哮喘患者气道高反应性特点及其日间差异性研究

doi:10.12114/j.issn.1007-9572.2022.01.001

摘要/Abstract

摘要： 背景哮喘患者呼气峰值流量（PEF）、第1秒用力呼气容积（FEV1）等肺功能指标存在昼夜变异的特点，评估药物治疗对哮喘患者肺功能和气道高反应性影响的研究均要求患者在1 d中的相同时间点进行肺功能检测，而哮喘患者气道高反应性是否存在日间差异尚不清楚。目的探讨哮喘患者气道高反应性特点及日间变异性。方法收集2018年1月至2020年9月在广州医科大学附属第一医院呼吸科就诊的202例哮喘患者资料并进行统计分析。患者均完成乙酰甲胆碱支气管激发试验，根据其进行支气管激发试验的时间分为上午检测组（上午组）81例和下午检测组（下午组）121例；根据患者的病程分组，病程≤6个月为初诊组98例，>6个月为复诊组104例，其中初诊组和复诊组又根据检测时间分为初诊上午组、初诊下午组和复诊上午组、复诊下午组；参照中国肺功能指南气道高反应性分级，根据使FEV1下降20%的累积激发剂量（PD20-FEV1）将患者分为极轻度组、轻度组、中度组和重度组。比较各组间气道高反应性特点及主要肺功能指标〔用力肺活量（FVC）占预计值百分比（FVC%pred）、FEV1占预计值百分比（FEV1%pred）、呼气峰值流量（PEF）占预计值百分比（PEF%pred）、最大呼气中段流量（MMEF）占预计值百分比（MMEF%pred）、50%肺容量位的用力呼气流量（MEF50%）占预计值百分比（MEF50%pred）、25%肺容量位的用力呼气流量（MEF25%）占预计值百分比（MEF25%pred）〕及下降20%的累积激发剂量（PD20）〔使FVC下降20%的累积激发剂量（PD20-FVC）、PD20-FEV1、使PEF下降20%的累积激发剂量（PD20-PEF）、使MMEF下降20%的累积激发剂量（PD20-MMEF）、使MEF25%下降20%的累积激发剂量（PD20-MEF25%）、使MEF50%下降20%的累积激发剂量（PD20-MEF50%）〕。结果上午组和下午组患者主要肺功能指标及PD20比较，差异无统计学意义（P>0.05）。初诊组FEV1%pred及PD20-PEF均高于复诊组（P<0.05）；初诊组与复诊组FVC%pred、PEF%pred、MMEF%pred、MEF50%pred、MEF25%pred、PD20-FEV1、PD20-MMEF、PD20-MEF25%、PD20-MEF50%比较，差异无统计学意义（P>0.05）。复诊组患者下午MMEF%pred、MEF50%pred高于上午（P<0.05）；复诊组上、下午其余主要肺功能指标及PD20比较，差异无统计学意义（P>0.05）；初诊组上、下午主要肺功能指标及PD20比较，差异无统计学意义（P>0.05）。病程与PD20-FVC、PD20-FEV1、PD20-PEF、PD20-MMEF、PD20-MEF25%、PD20-MEF50%无直线相关关系（P>0.05）。极轻度组、轻度组、中度组、重度组上午与下午、初诊与复诊PD20-FEV1组内比较，差异无统计学意义（P>0.05）。结论哮喘患者病程越长肺功能受损越严重，而气道高反应性在上午与下午无明显差异。

关键词: 哮喘, 呼吸功能试验, 肺功能, 气道高反应性, 支气管激发试验

Abstract: Background

There are daytime variability in pulmonary function indexes such as peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV₁) in asthma patients. Studies evaluating the effects of drug therapy on lung function and airway hyperresponsiveness (AHR) in asthma patients all required patients to perform spirometry and bronchial challenge test in the same time point of the days. However, whether there is a daily diurnal AHR variability is still not clear.

Objective

To explore the characteristics and diurnal variability of AHR in asthma patients.

Methods

The data of 202 patients with asthma who consulted in respiratory department of the First Affiliated Hospital of Guangzhou Medical University from January 2018 to September 2020 were included for statistical analysis. All patients completed the methacholine bronchial provocation tests, they were divided into the morning detection group (morning group) with 81 cases and the afternoon detection group (afternoon group) with 121 cases; according to the disease course, 98 cases were divided into the initial diagnosis group if the disease course was ≤6 months, and 104 cases were divided into the follow-up group if the disease course was >6 months. The initial diagnosis group and the follow-up group were divided into the initial diagnosis morning group, the initial diagnosis afternoon group, the follow-up morning group, and the follow-up afternoon group according to the detection time; according to the AHR, the patients were divided into very mild, mild, moderate and severe groups. The characteristics of AHR and the main pulmonary function indexes including FVC%pred, FEV₁%pred, PEF%pred, MMEF%pred, MEF50%pred, MEF25%pred, PD20-FEV₁, PD20-PEF, PD20-MMEF, PD20-MEF25%, PD20-MEF50% of these groups were analyzed and compared.

Results

There were no significant differences of the math pulmonary function indexes and PD20 between morning and afternoon groups (P<0.05) . FEV₁%pred and PD20-PEF were significantly higher in initial diagnosed group than follow-up group (P<0.05) . There was no significant difference in FVC%pred, PEF%pred, MMEF%pred, MEF50%pred, MEF25%pred, PD20-FEV₁, PD20-MMEF, PD20-MEF25%, and PD20-MEF50% between the initial visit group and the follow-up visit group (P>0.05) . In follow-up group, MMEF%pred and MEF50%pred were higher in afternoon than in morning (P<0.05) . There were no differences of lung function and AHR between morning and afternoon in initial diagnosed group (P<0.05) . No obvious correlations were found between disease history and PD20. There were no significant differences of PD20-FEV₁ between the morning and afternoon, initial diagnosed and follow-up (P>0.05) .

Conclusion

The longer the duration of asthma, more serious impairment of lung function found in asthma, while the AHR had no significant difference between morning and afternoon.

Key words: Asthma, Respiratory function tests, Lung function, Airway hyperresponsiveness, Bronchial provocation test

中图分类号:

R562.25

虞欣欣,郑劲平,高怡,等. 哮喘患者气道高反应性特点及其日间差异性研究[J]. 中国全科医学, 2022, 25(11): 1351-1356. DOI: 10.12114/j.issn.1007-9572.2022.01.001.

YU Xinxin, ZHENG Jinping, GAO Yi, XIE Yanqing, AN Jiaying, LIU Wenting, ZHONG Liping, WU Zhongping, ZHU Zheng.

Iurnal Variability of Airway Hyperresponsiveness in Asthma Patients [J]. Chinese General Practice, 2022, 25(11): 1351-1356.

图/表 6

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组别	例数	性别（男/女）	年龄（±s，岁）	身高（±s，cm）	体质量（±s，kg）	BMI（±s，kg/m²）
上午组	81	30/51	43.4±12.4	161.6±7.3	60.5±11.2	23.1±3.7
下午组	121	36/85	40.0±12.2	160.2±8.8	57.7±10.6	22.4±3.1
t（χ²）值		-1.08^a	1.88	1.14	1.84	1.57
P值		0.28	0.06	0.26	0.07	0.12

组别	例数	性别（男/女）	年龄（±s，岁）	身高（±s，cm）	体质量（±s，kg）	BMI（±s，kg/m²）
上午组	81	30/51	43.4±12.4	161.6±7.3	60.5±11.2	23.1±3.7
下午组	121	36/85	40.0±12.2	160.2±8.8	57.7±10.6	22.4±3.1
t（χ²）值		-1.08^a	1.88	1.14	1.84	1.57
P值		0.28	0.06	0.26	0.07	0.12

组别	例数	FVC%pred（±s，L）	FEV₁%pred（±s，L）	PEF%pred（±s，L/s）	MMEF%pred（±s，L/s）	MEF50%pred（±s，L/s）	MEF25%pred（±s，L/s）
上午组	81	98.40±13.33	88.38±11.50	92.79±16.16	53.63±17.58	59.04±17.45	48.07±20.74
下午组	121	98.15±12.78	90.52±11.43	91.66±12.88	58.67±21.39	64.33±20.48	52.89±26.20
t（Z）值		0.13	-1.31	0.55	-1.76	-1.91	-1.39
P值		0.90	0.19	0.58	0.08	0.06	0.17

组别	例数	FVC%pred（±s，L）	FEV₁%pred（±s，L）	PEF%pred（±s，L/s）	MMEF%pred（±s，L/s）	MEF50%pred（±s，L/s）	MEF25%pred（±s，L/s）
上午组	81	98.40±13.33	88.38±11.50	92.79±16.16	53.63±17.58	59.04±17.45	48.07±20.74
下午组	121	98.15±12.78	90.52±11.43	91.66±12.88	58.67±21.39	64.33±20.48	52.89±26.20
t（Z）值		0.13	-1.31	0.55	-1.76	-1.91	-1.39
P值		0.90	0.19	0.58	0.08	0.06	0.17

组别	例数	FVC%pred（±s，L）	FEV₁%pred（±s，L）	PEF%pred（±s，L/s）	MMEF%pred（±s，L/s）	MEF50%pred（±s，L/s）	MEF25%pred（±s，L/s）
初诊组	98	98.85±13.80	91.35±11.70	93.62±13.95	59.47±21.36	64.82±20.33	53.63±25.24
复诊组	104	97.68±12.18	88.07±11.08	90.69±14.67	53.00±18.46	59.75±18.34	48.44±23.07
t（Z）值		0.65	2.05	1.46	1.95	1.86	1.53
P值		0.52	0.04	0.15	0.05	0.06	0.13