咳嗽变异型哮喘多项检测指标的Bayes判别分析

Study of several indexes in cough variant asthma by Bayes discriminant analysis

目的探讨咳嗽变异型哮喘(CVA)肺功能、气道弹性阻力、支气管激发试验、最大呼气峰流量(PEF)日内波动率[△PEFR(%)]、支气管肺泡灌洗液(BALF)细胞学以及血清IgE的变化特点及诊断意义。方法对22例CVA、20例慢性阻塞性肺病(COPD)稳定期患者以及20名健康成年人进行最大呼气流量-容积曲线(MEFV曲线)、气道弹性阻力、支气管激发试验、[△PEFR(%)]、BALF细胞学分析以及血清IgE测定。结果(1)CVA患者呼气流量指标[PEF、一秒用力呼气容积(FEV1)、FEV1/FVC、最大呼气中段流量(MMEF)]与健康对照组比较差异无统计学意义(P>0.05)。CVA组气道弹性阻力增高,与健康对照组比较差异有统计学意义(P<0.01),但与COPD组比较差异无统计学意义(P>0.05);(2)CVA组患者气道反应性明显增高,支气管激发试验阳性,Mch-PC20-FEV1明显降低、[△PEFR(%)]增大(>20%)、BALF中嗜酸性粒细胞明显增高、血清IgE明显增高与健康对照组及COPD组比较差异有统计学意义(均P<0.01)。结论气道弹性阻力、支气管激发试验、[△PEFR(%)]、BALF细胞学以及血清IgE的测定有助于CVA的诊断且与COPD等的鉴别。根据Bayes判别结果,鉴别CVA与COPD的上述病因学指标作用大小依次为Mch-PC20-FEV1、IgE、[△PEFR(%)]、BALF嗜酸性粒细胞计数、FEV1/FVC、FEV1、PEF、MMEF和气道弹性阻力,其中主要为Mch-PC20-FEV1、IgE、[△PEFR(%)]、BALF嗜酸性粒细胞计数。

Objective To study of diagnosis value of pulmonary function, airway elastic resistance, bronchial provocative test, [ △PEFR（ % ） ], cytology of BALF, serum IgE in patients with cough variant asthma （CVA）. Methods Curve of MEFV, airway elastic resistance, bronchial provocative test, [ △PEFR（ % ） ] ,cytology of the BALF, serum lgE were measured in 22 cases with cough variant asthma, 20 cases with COPD in stability and 20 normal controls. Results （ 1 ） The indexes of volume of expiration flow （ PEF, FEV1 , FEV1/FVC, MMEF） in the CVA group were no significant different from that of the normal controls （P 〉 0. 05, respectively）. The airway elastic resistance in the CVA group was higher than that of normal controls （ P 〈 0. 01 ）. But no significant difference was detected between the CVA group and the COPD group （P 〉0.05） ; （2） The patients in the CVA group had significant lower value of MchPC20-FEVj ; significant higher value of [ △ PEFR（ % ） ] and higher percentage of eosinophils in BALF and serum IgE as compared to the COPD group and the healthy control group （ P 〈 0. 01, respectively）. Conclusion The levels of Mch - PC20 - FEV1, IgE, [ △ PEFR （ % ） ] and eosinophils in BALF were beneficial to the diagnosis in patients with CVA.