成人新诊断哮喘患者的临床特征和治疗情况分析

Annalysis of clinical features and treatment in newly diagnosed adult-onset asthma

目的:提高临床医师对成年发病哮喘患者临床特征的认识和诊治水平。方法:收集2015年8月至2016年8月在复旦大学附属中山医院呼吸内科就诊的成年发病且新诊断的哮喘患者的临床资料,分析人口统计学、过敏状态、家族史、哮喘急性加重因素、哮喘控制测试(asthma control test,ACT)评分、肺功能及疗效。结果:成年发病且新诊断的哮喘患者共135例,平均年龄(43±12)岁。135例行血清总IgE检测,平均(204.32±26.67)U/mL。79例患者行特异性IgE抗原检测,阳性36例,以粉尘螨(25例,69.44%)最常见。135例行肺功能检查,第1秒用力肺活量与预测值的比值(FEV 1%pred)为(80.87±20.9)%,呼出气一氧化氮(FeNO)为(92.19±83.97)ppb(1 ppb=1μL/m 3)。135例哮喘患者中,处于间歇状态者8例、轻度持续者19例、中度持续者17例、重度持续者91例。135例哮喘患者的FeNO与血清总IgE无相关性;77例过敏性哮喘患者的FeNO与血清总IgE正相关(r=0.245,P<0.05)。135例哮喘患者和77例过敏性哮喘患者的FeNO和FEV 1%pred均无相关性。治疗3个月后FEV 1%pred为(91.87±16.50)%,FeNO为(57.59±23.98)ppb,均较前改善(P<0.05)。结论:成年新发哮喘较常见,患者常有吸烟史和过敏史;成人哮喘患者就诊时间常较晚,但经规范治疗后控制较佳,症状改善,肺功能水平提高。

Objective:To improve the clinical diagnosis and treatment of adult-onset asthma.Methods:The clinical data of adult-onset and newly diagnosed asthma including demography,allergic status,family history,acute aggravating factors,asthma control test(ACT)score,lung function,and follow-up treatment were collected in the Respiratory Department of Zhongshan Hospital,Fudan University from August 2015 to August 2016.Results:A total of 135 adult-onset and newly diagnosed asthma patients were enrolled,with an average age of 43±12 years old.Totally,79 underwent allergen tests(36 had positive results).The most common allergen was house dust mites(n=25,69.44%).All 135 patients received serum total IgE test with an average value of(204.32±26.67)U/mL.All 135 patients received lung function test with an average FEV 1%pred and FeNO value of(80.87±20.9)%and(92.19±83.97)ppb(1 ppb=1μL/m 3),respectively.In the 135 cases,8 cases were in intermittent state,19 cases in mild persistent state,17 cases in moderate persistent state,and 91 cases in severe persistent state.There was no correlation between FeNO and serum total IgE in 135 patients.But FeNO was positively correlated with serum total IgE in 77 allergic asthmatic patients(r=0.245,P<0.05).There was no correlation between FeNO and FEV 1%pred in 135 asthma patients and 77 allergic asthma patients.After three months of treatment,FEV 1%pred was(91.87±16.5)%and FeNO was(57.59±23.98)ppb,and the difference before and after treatment is statistically significant(P<0.05).Conclusions:Adult-onset asthma is common,and there is often a history of smoking and allergies.The most asthma patients have late visits,but after regular treatment,symptoms and lung function can be significantly improved.