支气管激发试验在慢性咳嗽病因诊断中的应用

Application of bronchial provocation test on etiological diagnosis of chronic cough

目的探讨慢性咳嗽患者支气管激发试验前后小气道功能、气道阻力及胸外气道反应的状况。方法68例慢性咳嗽患者进行组胺支气管激发试验,观察FEV1、呼气中期流速(MEF50)及吸气中期流速(M IF50)的变化,并应用强迫振荡技术测定激发前后患者气道阻力。结果支气管激发试验阳性率52%,激发阳性患者激发前MEF50、R0与阴性组患者差异有统计学意义。MEF50激发后/激发前比值(MEF50%)与FEV1激发后/激发前比值(FEV1%)呈正相关,与R0激发前后差值(R0-d)呈负相关。13例患者呈现胸外气道高反应(占总例数20%),其中6例为单独存在胸外气道高反应,7例患者合并支气管气道高反应。结论观察慢性咳嗽患者小气道功能变化,有利于对哮喘的及早诊治。激发试验时联合观察支气管气道反应和胸外气道反应,可为临床诊断提供线索。

Objective To investigate the changes of small airway function, airway resistance and responsiveness of extrathoracic airway in chronic cough patients before and after bronchial provocation test （BPT）. Methods 68 chronic cough patients were requested to conduct lung function test and BPT. The airway resistance were measured via forced oscillationary technology before and after BPT. Results BPT revealed airway hyperresponsiveness in 52% subjects. MEF50 and R0 before BIT were significantly different between the patients with or without airway hyperresponsiveness. Post BIT changes in MEF50 （ MEF50% ） were correlated positively to the changes in FEV1 （FEV1 % ）, and negatively to the changes in R0 [ R0-d ]. Extrathoracic airway hyperresponsivenes （EAHR） was found in 13 patients, in which 6 patients were not revealed by routine BIT. Conclusion There is small airway function abnormalities in chronic cough patients. Extrathoracic airway responsiveness test is a valuable supplementary index to routine BPT.