小气道功能与气道高反应性的相关性分析

The correlation analysis between small airway function and airway hyperresponsiveness

目的：分析小气道功能与气道高反应的相关性。方法选取2012年10月至2013年5月于北京友谊医院及北京房山区良乡医院呼吸科门诊就诊的符合纳入及排除标准的临床怀疑哮喘的患者110例,用肺通气功能进行支气管激发试验（BPT）,比较 BPT 阳性组与阴性组肺通气肺功能参数及小气道异常率,使用受试者工作特征曲线（ROC 曲线）评估 FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC 在 BPT 前后的变化量（△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC）对气道高反应的诊断准确性、敏感度及特异度,对阳性组 PD20-FEV1累积量与△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC进行相关性分析。结果 BPT 前后阳性组 FEV1、FEV1/FVC、FEF25、FEF50、FEF75、MMEF、FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC与阴性组比较,差异均有统计学意义（P 〈0.05）。BPT 前后阳性组小气道异常率与阴性组相比,差异均有统计学意义（χ2=22.482,P =0.000；χ2=25.852,P =0.000）。△FEF25/FVC的曲线下面积（AUC）为0.792[95%CI （0.703~0.881）]（P =0.000）,△FEF50/FVC的 AUC 为0.767[95%CI （0.677~0.858）]（P =0.000）,△MMEF/FVC 的 AUC 为0.667[95%CI （0.563~0.771）]（P =0.004）。△FEF50/FVC、△MMEF/FVC 与 PD20-FEV1呈正相关（r=0.360,P=0.007；r=0.271,P=0.035）。结论存在气道高反应的患者大小气道功能均明显低于气道反应性正常的患者,存在小气道功能异常的患者BPT可能更易出现阳性结果,小气道功能在激发试验前后的变化可以反映气道高反应性的严重程度。

Objective To analyse the relationship between small airway function and airway hyperresponsiveness.Methods From October 2012 to May 2013 in Beijing Friendship Hospital and Beijing Fangshan District Liangxiang Hospital,110 suspected asthma outpatients were selected according to the inclusion criteria and exclusion criteria.Pulmonary ventilation function were employed in bronchial provocation tests （BPT）.Compare pulmonary ventilation function and small airway abnormality rate between BPT positive group and negative group.Receiver operating characteristic curve （ROC） was used to evaluate the variations of FEF25/FVC,FEF50/FVC,FEF75/FVC,MMEF/FVC before and after BPT （△FEF25/FVC,△FEF50/FVC,△FEF75/FVC,△MMEF/FVC） diagnostic accuracy,sensitivity and specificity of airway hyperresponsiveness.Correlation analysis between PD20-FEV1 cumulant and△FEF25-75/FVC,△MMEF/FVC on BPT positive group.Results The differences between BPT negative group and positive group were statistically significant in FEV1 ,FEV1/FVC,FEF25,FEF50, FEF75,MMEF,FEF25/FVC,FEF50/FVC,FEF75/FVC,MMEF/FVC before and after BPT （P ＆lt;0.05）.Both before and after BPT,negative group and positive group showed significant differences in the small airway abnormality rate（χ2=22.482,P =0.000;χ2=25.852,P =0.000）.The areas under the＆amp;nbsp;curve（AUC）of △FEF25/FVC is 0.792[95%CI（0.703-0.881）]（P=0.000）,AUC of △FEF50/FVC is 0.767[95%CI （0.677-0.858）]（P =0.000）,AUC of △MMEF/FVC is 0.667[95%CI （0.563-0.771）]（P =0.004）.△FEF50/FVC,△MMEF/FVC and PD20-FEV1 are positively correlated with each other（r =0.360,P =0.007;r =0.271,P =0.035）.Conclusions Main airways and small airways′functions of patients with airway hyperresponsiveness are significantly lower than patients with normal airway responsiveness.Patients with abnormal small airway function are more likely to have a positive result in BPT.The variations of small airway function before and after BPT can reflect the severity of airway hyperresponsiveness.