非变应性鼻炎患者小气道功能的改变

Changes in small airway function in patients with non-allergic rhinitis

目的小气道功能减退是哮喘气道损伤的早期表现,已证实无哮喘变应性鼻炎患者存在小气道功能的减退,但非变应性鼻炎(non-allergic rhinitis,NAR)患者的小气道功能的改变尚未见详细报道。文中旨在观察无下气道症状NAR患者的小气道功能改变,探讨NAR患者是否存在小气道病变及与气道反应性的关系。方法募集2008年6月至2012年12月在南京军区南京总医院和广州呼吸疾病研究所受试者324例,其中NAR患者262例为NAR组,健康对照组62例。并根据NAR是否具有气道高反应性将其分为气道高反应性组和无气道高反应性组。对所有受试者均行病史采集、鼻部专科检查、变应原皮肤点刺实验、血常规、血清总Ig E、肺通气功能检查[用力肺活量占预计值的百分比(forced vital capacity,FVC)、第1秒用力呼气容积占预计值的百分比(forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占肺活量比值(FEV1/FVC);最大呼气中段流量占预计值的百分比(maximal midexpiratory flow,MMEF)、用力呼出75%肺活量的呼气流量占预计值的百分比(mid-expiratory flow,MEF)、用力呼出50%肺活量的呼气流量占预计值的百分比(MEF50)、用力呼出25%肺活量的呼气流量占预计值的百分比(MEF25)]、支气管激发试验。结果 NAR组反应小气道功能的指标:MMEF、MEF75、MEF50、MEF25分别为(81.3±19.9)%、(88.8±23.1)%、(84.8±20.8)%、(82.9±28.7)%,均明显低于健康对照组[(85.6±17.1)%、(96.1±16.1)%、(88.4±17.8)%、(92.7±25.9)%](P<0.05),而FVC、FEV1、FEV1/FVC与健康对照组比较差异均无统计学意义(P>0.05)。NAR患者中出现气道高反应性者占6.1%(16/262)。其中气道高反应性者MMEF、MEF75、MEF50、MEF25均低于无气道高反应性者(P<0.01)。结论 NAR患者易出现明显小气道功能的改变,部分NAR患者有气道高反应性,且与下气道功能改变相关。

Objective Small airway hypofunction is an early manifestation of asthmatic airway injury and is found in patients with non-asthma allergic rhinitis. However, no report has been seen on the changes of small airway function in patients with non-allergic rhinitis （NAR）. This study was to investigate the possibility of small airway lesion in NAR patients and its relationship with airway responsiveness by observing the changes of small airway function in NAR patients without asthma and/or lower airway symptoms. Methods We recruited 324 subjects for this study, including 262 NAR patients and 62 healthy controls, and assigned them to an airway hyperresponsiveness （AHR） and a non-airway hyperresponsiveness （nAHR） group. All the subjects underwent medical history collection, nasal examination, allergen skin prick test, blood routine test, serum total immnnoglobin E assay, pulmonary function test, and bronchial challenge test. Results Compared with the healthy controls, the NAR patients showed remarkably lower predicted percentages of maximal mid-expiratory flow （ [ 85.6 ± 17. 1 ] vs [ 81.3 ± 19.91% ） , mid-expiratory flow （MEF） with 75% of forced vital capacity （FVC） expired （ [96.1 ± 16.1 ] vs [ 88.8 ± 23.1 ] % ）, MEF with 50% of FVC expired （ [ 88.4 ± 17.8 ] vs [ 84.8 ± 20.8 ] % ）, and MEF with 25% of FVC expired （ [ 92.7 ± 25.9 ] vs [ 82.9 ± 28.7 ] % ） （ P 〈 0.05 ） , but had no statistically significant differences in the predicted percentages of FVC, forced expiratory volume in 1 second （FEV1 ） , and the ratio of FEV1 to FVC （P 〉0.05）. The positive rate of AHR was 6. 1% （16/246） in the NAR group. All the indices of small airway function were significantly lower in the AHR than in the nAHR group （ P 〈 0.01 ）. Conclusion NAR patients are apt to undergo obvious changes in small airway function, some with AHR, which is associated with lower airway function changes.