支气管激发试验在哮喘患者激素治疗后长期效果分级中的应用

Application of bronchial provocation test in long-term effect grading of hormone therapy for asthma patients

目的探讨支气管激发试验（BPT）在哮喘患者激素治疗长期预后临床分级中的作用和对远期预后的判断价值。方法选取2013年3月至2015年3月于安徽省合肥市第二人民医院住院并确诊为支气管哮喘的患者120例,治疗均采用吸入式糖皮质激素控制患者哮喘症状,丙酸倍氯米松和丁地去炎松,每次200-400μg,每日3次,持续3个月。按照吸入乙酰胆碱的不同浓度,分为49、98、195、390、781、1 563、3 125、6 250、12 500、25 000μg/mL 10组,对患者进行BPT试验。分别于治疗前及治疗后3、6、12、24个月复查BPT,比较气道高反应性（AHR）阳性率。结果治疗前AHR阳性的患者有85例,阳性率为70.8%,经过药物治疗后阳性率下降;治疗后3、6、12、24个月,患者的AHR阳性率与乙酰胆碱浓度有关,随着乙酰胆碱浓度的增大而减小,根据不同乙酰胆碱浓度对患者AHR阳性率影响,出现2个阶段的分层,即49-3 125μg/mL和6 250-25 000μg/mL。经Kaplan-Meier法分析,处于49-3 125μg/mL的平均阳性例数（22.00例）大于6 250-25 000μg/mL的5.25例,乙酰胆碱浓度在49-3 125μg/mL阶段患者治疗后3、6、12、24个月的阳性率均高于6 250-25 000μg/mL,差异有统计学意义（P〈0.05）。经Cox回归分析,49-3 125μg/mL阶段风险比为0.89,大于6 250-25 000μg/mL阶段风险比（0.73）,提示49-3 125μg/mL阶段预后效果较6 250-25 000μg/mL阶段差。结论 BPT在经糖皮质激素长期治疗后,可以对哮喘患者的治疗效果进行分级,吸入乙酰胆碱浓度在49-3125μg/mL是高度复发阶段,在6 250-25 000μg/mL是低度复发阶段。

Objective To study the application of bronchial provocation test（BPT）in the long-term clinical prognosis grading of hormone therapy in asthma patients.Methods 120 inpatients with bronchial asthma in the Hefei Municipal Second People′s Hospital from March 2013 to March 2015 were selected and treated with inhaled sugar cortical hormone for controlling the asthmatic symptoms,beclomethasone and triamcinolone,200-400μg each time,three times a day,for continuous 3 months.According to different concentrations of inhaled acetylcholine,the patients were divided into 10 groups of 49,98,195,390,781,1 563,3 125,6 250,12 500 and 25 000μg/mL,and the BPT test was performed.BPT was reviewed before treatment and at 3,6,12,24 months after treatment,and the positive rate of airway high reaction（AHR）was compared.Results 85 cases were the AHR positive before treatment with the positive rate of 70.8%,which was decreased after treatment;the AHR positive rate at 2,6,12,24 months after treatment was related to the concentration of acetylcholine,which was decreased with the acetylcholine concentration increase.According to the influence of different acetylcholine concentrations on the AHR positive rate,two stages of levels were appeared,i.e.,49-3 125μg/mL and 6 250-25 000μg/mL.The Kaplan-Meier method analysis showed that the average positive case number in 9-3 125μg/mL was 22.00 cases which was more than5.25 cases in 6 250-25 000μg/mL,and the positive rate after 3,6,12,24 months treatment in the stage of 49-3 125μg/mL was higher than that in the stage of 6 250-25 000μg/mL,the difference was statistically significant（P〈0.05）.By the Cox regression analysis,the risk ratio in the stage of 49-3 125μg/mL was 0.89,which was more than 0.73 in the stage of 6 250-25 000μg/mL,prompting that the prognosis effect in the stage of 49-3 125μg/mL was poorer than that in the stage of 6 250-25 000μg/mL.Conclusion The curative effects in the asthmatic patients after long-term glucocoticoid treatment can be performed the classification according to BPT.The inhaled acetylcholine concentration in 49-3 125μg/mL is a high recurrence stage,while which in 6 250-25 000μg/mL is a low recurrence stage.