慢性咳嗽患者小气道功能及气道反应性测定的临床价值

The Clinical Value of Small Airway Function and Bronchial Responsiveness Measurement to Patients with Chronic Cough

目的探讨小气道功能及气道反应性测定在慢性咳嗽患者诊断中的临床价值。方法对2015年1月-2016年8月呼吸内科门诊筛选的268例慢性咳嗽患者进行常规肺功能检测和支气管激发试验,观察支气管激发试验阳性患者与阴性患者小气道功能指标的差异,进一步分析小气道功能异常与气道高反应性之间的相关性及与患者年龄之间的关系。结果 268例患者中支气管激发试验阳性107例,阴性161例。支气管激发试验阳性组患者25%、50%、75%肺活量位的用力呼气流量和最大呼气中期流速较阴性患者明显降低,差异有统计学意义,P<0.05;两组肺活量、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量百分比、峰值呼气流速比较差异无统计学意义,P>0.05。268例患者中有104例提示小气道功能异常,有小气道功能异常患者的支气管激发试验阳性率(83.7%,87/104)较小气道功能正常患者(27.4%,45/164)明显增高,差异有统计学意义,P<0.01。小气道功能异常患者中,<40岁组的激发试验阳性率(91.0%,61/67)明显高于≥40岁组(70.3%,26/37),差异有统计学意义,P<0.05。结论慢性咳嗽患者小气道功能及气道反应性测定,可早期诊断咳嗽变异型哮喘,尤其对于合并小气道功能异常的年轻患者更重要。

Objectives To evaluate the clinical value of small airway function indexes in lung function and bronchial responsiveness measurement in the diagnosis of patients with chronic cough. Methods 268 patients with chronic cough selected from respiration medicine department from January 2015 to August 2016 were managed with conventional pulmonary function testing and bronchial provocation test. The difference of small airway function between bronchial provocation test positive and negative indicators, and the relation＇ of small airway function change to hyper-responsiveness were observed. Results 107 cases in 268 patients had positive bronchial provocation test and 161cases were negative. Forced expiratory flow of vital capacity （FEF） 25%, FEF50%, FEF75%, maximal midexpiratory flow rate （MMEF） 75/25 were lower than those in negative cases （P〈 0.05）, ventilatory capacity（VC）, forced vital capacity（FVC）, forced expiratory volume in one second （FEV1）, FEV1/FVC, peak expiratory flow （PEF） had no significant differences （P〉0. 05）. 104 cases had small airway dysfunction, the incidence of positive tests for bronchial provocation in 104 cases （83.7%, 87/104） with small airway dysfunction was significantly higher than that in 164 cases （27.4%, 45/164） without it （P〈0. 01）. Also, there was a significant difference in the incidence of positive tests for bronchial provocation in cases with small airway dysfunction between less than 40 years old and no less than 40, 91.0%vs 70. 3% （P〈0. 05）. Conclusions In patients with chronic cough, measuring small airway function and bronchial responsiveness can be made a early diagnosis of cough variant asthma, especially important to those young with small airway dysfunction.