慢性持续期支气管哮喘小气道功能障碍的临床特征及危险因素分析

Clinical features and risk factors of chronic persistent asthma small airway dysfunction

目的 分析慢性持续期支气管哮喘患者小气道功能障碍(SAD)的临床特征并探讨危险因素。方法 纳入200例慢性持续期支气管哮喘患者的临床资料,包括一般资料、疾病相关情况、肺功能检测结果、依从性评价、哮喘控制状况。比较2组临床特征;采用Logistic回归分析支气管哮喘SAD的危险因素;通过绘制受试者工作特征(ROC)曲线评估模型的预测效能。结果 200例入选患者根据肺功能检查结果分为SAD组(128例)和非SAD组(72例)。影响慢性持续期哮喘患者SAD的主要危险因素包括:吸烟史(OR=4.758,95%CI:2.043~11.081)、超重(OR=2.952,95%CI:1.428~6.105)、哮喘无临床缓解期(OR=6.140,95%CI:2.289~12.870)、近1年出现哮喘急性发作(OR=3.406,95%CI:1.430~8.117)、变应性鼻炎(OR=2.289,95%CI:1.121~4.673)。ROC曲线分析显示上述危险因素的曲线下面积(AUC)分别为0.612、0.610、0.716、0.614和0.600,以上指标联合预测的曲线下面积为0.826(95%CI:0.769~0.883)。结论吸烟史、超重、近1年出现哮喘急性发作、哮喘无临床缓解期、变应性鼻炎是慢性持续期支气管哮喘发生SAD的独立危险因素,应尽早识别SAD危险因素并采取个体化监督及诊疗措施。

Objective To analyze the clinical characteristics and risk factors of small airway dysfunction(SAD)in patients with asthma.Methods The clinical data of 200 patients with chronic persistent asthma were included,including general data,disease-related condition,pulmonary function test result,compliance assessment and asthma control status.The clinical features of the two groups were compared.Logistic regression was used to analyze risk factors for asthma SAD,and ROC curves were plotted to assess the predictive power of the model.Results Two hundred patients were divided into the SAD group(128 cases)and the non-SAD group(72 cases).The main risk factors of SAD in patients with chronic persistent asthma included smoking history(OR=4.758,95%CI:2.043-11.081),overweight(OR=2.952,95%CI:1.428-6.105),asthma without clinical remission(OR=6.140,95%CI:2.929-12.870),acute asthma attack in recent 1 year(OR=3.406,95%CI:1.430-8.117)and allergic rhinitis(OR=2.289,95%CI:1.121-4.673).The area under the curve(AUC)of above risk factors were 0.612,0.610,0.716,0.614 and 0.600,respectively.The AUC of the composite prediction model was 0.826(95%CI:0.769-0.883),which had good prediction value.Conclusion Smoking,overweight,acute asthma attack in recent one year,non-remission period of asthma and allergic rhinitis are independent risk factors for SAD in chronic persistent asthma.The risk factors of SAD should be identified as early as possible,and individualized monitoring and treatment should be taken.