老年不吸烟支气管哮喘病人的病程及其生理结局

The Natural History and Physiological Outcomes of the Elderly Asthmatics Without Cigarette Smoking

目的对老年不吸烟支气管哮喘患者的肺功能状态及其生理结局进行观察。方法80例老年不吸烟支气管哮喘患者分成LDA病程(中位数≥25年)及SDA(中位数<25年)两个亚组,测定血清IgE水平、变应源皮试、基础肺功能及支气管扩张剂应用后肺功能测验。结果LDA和SDA患者血清IgE水平相似;两亚组患者都存在有意义的气流限制。支气管哮喘病程和FVE1预计值(%)及V50预计值(%)之间存在负相关(P<0.05);Raw和支气管哮喘病程之间存在正相关(P<0.01)。支气管扩张剂应用后FEV1预计值(%)LDA患者显著低于SDA(P<0.01),PEER在LDA患者明显低于SDA(P<0.01);无论是基础值或是支气管扩张剂应用后测验FEV1/FVC表明,LDA患者均低于SDA(P<0.05或P<0.01)。结论长期存在的支气管哮喘导致不可逆性肺功能减退,可能与持续的气道炎症引起的气道重构有关。

Objective The purpose of this study is to observe the natural history and physiological outcomes of the elderly asthmatics without cigarette smoking. Methods 80 the elderly asthmatics without cigarette smoking are divided into two groups, the patients with asthma of long duration （ LDA ,n = 38 ,median in duration of asthmas〉25 years） and short duration（ SDA ,n = 42, median 〈 25 years） ,the serum IgE level, allergen skin test,and lung function of front and after of β2 - agonist administration were tested. Results The serum IgE level is similar in patients with LDA and SDA . Two groups exits the meaningful limitions of airflow. Patients with LDA had a significantly lower FEV1% predicted than did those with SDA （59.2 ± 2.6versus 73.8 ± 3. 1 , respectively, P 〈 0.01 ）. The asthmatic history was inversely associate with the FVE1% predicted value （r = 0.27 ,P 〈 0.05 ）. After of ±2 -agonist administration ,the patients with LDA continued to show airflow obstruction [ FEV1 % predicted （65.4 ± 2.9 ） 1 - The FRC% predicted was significantly higher in patients with LDA than those with SAD 143.0 ±6 versus 127.0 ±6,respectively,P 〈0.01. The FEV1 level and PEER or FEV1/FVC in the front and after of β2 - agonist administration shows markedly lower in patients with LDA than those with SDA（ P 〈 0.01 ） . Conclusions These data suggest that the duration of asthma is associated with the degree of airflow limitation and hyperinflation. Moreover,these abnormalities can become irreversible over time,and may reflect distal airway and/or parenchymal changes as well as proximal airway remodeling.