摘要
目的:分析慢性咳嗽、咳嗽变异型哮喘(cough variant asthma,CVA)患者小气道功能及其舒张试验的变化规律,并探讨将小气道舒张试验变异率纳入CVA诊断标准的可能性。方法:所有纳入患者均行用力肺活量检查和支气管舒张试验,按第1秒呼气容积(FEV1)标准支气管舒张试验阳性即可确诊CVA,并视为舒张试验阳性组。对支气管舒张试验阴性的患者3 d后再行支气管激发试验,阳性者诊断CVA,并视为激发试验阳性组。两组合为CVA组。分析所有患者小气道功能的变化,探讨其变化规律及其对CVA的诊断价值。结果:共纳入疑似CVA患者66例,确诊CVA 58例,FEV1支气管舒张试验阳性者14例,支气管激发试验阳性者44例。正常对照组36例。CVA组与正常对照组性别构成、年龄、身高、体质量、吸烟间差异均无统计学意义(P>0.05)。CVA组用力肺活量(FVC)为(3.50±1.55)L,正常对照组为(3.57±0.76)L,差异无统计学意义(P>0.05)。CVA组FEV1为(2.86±0.86)L·s^(-1),低于正常对照组的(2.97±0.60)L·s^(-1)(P<0.05)。CVA组用力呼出75%肺活量时的瞬间呼气流量(FEF75%)为(2.47±1.80)L·s^(-1),低于正常对照组的(2.58±1.51)L·s^(-1)(P<0.01);FEF50%为(2.33±1.80)L·s^(-1),低于正常对照组的(2.41±1.18)L·s^(-1)(P<0.01);FEF25%为(1.15±0.53)L·s^(-1),低于正常对照组的(1.53±0.45)L·s^(-1)(P<0.01)。CVA组FEV1、FEF75%、FEF50%、FEF25%平均变异率分别为(8.7±7.2)%、(14.4±13.5)%、(17.3±15.2)%、(21.6±21.1)%。前三者相比差异无统计学意义(P>0.05),而FEF25%的变异率明显高于前三者,与前三者比较差异有统计学意义(P<0.01)。FEV1舒张试验阳性12例,阳性率20.7%(12/58);FEF75%舒张试验阳性13例,阳性率22.4%(13/58);FEF50%舒张试验阳性11例,阳性率19.0%(11/58);FEF25%~75%舒张试验阳性15例,阳性率25.9%(15/58)。以FEF25%变异率大于25%作为诊断CVA的标准,其诊断的阳性率为41.4%(24/58),明显高于其他指标。结论:CVA患者小气道功能变化更明显,小气道舒张试验变异率对CVA的诊断率更高,用于临床CVA的诊断,其简单、安全、方便,便于临床应用。
Objective:To explore the changing pattern of small airway function and its dilation test in patients with chronic cough and cough variant asthma,and to explore the possibility of incorporating small airway dilation test variability into the diagnostic criteria of CVA.Methods:All included patients underwent forced vital capacity test and bronchial dilation test(BDT),and the diagnosis of CVA was confirmed by a positive dilation test according to the FEV1 criteria,and was regarded as the dilation test positive group.Bronchial provocation test(BPT)was performed 3 days later in patients with negative bronchial dilation test.A positive diagnosis of CVA was made and was regarded as the positive provocation test group.The two groups were all labeled as the CVA group.The changes in the function of small airways of all patients were analyzed to explore the pattern of change and its diagnostic value for CVA.Results:A total of 66 patients with suspected CVA were included,58 cases were diagnosed as CVA,including 14 cases with positive bronchial dilation test and 44 cases with positive BPT.There were 36 cases in the normal control group.There were no differences(P>0.05)in gender,age,height,weight,the proportion of smokers between the CVA group and the normal control group.Lung function of the two groups:FVC(L):3.50±1.55 in the CVA group,3.57±0.76 in the control group,there was no difference between the two groups(P>0.05).FEV1(L·s^(-1)):2.86±0.86 in the CVA group,2.97±0.60 in the control group,there was a difference between the two groups(P<0.05).FEF75%(L·s^(-1)):2.47±1.80 in the CVA group,2.58±1.51 in the control group,there was a difference between the two groups(P<0.01).FEF50%(L·s^(-1)):2.33±1.80 in the CVA group,2.41±1.18 in the control group,there was a difference between the two groups(P<0.01).There was a difference of FEF25%(L·s^(-1))between the two groups(P>0.05):1.15±0.53 in the CVA group,1.53±0.45 in the control group.The average variation rates(%)of FEV1,FEF75%,FEF50%,and FEF25%in the CVA group were:8.7±7.2,14.4±13.5,17.3±15.2,and 21.6±21.1,respectively,and the first three did not differ from each other(P>0.05),while the variation rate of FEF25%was significantly higher than that of the three.There were 12 positive FEV1 dilation tests,with a positive rate of 20.7%(12/58),13 positive FEF75%dilation tests,with a positive rate of 22.4%(13/58),11 positive FEF50%dilation tests,with a positive rate of 19.0%(11/58),and 11 positive FEF75%dilation tests,with a positive rate of 19.0%(11/58),and FEF25%-75%dilation test was positive in 15 cases with a positive rate of 25.9%(15/58).Taking FEF25%variation rate greater than 25%as the criterion for diagnosing CVA,the positive rate of its diagnosis was 41.4%(24/58),which was significantly higher than the other indicators.Conclusion:Small airway function changes are more obvious in patients with CVA,and small airway dilation test has a higher diagnostic rate for CVA,and is used for the diagnosis of clinical CVA,which is simple,convenient,safe to be applied clinically.
作者
王西华
何灿
李萍
周红梅
陈静
WANG Xihua;HE Can;LI Ping;ZHOU Hongmei;CHEN Jing(Department of Respiratory and Critical Care Medicine,Zhongda Hospital,Southeast University,Nanjing 210009,China)
出处
《东南大学学报(医学版)》
2025年第1期8-13,共6页
Journal of Southeast University(Medical Science Edition)
关键词
咳嗽变异型哮喘
小气道功能
诊断
支气管激发试验
支气管舒张试验
cough variant asthma
small airway function
diagnosis
bronchial provocation test
bronchial dilation test
