支气管激发试验预测支气管哮喘患者治疗的远期预后分级

Assessment of Bronchial Provocation Test in Predicting Long-term Prognostic Scale of Bronchial Asthma Patients

目的探讨支气管激发试验评估气道反应敏感性是否可以对支气管哮喘患者经糖皮质激素治疗的远期预后进行分级。方法选取2007—2009年白银市第一人民医院符合支气管哮喘诊断标准的支气管哮喘患者173例,按照不同药物激发浓度出现气道高反应性阳性,将患者分为10组,分别为乙酰甲胆碱吸入剂量0.030μmol组、0.060μmol组、0.125μmol组、0.250μmol组、0.500μmol组、1.000μmol组、2.000μmol组、4.000μmol组、6.000μmol组、8.000μmol组。患者均行标准支气管哮喘糖皮质激素吸入治疗方案：舒利迭（沙美特罗/丙酸氟替卡松50/250μg,2次/d,持续3个月）。分别于治疗后6个月及1、2、3年复查支气管激发试验,评估治疗后气道高反应阳性率。结果各组患者性别、年龄、病程比较,差异均无统计学意义（χ2性别=1.615,F年龄=0.385,F病程=0.533,P〉0.05）。随访6个月及1、2、3年时,不同组别复发率比较,差异均有统计学意义（P〈0.05）。在不同组别复发率下降过程中,出现3个较为明显的平台期,即0.030~0.250μmol、0.500~4.000μmol、6.000~8.000μmol。结论气道反应的敏感性可以对支气管哮喘糖皮质激素治疗患者远期预后进行分级,即乙酰甲胆碱吸入浓度在0.030~0.250μmol为高度复发可能患者（〉40%）,吸入浓度在0.500~4.000μmol为中度复发可能患者（30%~35%）,吸入浓度在6.000~8.000μmol为低度复发可能患者（〈20%）。

Objective To learn whether bronchial provocation test in assessing the sensitivity of airway responsiveness of bronchial asthma can be used to grade the long- term prognosis of bronchial asthma treated by glucocorticoid. Methods A total of 173 patients with bronchial asthma meeting the standard of asthma were chosen from the First Hospital of Baiyin City from2007 to 2009 and divided into 10 groups according to the haled methacholine concentrations stimulating positive airway hyper responsiveness： 0. 030,0. 060, 0. 125, 0. 250, 0. 500, 1. 000, 2. 000, 4. 000, 6. 000 and 8. 000 μmol. This study selected glucocorticoid inhaled treatment protocols and treated the patients by Seretide Accuhaler（ salmeterol / fluticasone propionate,2 times / d,3 weeks） and then did bronchial provocation test again to assess the positive rate of airway hyper responsiveness,6 months,1,2 and 3 years after treatment. Results There were no significant differences in gender,age and course of disease（ χ2gender= 1. 615,Fage= 0. 385,Fcourse= 0. 533,P 0. 05）. After 6 months,1,2 and 3 years of follow- up,the differences of the 10 groups in recurrence rate were all significant（ P 0. 05）. During the decline of relapse rate,3 obvious platform periods appeared： 0. 030- 0. 250 μmol,0. 500- 4. 000 μmol,6. 000- 8. 000 μmol. Conclusion The sensitivity of airway responsiveness of bronchial asthma can be used to grade long- term prognostic effect of glucocorticoid treatment. When inhaled methacholine concentration is between 0. 030- 0. 250 μmol, the recurrence probability is high（ 40%）; when between 0. 500- 4. 000 μmol,the probability is moderate（ 30%- 35%）; when between 6. 000- 8. 000 μmol,the probability is low（ 20%）.