COPD及支气管哮喘患者支气管舒张试验前后气道阻力变化的对比研究

Changes of Airway Resistances before and after Bronchial Dilation Test in COPD and Asthma

目的探讨COPD和支气管哮喘患者在支气管舒张试验测定前后气道阻力的变化规律及应用价值。方法用脉冲振荡法(IOS)测定不同严重程度的61例COPD患者、42例哮喘患者支气管舒张试验前后的气道阻力,以21例健康人作为对照,分析两种疾病不同的气道阻力特征及变化情况。结果 COPD和哮喘支气管患者在舒张试验前除X5外各项气道阻力指标均明显高于健康人(P<0.05);轻度哮喘患者与中重度患者比较除X5、Rc外各阻力指标均有明显差异(P<0.05);中度及重度COPD与轻度比较仅有Z5、Fres、Rp有明显差异(P<0.05),重度与中度间各气道阻力指标未见明显差异(P>0.05)。COPD及哮喘支气管舒张试验前后比较除X5外其他各项指标均有明显差异(P<0.05),Z5、Fres、R5、Rp指标变异率均明显高于FEV1%pred(P<0.05),哮喘组中差异较COPD更为明显(P<0.05)。Z5、Fres、R5、Rp在COPD及哮喘均与FEV1%pred呈显著负相关(P<0.01),两组均以Fres相关性最好(r值分别为-0.561、-0.761)。结论 IOS法测定气道阻力是判断COPD及哮喘气流阻塞的敏感指标,通过测定支气管舒张试验前后气道阻力对早期诊断COPD和哮喘及其鉴别诊断有重要应用价值。

Objective To explore the profile and diagnosis value of airway resistances before and after bronchial dilation test （BDT） in patients with COPD and asthma.Methods Airway resistances before and after BDT were measured in COPD patients and asthma patients with different severity by impulse oscillometry （IOS）,and the characteristic changes of the two different diseases were analyzed compared with healthy subjects.Results Airway resistance indexes except X5 were higher in the COPD and the asthma patients than those in the healthy subjects before BDT （P0.05）.There were significant differences in airway resistance indexes except X5 and Rc between the mild asthma patients and the moderate to severe asthma patients.Significant difference in Z5,Fres,and Rp were observed in the mild COPD patients compared with the moderate to severe COPD patients.There were statistical differences in airway resistance indexes except X5 between the two groups before and after BDT both in the COPD and the asthma patients （P0.05）.The rates of change in Z5,Fres,R5,and Rp were higher than those of FEV1%pred,especially higher in the asthma patients than in the COPD patients （P0.05）.Significant negative correlations between FEV1%pred and Z5,Fres,R5,Rp were revealed in the COPD and the asthma patients （P0.01）.The correlation between Fres and FEV1%pred was most significant in the COPD and the asthma patients （r=-0.561,-0.761）.Conclusion Airway resistances measured by IOS is sensitive indicators in detecting the airflow obstruction in COPD and asthma,and is useful in early and differential diagnosis of COPD and asthma.