Analysis on relationship of parameters such as R5 and MEFV with severity of chronic cough in 3 to 5 years old children by impulse oscillometry detection

Objective:The article aims to investigate the relationship of parameters such as airway vicosity resistance (R5) and maximal expiratory flow-volume curve (MEFV) with severity of chronic cough in 3 to 5 years old children by impulse oscillometry (IOS) detection when the oscillation frequency is 5Hz.Method: The article chooses eighty children with chronic cough who were diagnosed or treated in our hospital from March 2017 to March 2018 as the research group, and chooses 50 healthy children who had physical examination in our hospital as the control group. Children's asthma control test (C-ACT) is used to assess the disease severity of children. MEFV detection is carried out to the two groups of children to obtain the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC) and the peak expiratory flow (PEF). LsS inductance (X5) is detected by IOS when R5, the resonant frequency (Fres), and the oscillation frequency is 5Hz. The relationship of ACT score with MEFV and IOS indicators is analyzed by Pearson correlation. The receiver operating characteristic (ROC) curve is used to evaluate the diagnostic value of MEFV and IOS indicators to chronic cough. Results: The C-ACT score of the severe group is significantly lower than that of the control group (P<0.05). FEV1/FVC and PEF of the mild and severe groups are both lower than those of the control group, and FEV1/FVC and PEF of the severe group is lower than those of the mild group (P<0.05). Fres, R5 and X5 of the mild and severe groups are significantly higher than those of the control group, and Fres, R5 and X5 of the severe group are higher than the mild group (P<0.05). FEV1/FVC and PEF are positively correlated with C-ACT score (P<0.05), while Fres, R5 and X5 are negatively correlated with C-ACT score (P<0.05). FEV1/FVC and PEF respectively shows significant negative correlations with Fres, R5 and X5 (P<0.05). R5 has a self-high ROC value of 0.938, followed by Fres, which is 0.917. And the value of IOS diagnostic indicators is higher than MEFV indicators.Conclusion: FEV1 / FVC and PEF of children with chronic cough will decrease while Fres, R5 and X5 will increase, of which Fres, R5 and X5 have a higher correlation with the severity of cough symptoms, and ROC analysis results also show that R5 has the highest diagnostic value to 3~5 years old children with chronic cough.

The Diagnosis Value and Its Implication of Impulse Oscillometry in Obstructive Sleep Apnea Syndrome Patients

The change of measurements of impulse oscillometry (105) in obstructive sleep apnea syn- drome (OSAS) patients and its mechanism were observed. The respiratory impedance was measured by using IOS technique and polysomnography (PSG) was monitored synchronously in 36 OSAS pa- tients,14 patients with chronic obstructive pulmonary disease (COPD) and 12 normal controls. Re- sults showed that R20 in OSAS group was significantly higher than in COPD group and control group (P<0.01). R5-R20 in OSAS group was lower than that in COPD group, but significantly higher than that in control group(P<0. 01). The levels of R20 and R5-R20 were positively correlated with severity degree of the disease. In addition, apnea-hyponea index (AHI) was positively correlated with R5 and R20 with the correlation index (r)being 0. 66 and 0. 86 respectively. The lowest SO2 was negatively correlated with R5 and R5-R20, with r being-0. 66 and- 0. 79 respectively. The mean SO2 was negatively correlated with R5 and R5-R20 with r being-0. 81 and-0. 69 respectively. IOS technique could be used as a valuable tool for assessing the degree of upper airway obstruction in the patients with OSAS, and could help to explore its pathological mechanism.

Association of Superior Vena Cava Syndrome with Sleep Apnea: Investigation Using an Impulse Oscillometry System

Superior vena cava syndrome (SVCS) patients sometimes show signs of obstructive sleep apnea (OSA). However, the mechanism causing hypoxia during sleep in SVCS patients is still uncertain. The aim of this study was to elucidate 1) the changes in central and peripheral respiratory resistance with SVCS, and 2) interpret the mechanism underlying the development of hypoxia during sleep in patients with SVCS related to OSA. Ten SVCS patients related to a neoplasm were recruited for this study. The degree of apnea hypopnea index (AHI) for OSA was evaluated by portable diagnosing device before and after SVCS treatment. We also analyzed the airway resistance and reactance quantitatively in the supine position by Master Screen impulse oscillometry system (MS-IOS?). After SVCS treatment, mean values of AHI were significantly decreased from 30.9 to 16.9 (/hour) (p = 0.001). Central respiratory resistance (R20) also decreased significantly from 0.40 to 0.33 kPa/L/s (p = 0.025) in the supine position. In contrast, peripheral respiratory resistance (R5-R20) and distal capacitive reactance (X5) did not change significantly. It is thought that the exacerbation of OSA due to SVCS is caused by increasing upper airway resistance related to reversible edema of the upper airway mucous or tissue. In contrast, SVCS may not cause peripheral respiratory tract and lung parenchyma edema.

儿童常见周围性眩晕视频头脉冲结果分析

目的分析儿童常见周围性眩晕的视频头脉冲试验(video head impulse test,vHIT)结果并探讨vHIT的诊断价值。方法回顾性选取2020年1月至2022年3月就诊于苏州大学附属第二医院眩晕诊治中心的儿童常见周围性眩晕患儿78例,根据年龄将患儿分为≤10岁组26例和>10岁组52例,分析其vHIT检查结果。结果78例周围性眩晕患儿中儿童良性阵发性眩晕(benign paroxysmal vertigo of childhood,BPVC)28例,前庭性偏头痛(vestibular mi⁃graine,VM)20例,前庭神经炎(vestibular neuritis,VN)15例,突发性聋伴眩晕(sudden deafness with vertigo,SD)8例,梅尼埃病(Meniere's disease,MD)7例。vHIT检查结果异常47例,其中BPVC14例,VM12例,VN14例,SD3例,MD4例。儿童vHIT检查中出现伪迹的概率更高,最常见的伪迹类型为眨眼,高增益值及追踪震荡,≤10岁组vHIT检查出现伪迹多于>10岁组,差异有统计学意义(P<0.001)。结论儿童周围性眩晕最常见的病因主要为BPVC及VM,vHIT在儿童眩晕的诊断中具有很高的特异性,但出现伪迹的概率较高,检查过程中需注意甄别并防范。

阻断阻力肺功能检查在学龄前儿童哮喘诊断中应用的单中心研究

目的探讨阻断阻力(interrupter resistance,Rint)肺功能检查对学龄前儿童哮喘的诊断价值,同时对比Rint肺功能检查和脉冲振荡(impulse oscillometry,IOS)对哮喘的诊断意义。方法前瞻性收集2022年7月—2023年11月收治的4~<6岁反复喘息儿童108例为研究对象,根据结局分为哮喘组(n=61)和非哮喘组(n=47)。对2组患儿的Rint、IOS肺功能参数等进行分析,并比较两者的可行性及价值。结果哮喘组中Rint实测值/预计值百分比、Rint实测值改善率、Rint预计值改善率高于非哮喘组(P<0.05)。受试者操作特征曲线结果显示,Rint预计值改善率诊断学龄前儿童哮喘的最佳截断值为32.0%,曲线下面积为0.705,灵敏度为41.0%,特异度为91.5%(P<0.05)。在完成度方面,有18例(16.7%)患儿未能完成IOS检查,但是可以顺利完成Rint肺功能检查,且质控良好。Rint肺功能检查及IOS各参数对学龄前儿童哮喘诊断的曲线下面积比较差异均无统计学意义(P>0.05)。结论Rint肺功能检查可用于辅助诊断学龄前儿童哮喘,其诊断价值与IOS相当,且具有较高的可行性。支气管舒张试验提示Rint预计值改善率≥32%可作为哮喘诊断的截断值。

脉冲振荡肺功能检测在慢性阻塞性肺疾病患者恶化风险评估中的应用

目的探讨脉冲振荡肺功能检测(IOS)在慢性阻塞性肺疾病(COPD)恶化风险评估中的应用价值。方法选取184例COPD患者,用1年内发生COPD急性加重期(AECOPD)的次数评估COPD患者恶化风险,将COPD患者分为非频繁发作组(AECOPD发作≤1次/年)81例、频繁发作组(AECOPD≥2次/年)103例。患者稳定期均行常规肺功能测试(PFT)、IOS,PFT参数包括第1秒用力呼气末容积(FEV1)、用力肺活量(FVC)、FVC实际值与预计值比值(FVC%pred)、第1秒用力呼气末容积占其预计值的百分比(FEV1%pred)、用力呼出50%肺活量时的瞬时呼气流量(FEF50%)、用力呼出75%肺活量时的瞬时呼气流量(FEF75%)、呼气峰流速(PEF)、用力呼气时中段呼气流速(MMEF),根据FEV1%pred对气道阻塞严重程度进行分级(GOLD分级);IOS参数包括振荡频率为5 Hz时呼吸总阻抗(Z5)、振荡频率为5 Hz时电抗(X5)、振荡频率为5 Hz时电抗占其预计值的百分比(X5%pred)、振荡频率为5 Hz时气道总阻力(R5)、振荡频率为5 Hz时气道总阻力占其预计值的百分比(R5%pred)、振荡频率为20 Hz时的气道阻力(R20)、振荡频率为5和20 Hz时气道阻力差值(R5-R20)、ΔR5-R20[100×(R5-R20)/R20]、响应频率(Fres),用X5和R5对气道阻塞严重程度进行分级。用改良版英国医学研究委员会呼吸问卷(mMRC)评估患者的呼吸困难程度,用COPD评估测试(CAT)问卷评估患者的生活质量。用Pearson相关法分析各指标间的相关性。结果频繁发作组FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF等PFT参数均较非频繁发作组低(P均<0.05),非频繁发作组和频繁发作组GOLD分级差异有统计学意义(P<0.05)。频繁发作组Z5、X5、X5%pred、R5、R5%pred、R20、R5-R20、ΔR5-R20、Fres等IOS参数均较非频繁发作组高(P均<0.05),非频繁发作组和频繁发作组IOS分级差异有统计学意义(P<0.05)。频繁发作组mMRC、CAT评分均较非频繁发作组高(P均<0.05)。COPD患者Z5、X5%pred、R5、R5%pred、R20、R5-R20、ΔR5-R20、Fres与FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF、mMRC评分、CAT评分均呈负相关(P均<0.05),X5与FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF、mMRC评分、CAT评分均呈正相关(P均<0.05)。结论IOS可用于评价COPD患者的恶化风险。

呼出气一氧化氮、脉冲振荡检查在儿童哮喘中的诊断价值分析

目的:分析呼出气一氧化氮(FeNO)、脉冲振荡(IOS)检查在儿童哮喘中的诊断价值。方法:选取2019年1月—2022年1月成都市成华区妇幼保健院呼吸科收治的48例非哮喘患儿作为对照组,选取同期48例哮喘患儿作为研究组。两组患儿均进行FeNO检测、IOS检查,分析检查结果。结果:研究组FeNO水平及中心气道阻力(R20)、呼吸总阻抗(R5)、呼吸系统总阻抗(Z5)、响应频率(Fres)高于对照组,差异有统计学意义(P<0.001)。急性期FeNO水平及R20、R5、Z5、Fres高于缓解期,差异有统计学意义(P<0.001)。结论:哮喘患儿FeNO检测、IOS检查结果呈高表达水平,且急性期表达水平更高,可为儿童哮喘的诊断与病情评估提供参考。

脉冲振荡肺功能检测在儿童支气管舒张试验中诊断阈值探讨

目的探讨脉冲振荡(impulse oscillometry,IOS)肺功能检测在儿童支气管舒张试验中的诊断价值,确定脉冲振荡肺功能各指标舒张试验的阳性标准。方法本研究选取2021年1月—2022年8月在四川大学华西第二医院就诊的86例儿童为研究对象,年龄在4~14岁。其中,哮喘门诊就诊患儿为哮喘组(51例),健康体检儿童为对照组(35例)。两组患者均在吸入沙丁胺醇前后进行常规肺通气功能测定和IOS肺功能检测,以第一秒用力呼气容积(forced expiratory volume in one second,FEV1)≥12%作为标准,比较两组受试者在支气管舒张试验前后IOS各参数的差异,确定IOS舒张试验的阳性标准。结果舒张试验前,哮喘组肺通气功能测定指标FEV1/FVC、FEV1为(82.64±7.53)和(78.64±16.49),对照组为(99.27±6.16)和(98.19±9.02),吸入沙丁胺醇后哮喘组FEV1改善率≥12%,而对照组<12%。支气管舒张试验后,哮喘组和对照组IOS肺功能各参数均有不同程度改善。ROC结果显示,IOS各指标中,振荡频率为5Hz时的呼吸总阻抗(Z5)、周边弹性阻力(X5)、气道黏性阻力(R5)等指标对于支气管舒张试验阳性有较好的诊断价值。以Z5下降≥13.91%、X5下降≥14.78%、R5下降≥14.96%为脉冲振荡肺功能支气管舒张试验阳性的分界点,敏感性和特异性较高。结论支气管舒张试验后,Z5下降≥13.91%、X5下降≥14.78%、R5下降≥14.96%可以判断支气管舒张试验阳性。

Is there a correlation between the changes in airway inflammation and the changes in respiratory mechanics after vaping in patients with asthma?

BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.

脉冲振荡肺功能检查在学龄前儿童哮喘诊断中的价值

目的 探讨脉冲振荡(IOS)肺功能检查在学龄前儿童哮喘诊断中的价值。方法 将96例学龄前哮喘患儿作为研究组,96例健康儿童作为对照组,比较2组IOS肺功能检查参数[总呼吸黏性阻力(R5)、周边气道黏性阻力(R5-R20)、中心气道黏性阻力(R20)、共振频率(Fres)]、常规肺功能指标[用力肺活量(FVC)、呼气峰流速(PEF)、第1秒用力呼气容积(FEV1)]。将研究组患儿按哮喘急性发作程度分为轻度组、中度组、重度组,比较不同病情程度患儿IOS肺功能检查参数、哮喘控制测试(ACT)评分、常规肺功能指标,分析IOS肺功能检查参数与ACT评分、常规肺功能指标的关系。结果 研究组R5、R5-R20、Fres、R20值均显著高于对照组(P<0.001),FVC、PEF、FEV1值均显著低于对照组(P<0.001)。研究组患儿R5、R5-R20、Fres、R20值随着病情的加重而增加,FVC、PEF、FEV1值及ACT评分随着病情的加重而降低,上述指标不同病情患儿之间比较差异均有统计学意义(P<0.001)。IOS肺功能检查参数与ACT评分、常规肺功能指标均呈显著负相关(P<0.05)。结论 IOS肺功能检查参数随学龄前儿童哮喘发生发展而变化,在学龄前儿童哮喘临床诊断及疗效监测中有较高的应用价值。

Assessment of Respiratory lmpedance During Deep Slow Breathing with lmpulse Oscillometry in Patients with Chronic Obstructive Pulmonary Disease

Objective: To observe the relationship of deep slow respiratory pattern and respiratory impedance(RI) in patients with chronic obstructive pulmonary disease (COPD). Methods: RI under normal respiration and during deep slow respira tion was measured one after the other with impulse oscillometry for 8 patients with COPD and for 9 healthy volunteers as control. Results: When r espiration was changed from normal pattern to the deep slow pattern, the tida l volume increased and respiratory frequency significantly decreased in both gro ups , the total respiratory impedance (Z respir) showed a decreasing trend in COPD group, but with no obvious change in the control group. No chang e in the resonant frequency (fres) was found in both groups, and the respiratory viscous resistance obviously decreased in the COPD group(R5: P =0.0168 ; R20: P =0.0498; R5—R20: P =0.0388),though in the control group it was unchanged. Conclusion: IOS detection could reflect the response he terogeneity of different compartments of respiratory system during tidal breathi ng. During deep slow respiration, the viscous resistance in both central airw ay and peripheral airway was decreased in patients with COPD. RI measurement by impulse oscillometry may be a convenient pathophysiological method for studying the application of breathing exercise in patients with COPD.

脉冲振荡技术在呼吸阻力测试中的诊断价值

目的本研究旨在了解三种呼吸阻力测试法(IOS法、体描箱法、超声阻断法)评估肺通气功能的差异,了解国人正常预计值(z值)与传统实测值占预计值百分比(实测值%pred)评估肺通气功能的差异,了解脉冲振荡(Impulse oscillometry,IOS)技术在不同呼吸频率及舌置咬嘴的不同位置(舌不同位置)对呼吸阻力的影响。方法纳入受检者277例,以不同观察目的分组:三种方法组、z值组、舌位置组、呼吸频率组,其中78例受检者纳入三种方法组,用3种不同方法测试呼吸阻力计算异常检出率;85例受检者入z值组,受检者使用IOS法测试呼吸阻力,用z值与实测值%pred评估肺通气功能比较差异;44例受检者入舌位置组,观察舌不同位置对呼吸阻抗的影响;70例受检者纳入呼吸频率组,观察不同呼吸频率对呼吸阻抗的影响。结果IOS测定的呼吸阻抗与体描箱法的气道阻力异常检出率比无显著性差异,但这两种方法与超声阻断法气道阻力异常检出率比差异有统计学意义(P<0.05);IOS测试的R_(5)、R_(20)、X_(5)的z值与其实测值%pred的异常检出率比差异有显著统计学意义(P<0.05);测试R_(5)、R_(20)、X_(5)数值于舌不同位置及受检者在不同呼吸频率下测试值无统计学意义。结论IOS法与体描箱法测定的气道阻力有良好的一致性;使用z值评估R_(5)、R_(20)、X_(5)的呼吸阻力比实测值%pred评估的呼吸阻力敏感;IOS测试值受舌不同位置及不同呼吸频率的影响不明显。

脉冲振荡肺功能在儿童小气道功能障碍疾病中的临床应用

小气道功能障碍已被证实广泛存在于哮喘、慢性阻塞性肺病等疾病中,其临床表现不典型,不易被早期发现。及时明确小气道功能障碍,有利于疾病的早期治疗、准确判断及改善预后。脉冲振荡肺功能是一种新型的肺功能检测方式,目前被广泛认为是评估小气道功能最敏感的技术之一,其可以测量被检查者在平静呼吸时呼吸系统的阻抗(R)和电抗(X),了解中央和外周气道阻塞情况,同时具有无创、操作简单、重复性好等优点。

昆明地区健康成人脉冲振荡肺功能测定

目的确定昆明地区健康成人脉冲振荡肺功能的正常参考值及预计值.方法185例昆明地区的的健康成人,常规肺功能正常,测定脉冲振荡肺功能,指标包括R(5～35)Hz粘性阻力,X(5～35)Hz弹性阻力及惯性阻力,Fres(共振频率),Zrs(呼吸总阻抗),Rc(中心阻力),Rp(周边阻力),顺应性Cl、Cb及Cm等.结果X5～X35、Cl、Cb、Cm、Rp不呈正态分布.建立了阻抗R的多元回归方程式.结论建议临床使用本地区正常预计值,实测值/预计值%保持不变.

脉冲振荡技术在支气管哮喘诊断中的临床应用

目的探讨脉冲振荡技术(IOS)测定呼吸阻抗诊断支气管哮喘的价值。方法对86例支气管哮喘患者(哮喘组)和70例健康者(对照组)进行IOS及常规肺通气功能测定,比较两组患者的呼吸阻抗指标,并与常规肺通气功能指标进行相关性分析。结果哮喘组IOS指标共振频率(Fres)、呼吸总抗阻(Zrs)、5Hz黏性阻力(R5)、20Hz黏性阻力(R20)、5Hz和20Hz黏性阻力差(R5-R20)、中心阻力(Rc)、周边阻力(Rp)均明显高于对照组,X5明显低于对照组。哮喘组Fres、Zrs、R5、R5-R20、Rp与常规肺通气指标第1秒用力呼气量/1秒用力呼气量预计值的百分比(FEV1%)、1秒用力呼气量/用力肺活量(FEV1/FVC)、用力呼气50%肺活量瞬间流量(FEF50%)、用力呼气75%肺活量瞬间流量(FEF75%)呈显著负相关,其中Fres与FEV1%和FEV1/FVC相关性最密切(r=-0.642、-0.590,P<0.01);X5与FEV1%、FEV1/FVC%呈显著正相关,R20、Rc与常规肺功能指标无相关性。结论 IOS可用于支气管哮喘的病情判断,是一种无创、简便、实用的方法,值得临床推广应用。Fres是IOS参数中诊断哮喘气流阻塞最敏感的指标。

脉冲振荡肺功能在阻塞性睡眠呼吸暂停低通气综合征中的应用

目的:观察脉冲振荡(IOS)呼吸阻抗值在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中的变化,并探讨其在OSAHS诊断中的应用价值。方法:对38例OSAHS患者(OSAHS组)、22例单纯打鼾而无睡眠呼吸暂停患者(单纯鼾症组)和20名健康人(对照组)进行IOS肺功能检测,比较3组的呼吸阻抗指标,并将OSAHS患者睡眠监测有关指标与呼吸阻抗指标进行相关性分析。结果:OSAHS患者上气道阻力(R35)、中心气道阻力(R20)、呼吸总阻抗(Zrs)、总气道阻力(R5)明显高于单纯鼾症组和对照组,差异有非常显著性(P<0.01),单纯鼾症组又高于对照组,差异亦有显著性(P<0.05)。OSAHS组呼吸暂停低通气指数(AHI)与R35和R20呈正相关,相关系数(r)分别为0.623和0.617(P<0.01);最低SO2与R35、R20、Zrs呈负相关,r分别为-0.607、-0.591和-0.462(P<0.01)。结论:IOS肺功能可作为检测OSAHS患者上气道阻力的一种方法,为非睡眠状态下OSAHS诊断及病情程度判断提供帮助。

脉冲振荡法在支气管舒张试验中的应用价值

为探讨脉冲振荡法在支气管舒张试验中的应用价值 ,采用脉冲振荡法测定了 2 1例哮喘发作期患者吸入支气管舒张剂前后呼吸阻抗的变化及改善率 ,同时测定肺通气功能变化及改善率 ,并对两种方法所测结果进行对比及相关性分析。结果显示 ,吸入沙丁胺醇后 5 Hz和 2 0 Hz振荡频率时粘性阻力 ( R5、R2 0 )、5 Hz振荡频率时电抗( X5)及共振频率 ( Fres)与用药前比较均明显改善 ( P<0 .0 1) ,其中以 Fres改善最明显 ;一秒钟用力呼气容积( FEV1 )、最大峰流速 ( PEF)、5 0 %和 2 5 %肺活量最大呼气流速 ( V50 、V2 5)均明显改善 ( P<0 .0 1) ;呼吸阻抗改善率显著高于肺通气功能改善率 ( P<0 .0 5 ) ;吸药后 FEV1 增加与 Fres、R5和 X5变化相关密切 ,相关系数分别为0 .69、0 .4 8和 - 0 .4 2。认为 ,脉冲振荡法用于支气管舒张试验是诊断、鉴别诊断支气管哮喘及观察药物疗效的有用工具 。

支气管哮喘患者呼出气一氧化氮与小气道功能的相关性及其影响因素

目的探讨初次诊断成人支气管哮喘(以下简称哮喘)患者呼出气一氧化氮(FeNO)与小气道功能间的相关性,以及吸烟、过敏性鼻炎对FeNO的影响。方法选择2016年9月1日—11月30日于上海交通大学附属第一人民医院呼吸科门诊就诊的成人哮喘患者,按入选和排除标准纳入受试者42例。进行FeNO测定和嗜酸性粒细胞相对值(Eos%)计数;检测肺功能,主要记录第1秒用力呼气容积(FEV_1)占预计值的百分比(FEV_1%)、最大中期呼气流量(MMEF);检测脉冲震荡肺功能(IOS),主要记录频率在5Hz与20Hz时的气道阻抗差值(R5-R20)。分析FeNO与小气道功能的相关性,以及吸烟、过敏性鼻炎对FeNO的影响。结果哮喘患者的FeNO与Eos%、MMEF、FEV_1%均呈正相关(r值分别为0.433、0.399、0.315,P值分别为0.004、0.009、0.043),与R5-R20不相关(P>0.05);MMEF与R5-R20呈负相关(r=-0.501,P=0.001)。合并过敏性鼻炎的哮喘患者(16例)的FeNO与Eos%呈正相关(r=0.585,P=0.002),与FEV_1%、MMEF、R5-R20均不相关(P值均>0.05);无过敏性鼻炎的哮喘患者(26例)的FeNO与FEV_1、MMEF呈正相关(r值分别为0.505、0.431,P值分别为0.009、0.027),与Eos%、R5-R20不相关(P值均>0.05)。吸烟哮喘患者(14例)的FeNO与其他肺功能、小气道功能指标均不相关(P值均>0.05);不吸烟哮喘患者(28例)的FeNO与Eos%、FEV_1、MMEF均呈正相关(r值分别为0.562、0.572、0.485,P值分别为0.002、0.002、0.009),与R5-R20不相关(P>0.05)。FeNO联合MMEF诊断哮喘小气道功能异常的ROC曲线的AUC(AUC为0.967,95%CI为0.901~1.033,P=0.002)显著大于MMEF(AUC为0.954,95%CI为0.866~1.042,P=0.003)和FeNO联合R5-R20(AUC为0.849,95%CI为0.691~1.007,P=0.022)。结论哮喘患者的FeNO水平对评估哮喘患者小气道功能障碍有一定临床价值,结合MMEF评价意义更高;FeNO水平在不吸烟和不合并过敏性鼻炎的哮喘患者中更有诊断意义。

脉冲强迫振荡测定值在睡眠呼吸暂停综合征中的变化及其临床意义

目的 观察脉冲强迫振荡 (IOS)测定值在阻塞性睡眠呼吸暂停综合征 (OSAS)患者中的变化 ,并探讨其临床意义。方法 用IOS技术检测 3 6例OSAS患者、14例慢性阻塞性肺疾病(COPD)患者和 12名正常人呼吸阻抗 ,同时进行睡眠监测。结果 OSAS患者R2 0 明显高于COPD组和对照组 ,差异有非常显著性 (P <0 .0 1) ,R5～R2 0 虽低于COPD组 ,但仍高于对照组 ,差异亦有非常显著性 (P <0 .0 1)。将OSAS患者睡眠监测指标与IOS测定指标相关性进行研究 ,发现呼吸暂停低通气指数 (AHI)与R5和R2 0 呈正相关 ,相关系数 (r)分别为 0 .66和 0 .86(P <0 .0 1) ;最低SO2 与R5、R5～R2 0 呈负相关 ,r分别为 -0 .66和 -0 .79(P <0 .0 1) ;平均SO2 与R5、R5～R2 0 呈负相关 ,r分别为 -0 .81和 -0 .69(P <0 .0 1)。结论 IOS技术可作为用于检测OSAS患者上气道阻力的一种方法 ,并且有助于其病理机制的探讨。