异性哮喘向典型哮喘 进展提供依据。方法43 例初诊哮喘患者分为典型哮喘激发试验阳性组（TA BPT(+)，n=15）、典型哮喘舒张试验阳性组（TA BDT(+)，n=12）和咳嗽变异性哮喘组（CVA，n=16）；以同时段27例健康体检者为对照组。受试者进行资料采集、哮喘控制测试、 哮喘测试控制量表、呼出气一氧化氮、脉冲震荡气道阻力检查、肺通气功能检查，支气管激发试验或舒张试验。结果TA BDT (+)起病至明确诊断间隔时间最长、TA BPT(+)次之、CVA最短（P=0.022）。TA BDT(+)肺通气功能指标明显低于TA BPT(+)、 CVA、对照组（均P<0.05）；TA BDT(+)、TA BPT(+)、CVA患者最大呼气中期流速、75%、50%、25%肺活量时最大呼气流速均较对 照组低（P<0.01）。TA BDT(+)患者响应频率、呼吸总阻抗、总气道阻力、中心气道阻力、外周气道阻力、外周弹性阻力较对照组高 （P<0.05），而TA BPT(+)、CVA与对照组无统计学差异。TA BPT(+)、CVA、对照组激发试验前后气道阻力指标升高，气道阻力指 标改变量TA BPT(+)最大，CVA次之。CVA患者呼出气一氧化氮与呼吸总阻抗、总气道阻力、中心气道阻力呈强正相关性（r= 0.523，0.542，0.524，P=0.038，0.030，0.037），气道反应性与中心气道阻力呈强正相关性（ρ=-0.512，P=0.043）。结论CVA是TA 的早期阶段，推测CVA、TA BPT(+)、TA BDT(+)是哮喘的不同阶段。当CVA未控制可发展为TA BPT(+)；继续进展可出现气道 功能改变及肺功能损害，可能发展为TA BDT(+)。

Abstract: Objective To compare the functional parameters of the small airways and clinical characteristics between patients with typical asthma (TA) and cough-variant asthma (CVA). Methods Forty-three newly diagnosed asthmatic patients were enrolled, including 15 with TA and positive bronchial provocation test [TA BPT(+)], 12 with TA and positive bronchial dilation test [TA BDT(+ )] and 16 with CVA, and 27 healthy subjects served as the control group. All the subjects were required to complete data acquisition, asthma control test, asthma control test scale, fractional exhaled nitric oxide, airway resistance and pulmonary function tests, BPT or BDT. Results The interval from onset to a definite diagnosis of TA BDT(+) was longer than that of TA BPT(+ ), while that of CVA was the shortest (P=0.022). The pulmonary functional parameters of TA BDT (+ ) was significantly lower than those of the other 3 groups (P<0.05). MMEF, MEF75, MEF50, and MEF25 in patients with TA BDT(+), TA BPT(+ ) and CVA were significantly lower than those in the control group (P<0.01). The resonant frequency, respiratory impedance, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz were significant higher in patients with TA BDT (+) than in the control subjects, while these parameters showed no significant differences among TA BPT (+ ), CVA and control groups. The airway resistance in TA BPT(+), CVA, and control groups increased after BPT, and the patients with TA BPT(+) showed greater changes in airway resistance than those in CVA and control groups. In CVA patients, FeNO showed a strong positive correlation with respiratory impedance (r=0.523, P=0.038), resistance at 5 Hz (r=0.542, P=0.030), and resistance at 20 Hz (r=0.524, P=0.037), and the airway responsiveness showed a strong positive correlation with resistance at 20 Hz (ρ=-0.512, P= 0.043). Conclusion CVA is the early stage of TA, and CVA, TA BPT(+), and TA BDT(+) may represent different stages of asthma. Uncontrolled, prolonged CVA may evolve into TA BPT (+), whose further progression can cause damages of the pulmonary function and small airway function and leads eventually to TABDT (+).