疑似哮喘患者气道反应性与性别及年龄关系251例探讨

Relationships between gender,age,and airway hyperresponsiveness in 251 suspected asthmatic patients

目的探讨气道高反应性(AHR)与性别、年龄及哮喘之间的关系,为诊断、治疗和研究哮喘的发病规律提供依据。方法对251例可疑哮喘患者支气管药物激发试验(BCT)的结果进行分析。251例患者中男99例,女152例,年龄21～66岁,根据年龄分为A组(21～30岁,n=40例)、B组(31～40岁,n=109例)、C组(41～50岁,n=59例)、D组(50岁以上,n=43例)。所有受试者在受试前满足试验要求:①排除心功能不全、高血压、甲状腺功能亢进及减退、妊娠等。②症状应缓解,无呼吸困难及哮鸣音、1秒钟用力呼气容积(FEV1)占预计值百分比>70%。③停用支气管扩张剂(茶碱类、β受体兴奋剂或胆碱药)12小时以上、抗组胺药停用48小时、停用皮质激素口服剂24小时。④停吸烟至少2小时。结果①阳性率:251例中检出BCT阳性74例,总阳性率29.5%,其中A组16例(40.0%)、B组34例(31.2%)、C组14例(23.7%)、D组10例(23.2%)。②各年龄组男、女阳性检出率:A组40例中男、女分别为18例、22例,其中阳性6例、10例,检出率分别为33.3%、45.5%;B组109例中男、女分别为41例、68例,其中阳性23例、11例,检出率分别为56.1%、16.2%;C组59例中男、女分别为18例、41例,其中阳性1例、13例,检出率分别为5.6%、31.7%;D组43例中男、女分别为22例、21例,其中阳性2例、8例,检出率分别为9.1%、38.1%。③各年龄组BCT可疑阳性检出情况:251例中检出可疑阳性例数16例,可疑阳性率为6.4%。其中A组1例(2.5%)、B组3例(2.8%)、C组7例(11.8%)、D组5例(11.6%)。结论各年龄组男、女30岁以后AHR阳性率比较差异有统计学意义,AHR是诊断咳嗽变异性哮喘的重要指标。要保证结果准确,质量控制非常重要。

Objective To provide evidence for asthma diagnosis, treatment, and incidence regularity research through exploring and investigating the relationships among airway hyperresponsiveness （AHR）, gender, age, and asthma. Methods In this study,we analyzed the cross-section data of bronchial challenge test（BCT） results from 251 cases of suspected asthma patients. The 251 patients,male 99 cases,female 152 cases,aged from 21 to 66 years old, were divided into four different age groups：group A （21 to 30 years old, n =40 cases）,group B （31 to 40 years old, n = 109 cases）,group C （41 to 50 years old, n =59 cases） and group D （〉50 years old, n =43 cases）. Before BCT,the following criteria must be met： ① No symptoms of cardiac insufficiency, hypertension, hyperthyroidism, hypothyroidism, gestation, etc; ②AHR symptoms alleviated, no dyspnea or inspiratory wheeze, and percentage of one second forced expiratory volume （FEV1） over predicted FEV1 （（FEV1/predicted FEV1 ）%） greater than 70% ;③No use of bronehodilator （theophylline and derivatives, 13-receptor stimulants, or cholinergic medications） for over 12 hours,antihistamine for 48 hours,and oral corticosteroids agent for 24 hours;④No smoking for at least 2 hours. Results ①Positive rate：a total of 74 （or 29.5%） out of 251 cases had positive BCT results,16 cases （40.0%） from group A,34 cases （31.2%） from group B, 14 cases （23.7%） from group C, and 10 cases （23.2%） from group D. ② Detection rate by gender in each age group：within 40 patients in group A：6 out of 18 cases were detected with positive results in male, while 10 out of 22 female patients were detected with positive results, and detection rates were 33.3 %, 45.5% respectively;within 109 patients in group B： 23 out of 41 in male, 11 out of 68 in female, and detection rates were 56.1%,16.2% respectively; within 59 patients in group C： 1 out of 18 in male, 13 out of 41 in female, and detection rates were 5.6%, 31.7% respectively; within 43 patients in group D： 2 out of 22 in male, 8 out of 21 in female, and detection rates were 9.1%, 38.1% respectively. ③Suspected positive rate in different age groups：a total of 16 suspected positive results within the 251 cases were detected,and suspected positive rate was 6.4 %, 1 case （2.5 % ） in group A,3 cases （2.8%） in group B,7 cases （11.8%） in group C,and 5 cases（11. 6%） in group D. Conclusion For patients over 30 years old, the positive rate between male and female are significantly different among different agegroups. AHR could be used as one of the major indicators in diagnosing cough-variant asthma, and quality control is critical in ensuring accuracy.