支气管哮喘患者肺功能小气道参数与临床及炎症指标的相关性

Correlation between small airway parameters of pulmonary function and clinical and inflammatory indicators in patients with bronchial asthma

目的:探讨支气管哮喘(哮喘)患者肺功能小气道参数与临床及炎症指标的相关性。方法:本研究为横断面研究。根据纳入及排除标准,采用非随机抽样法收集2020年1月至2022年6月在北京大学第三医院门诊就诊并确诊为哮喘的患者119例,收集病史、一般资料、哮喘控制测试(ACT)评分、肺功能、血常规、过敏原总IgE等临床资料。根据肺功能小气道参数将患者分为小气道功能障碍(SAD)组和非SAD组,比较2组间一般资料、肺功能、炎症指标的差异。分析患者肺功能小气道参数与炎症指标的相关性,通过线性回归分析SAD是否影响哮喘控制和急性发作。结果:共入组患者119例,SAD组51(43%)例,非SAD组68(57%)例。SAD组年龄、入组前1年内因哮喘急性发作就医次数高于非SAD组,ACT评分低于非SAD组(均P<0.05)。SAD组支气管舒张试验前后的用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(FEV 1%pred)、FEV 1/FVC、呼气峰值流速占预计值百分比均低于非SAD组,支气管舒张试验前的残气量占预计值百分比(RV%pred)、残总比(RV/TLC)、支气管舒张试验后FEV 1改善率、绝对值增加和阳性率均高于非SAD组(均P<0.05)。患者用力呼出50%肺活量时瞬间流量占预计值百分比(FEF50%pred)与外周血嗜酸粒细胞计数呈负相关,RV%pred、RV/TLC与外周血中性粒细胞计数,单核细胞计数均呈正相关(均P<0.05)。最大呼气中期流量占预计值百分比、FEF50%pred、FEF75%pred与ACT评分均呈正相关,与入组前1年内急性发作就医次数均呈负相关(均P<0.05)。RV%pred、RV/TLC与ACT评分均呈负相关,与入组前1年内急性发作就医次数均呈正相关(均P<0.05)。线性回归分析显示,SAD影响哮喘急性发作就医次数(P<0.001)和ACT评分(P<0.001),若患者存在SAD,则其平均急性发作就医次数会有所增多,平均ACT评分有所降低。结论:哮喘患者SAD发生率较高,其影响哮喘控制和急性发作。哮喘患者肺功能小气道参数与外周血炎症指标存在一定相关性,积极降低炎症水平,早期识别和干预SAD将有助于改善哮喘患者的治疗和预后。

Objective To evaluate the correlation of pulmonary function small airway parameters with clinical and inflammatory indicators in patients with bronchial asthma(asthma).Methods This was a cross-sectional study.According to the inclusion and exclusion criteria,a total of 119 patients diagnosed with asthma in the outpatient department of Peking University Third Hospital from January 2020 to June 2022 were collected by non-random sampling method.Clinical data such as medical history,general information,asthma control test(ACT)score,pulmonary function,blood routine,and total allergen IgE were collected.According to the small airway parameters of pulmonary function,the patients were divided into small airway dysfunction(SAD)group and non-SAD group,and the differences in general data,lung function,and inflammatory indicators between the two groups were compared.The correlation between small airway parameters and inflammatory markers was analyzed.Linear-regression analysis was used to analyze whether SAD affected asthma control and acute attack.Results A total of 119 patients were enrolled.There were 51(43%)patients in the SAD group and 68(57%)patients in the non-SAD group.Compared with the non-SAD group,the SAD group had a significantly higher age and a significantly higher number of hospital visits due to asthma exacerbation in the previous year,and a significantly lower ACT score(all P<0.05).Before and after bronchoial dilation test,FVC%pred,FEV1%pred,FEV1/FVC,and PEF%pred in SAD group were lower than those in non-SAD group.RV%pred and RV/TLC before bronchial dilation test,the improvement rate and absolute increase in FEV1 and positive rate after bronchial dilation test were higher in the SAD group than those in the non-SAD group(all P<0.05).FEF50%pred was negatively correlated with the number of peripheral blood eosinophil,and RV%pred and RV/TLC were positively correlated with the number of peripheral blood neutrophil and monocyte(all P<0.05).MMEF%pred,FEF50%pred,and FEF75%pred were positively correlated with ACT score and negatively correlated with the number of acute attack visits in the prvious year before enrollment(all P<0.05).RV%pred and RV/TLC were negatively correlated with ACT score,and positively correlated with the number of acute attack visits in the previous year(all P<0.05).Linear-regression analysis showed that SAD affected the number of hospital visits for asthma exacerbation(P<0.001)and ACT score(P<0.001).If the patients had SAD,the average hospital visits for acute attack will be increased,and the average ACT score will be decreased.Conclusions The SAD incidence in asthma patients is high.SAD affects asthma control and acute attack.There is certain correlation between small airway parameters of lung function and peripheral blood inflammatory indicators in asthma patients.Actively reducing inflammation level,early identification,and intervention of SAD will help to improve the treatment and prognosis of asthma.