动态肺功能检查在呼吸道过敏性疾病诊治中的应用

Application of dynamic monitoring of lung function in diagnosing and treating respiratory allergic disease

目的探讨动态肺功能检查在呼吸道过敏性疾病诊治中的应用价值，为其临床应用与推广提供依据。方法选取2017年6月1日至2017年8月15日进行动态肺功能检查的4例病例，分别从支气管哮喘诊断及鉴别诊断、哮喘管理、皮下免疫治疗前、后的评估等角度分享动态肺功能在临床应用中的经验。结果通过两周动态肺功能检查，病例1患者最大呼气流速（PEF）日变异率多次大于10％，结合其在同时间有喘息发作，诊断为哮喘；病例2哮喘患者用药后监测其PEF值及变异率判断其病情未缓解，指导其后续用药；病例3哮喘患者拟行皮下免疫治疗，两周动态肺功能监测结果显示PEF日变异率多在10％以下，结合临床症状，判断其适合行皮下免疫治疗；病例4患者有发作性气短，两周动态肺功能监测结果显示其PEF日变异率、周变异率均正常，除外哮喘。结论动态肺功能检查通过监测患者的PEF日变异率、周变异率，并结合患者症状，在支气管哮喘诊断、鉴别诊断、用药管理、皮下免疫治疗等方面有重要作用。

Objective To detect the value of dynamic monitoring of lung function in diagnosing and treating respiratory allergic disease, and provide the basis for chinical application. Methods Four cases in which dynamic monitorin of lung function was applied during June 1st, 2017 and August 15th, 2017 are reported in this paper. This 4 cases are reported from different review such as diagnosis and differential diagnosis, management of asthma, and assessment before or after subcutaneous immunotherapy. Results In case 1, dynamic monitoring of lung function show the peak expiratory flow （PEF） variability exceeded 10%, which supported the diagnosis of asthma. In case 2, dynamic monitoring of lung function show PEF value and variability after medication of patient with asthma, which suggested non-remission and guide subsequent therapy. In case 3, before subcutaneous immunotherapy, the patient with asthma was applied for dynamic monitoring of lung function, and the rusult show the PEF variability was lower than 10%, which suggested indication of subcutaneous immunotherapy. In case 4, the patient with symptom of short breath was applied for dynamic monitoring of lung function for 2 weeks, and durinal and weekly variability of PEF were normal, according to which, asthma was excluded. Conclusions By means of monitoring durinal and weekly variability of PEF, dynamic monitoring of lung function plays an important role in areas of diagnosis and differential diagnosis, management of asthma, and assessment before or after subcutaneous immunotherapy.