支氣管哮喘肺功能動態(tài)變化的特點(diǎn)及意義

1、#論著#作者單位:200433同濟(jì)大學(xué)附屬上海市肺科醫(yī)院呼吸科(邱潔萍、劉錦銘、高蓓蘭、褚海青、周童、李霞、桂濤)肺功能室(鄭衛(wèi)、楊文蘭)通信作者:劉錦銘支氣管哮喘肺功能動態(tài)變化的特點(diǎn)及意義邱潔萍劉錦銘鄭衛(wèi)高蓓蘭楊文蘭褚海青周童李霞桂濤=摘要目的深入研究支氣管哮喘(簡稱哮喘)肺功能的動態(tài)改變特點(diǎn)和機(jī)制。方法對50例哮喘患者分別于急性發(fā)作期、慢性持續(xù)期和緩解期進(jìn)行肺通氣功能、肺容量、體積描記法和脈沖振蕩法(IOS)檢測。結(jié)果僅DLco和胸

2、腔內(nèi)氣體容積在不同分期間差異無統(tǒng)計(jì)學(xué)意義余各參數(shù)在不同分期間差異均有統(tǒng)計(jì)學(xué)意義。FVC、FEV1FVC、FVC%pred、FEV1、FEV1%pred、PEF、PEF%pred、FEF25、FEF50、X5在急性發(fā)作期顯著低于慢性持續(xù)期和緩解期RV、RVTLC、Rtot、Fres、Z5、R5、R20、AX在急性發(fā)作期顯著高于慢性持續(xù)期和緩解期而在慢性持續(xù)期和緩解期之間差異無統(tǒng)計(jì)學(xué)意義。FEV1緩解期較急性發(fā)作期的改善值和改善率均顯著高于

3、FVC($FEV1$FVC1)。R20的改善值大于R5R20[$R20$(R5R20)1]AX的改善率最高。肺容量參數(shù)IC、RV和RVTLC緩解期較急性發(fā)作期的改善值與FVC、FEV1、FEV1FVC、PEF的改善值均顯著相關(guān)(P哮喘肺功能脈沖振蕩法體積描記法Mechanismacteristicsofdynamicchangesofpulmonaryfunctionindifferentcoursesofbronchialasthma

4、QIUJiepingLIUJinmingZHENGWeiGAOBeilanYANGWenlanCHUHaiqingZHOUTongLIXiaGUITao.DepartmentofRespiratyMedicineShanghaiPneumologyHospitalofTongjiUniversityShanghai200433ChinaCrespondingauth:LIUJinming=AbstractObjectiveToinves

5、tigatelungmechanismacteristicsofpulmonaryfunctionindifferentcoursesofbronchialasthma.MethodsVentilationfunctionpulmometrytotalairwayresistance(Rtot)impedanceresistanceofrespiratysystemweremeasuredinthecourseofacuteonsetc

6、hronicpersistentcourseparacmasisin50patientswithasthma.ResultsThereweresignificantdifferenceinotherindicesamongthreecoursesexceptfDLcoITGV.FVCFEV1FVCFVCpreFEV1FEV1prePEFPEFpreFEF25FEF50X5weresignificantlylowerinthecourse

7、ofacuteonsetthanthoseinchronicpersistentcourseparacmasisRVRVTLCRtotFresZ5R5R20AXweresignificantlyhigherinthecourseofacuteonsetthanthoseinchronicpersistentcourseparacmasisbuttherewerenosignificantdifferencebetweenthelatte

8、rtwo.BoththeimprovementvaluetheimprovementrateofFEV1fromthecourseofacuteonsettoparacmasiswerehigherthanthoseofFVC($FEV1$FVC1).InparametersofIOStheimprovementvalueofR20washigherthanthatofR5R20[$R20$(R5R20)1]theimprovement

9、rateofAXwasthehighest.TheimprovementoflungcapacityindicesincludingICRVRVTLCwerecrelatedwiththoseofFVCFEV1FEV1FVCPEF(PAsthmaPulmonaryfunctionImpulseoscillometryBodyplethysmography#33#中華哮喘雜志(電子版)2009年2月第3卷第1期ChinJAsthma(El

10、ectronicEdition)February2009Vol.3No.1之間差異無統(tǒng)計(jì)學(xué)意義RV、RVTLC、Rtot、Fres、Z5、R5、R20、AX在急性發(fā)作期顯著高于慢性持續(xù)期和緩解期慢性持續(xù)期和緩解期之間差異無統(tǒng)計(jì)學(xué)意義IC、FEF75、R5R20則僅急性發(fā)作期和緩解期之間差異有統(tǒng)計(jì)學(xué)意義(表1)。表1哮喘患者不同分期肺功能參數(shù)比較(?xs)參數(shù)急性發(fā)作期慢性持續(xù)期緩解期F值FVC(L)2.660.643.050.88a3.

11、200.85b6.18bFVC%pred(%)79.9814.1890.4411.78c95.2712.10c18.84cFEV1(L)1.580.512.010.53c2.250.56c20.22cFEV1%pred(%)59.0721.6674.1114.82c83.0514.00c24.91cFEV1FVC(%)59.9114.3867.4112.39b71.2910.01c10.90cPEF(L#S1)4.031.685.211

12、.48b5.581.51c13.57cPEF%pred(%)58.2821.7174.1813.71c80.2815.94c12.48cIC(L)1.950.562.180.622.440.60c8.82cITGV(L)3.771.043.490.893.300.813.62RV(L)3.170.942.590.80c2.360.72c12.90cRVTLC(%)51.2911.3646.257.41a41.607.81c14.38cR

13、tot(kPa#L1#S1)0.770.420.480.25c0.380.12c23.67cFEF25(L#S1)2.251.213.231.35b3.851.31c18.33cFEF25%pred(%)38.4623.4953.8822.06b63.9921.09c15.71cFEF50(L#S1)1.050.621.530.65b1.790.64c16.05cFEF50%pred(%)26.2217.5936.2716.57a43.

14、3917.86c11.61cFEF75(L#S1)0.370.220.490.290.650.32c12.63cFEF75%pred(%)24.2916.4929.8816.8640.2318.09c10.24cDlco(ml#min1#mmHg1)20.375.1221.874.9121.955.401.48Fres(Hz)22.1412.5616.237.55b12.545.26c14.54cZ5(kPa#L1#S1)0.780.4

15、40.580.35a0.460.19c11.04cR5(kPa#L1#S1)0.690.360.540.30a0.450.18c9.34cR20(kPa#L1#S1)0.490.180.390.15b0.360.10c9.63cR5R20(kPa#L1#S1)0.200.210.140.160.090.17c7.22aX5(kPa#L1#S1)0.330.270.170.17c0.140.08c18.93cAX(kPa#L1#S1#Hz

16、)33.0239.9313.5616.79b5.717.95c15.35c注:aP1)PEF的改善率最高FEV1FVC的改善率最低。另外Rtot、RV、IC也有較高的改善率。IOS參數(shù)中Z5、R5緩解期較急性發(fā)作期的改善值較大R20的改善值大于R5R20($R20$(R5R20)1)AX、X5的改善率最高Fres也有較高的改善率(表2)。表2哮喘緩解期較急性發(fā)作期肺功能參數(shù)改善值和改善率參數(shù)平均改善絕對值平均改善率(%)FVC(L)0.

17、5421.27FEV1(L)0.6753.27FEV1FVC(%)11.3823.65PEF(L#S1)1.5660.86IC(L)0.5027.91RV(L)0.8124.13RVTLC(%)9.6917.18Rtot(kPa#L1#S1)0.3839.13Fres(Hz)9.6031.17Z50.3229.98R5(kPa#L1#S1)0.2426.44R20(kPa#L1#S1)0.1328.62R5R20(kPa#L1#S1)0

18、.1147.26X5(kPa#L1#S1)0.2245.41AX(kPa#L1#S1#Hz)27.3159.04三、緩解期較急性發(fā)作期肺功能參數(shù)改善值相關(guān)性分析本研究還發(fā)現(xiàn)RV和RVTLC的改善值與FVC、FEV1、FEV1FVC、PEF的改善值呈顯著負(fù)相關(guān)(P0.01)IC改善值與FVC、FEV1、FEV1FVC、PEF的改善值呈顯著正相關(guān)(P0.05)其中RVTLC改善#35#中華哮喘雜志(電子版)2009年2月第3卷第1期Chin