【摘要】：背景支氣管哮喘患者存在氣道慢性炎癥,氣道高反應(yīng)性,可逆性氣流受限及氣道重構(gòu)。臨床表現(xiàn)為反復(fù)發(fā)作的咳嗽,胸悶,喘息,呼吸困難,需要長(zhǎng)期規(guī)范化治療。醫(yī)生迫切需要了解哮喘患者氣道炎癥的情況以減少發(fā)作,目前臨床上尚缺乏既簡(jiǎn)便易行又真實(shí)可靠評(píng)價(jià)氣道炎癥和哮喘控制狀態(tài)以指導(dǎo)醫(yī)生治療的指標(biāo)。 目的探討分析呼出氣一氧化氮(Fractional exhaled Nitric Oxide, FeNO)與乙酰甲膽堿(methacholine)支氣管激發(fā)試驗(yàn)(bronchial provocation test, BPT)能否反應(yīng)哮喘控制程度及二者的相關(guān)性分析,評(píng)估二者在支氣管哮喘診斷及療效評(píng)價(jià)方面的臨床價(jià)值。 方法選取2012.1-2013.10新鄉(xiāng)市中心醫(yī)院呼吸內(nèi)科門(mén)診支氣管哮喘非急性發(fā)作期患者42例參加本研究測(cè)試,并根據(jù)《全球哮喘防治創(chuàng)議》2009方案非急性發(fā)作期哮喘控制狀態(tài)分級(jí)標(biāo)準(zhǔn)分為控制組16例,部分控制組14例,未控制組12例。設(shè)正常對(duì)照組18例。 首先進(jìn)行呼出氣一氧化氮測(cè)試,然后進(jìn)行肺通氣功能測(cè)試,最后進(jìn)行乙酰甲膽堿支氣管激發(fā)試驗(yàn)。應(yīng)用FEV1(第1秒鐘用力呼氣容積)下降20%時(shí)乙酰甲膽堿的藥物激發(fā)濃度(PC20)評(píng)價(jià)氣道反應(yīng)性。應(yīng)用FeNO評(píng)價(jià)氣道炎癥。觀察測(cè)試中間出現(xiàn)的不良反應(yīng)。 結(jié)果參加測(cè)試者共60人,測(cè)試中間有7例退出。最終有哮喘控制組15例,部分控制組13例,未控制組10例,正常對(duì)照組15例完成呼出氣一氧化氮、肺通氣功能測(cè)試和乙酰甲膽堿支氣管激發(fā)試驗(yàn)。 哮喘控制組,部分控制組,未控制組FeNO結(jié)果、BPT對(duì)數(shù)轉(zhuǎn)換PC20(lnPC20)與正常對(duì)照組均有顯著差異,有統(tǒng)計(jì)學(xué)意義,P0.05。哮喘控制組,部分控制組,未控制組用力肺活量結(jié)果與正常對(duì)照組無(wú)顯著差異,無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。 支氣管哮喘控制組、部分控制組、未控制組FeNO進(jìn)行組間比較,控制組、部分控制組分在一個(gè)子集,無(wú)顯著性差異。未控制組為一個(gè)子集,與控制組、部分控制組有顯著性差異。 支氣管哮喘乙酰甲膽堿支氣管激發(fā)試驗(yàn)對(duì)數(shù)轉(zhuǎn)換PC20(InPC20)控制組、部分控制組、未控制組進(jìn)行組間比較,分為三個(gè)獨(dú)立的子集,有顯著差異。 直線相關(guān)分析結(jié)果顯示：控制組、部分控制組、未控制組FeNO和支氣管激發(fā)試驗(yàn)藥物激發(fā)濃度lnPC20均有直線相關(guān)性,為負(fù)相關(guān)。(分別為r=-0.971,P0.05；r=-0.948,P0.05；r=-0.969,P0.05) 結(jié)論 1.評(píng)估哮喘控制狀態(tài)需綜合評(píng)定,不能單純用呼出氣一氧化氮結(jié)果來(lái)評(píng)定。 2.支氣管激發(fā)試驗(yàn)?zāi)芎芎玫姆磻?yīng)哮喘控制狀態(tài)。 3.呼出氣一氧化氮結(jié)果在35-126.9ppb之間與支氣管激發(fā)試驗(yàn)PC20呈負(fù)相關(guān)。呼出氣一氧化氮反映的氣道炎癥與支氣管激發(fā)試驗(yàn)反映的氣道反應(yīng)性呈正相關(guān)。 4.在臨床診斷及療效評(píng)價(jià)方面,呼出氣一氧化氮可部分取代支氣管激發(fā)試驗(yàn)評(píng)價(jià)支氣管哮喘患者的氣道炎癥及氣道高反應(yīng)性。
[Abstract]:Background chronic airway inflammation, airway hyperresponsiveness, reversible airflow limitation and airway remodeling are present in patients with bronchial asthma. The clinical manifestations are recurrent cough, chest tightness, wheezing, dyspnea, and require long-term standardized treatment. Doctors urgently need to understand the airway inflammation in asthmatic patients to reduce the attack. At present, there is still a lack of simple and reliable evaluation of airway inflammation and asthma control status in order to guide the treatment of doctors. Objective to investigate whether the exhaled nitric oxide (Fractional exhaled Nitric Oxide, FeNO) and methacholine (methacholine) bronchial provocation test (bronchial provocation test, BPT) can respond to asthma control and the correlation between them. To evaluate their clinical value in the diagnosis and curative effect evaluation of bronchial asthma. Methods 42 patients with non-acute attack of bronchial asthma in Department of Respiratory Medicine, Xinxiang Central Hospital, 2012.1-2013.10, were selected to participate in this study. According to the criteria of "Global Asthma Prevention and treatment Initiative" 2009, the patients were divided into control group (n = 16), partial control group (n = 14) and uncontrolled group (n = 12). 18 cases of normal control group were set up. The exhalation nitric oxide (no) test, pulmonary ventilation function test, and methacholine bronchial provocation test were carried out. Airway reactivity was evaluated by FEV1 (forced expiratory volume of 1 second) at the time of reduction of methacholine drug excitation concentration (PC20) 20. Airway inflammation was evaluated by FeNO. Adverse reactions in the middle of the test were observed. Results A total of 60 participants were involved, and 7 of them dropped out. Finally, there were 15 cases of asthma control group, 13 cases of partial control group and 10 cases of uncontrolled group, and 15 cases of normal control group completed the test of exhalation nitric oxide, pulmonary ventilation function and methacholine bronchial provocation test. The results of FeNO and BPT logarithmic conversion PC20 (lnPC20) in asthma control group, partial control group and uncontrolled group were significantly different from those in normal control group (P 0.05). The results of forced vital capacity in asthma control group, partial control group and uncontrolled group were not significantly different from those in normal control group (P 0.05). The FeNO of bronchial asthma control group, partial control group and uncontrolled group were compared among groups. There was no significant difference between control group and partial control group. The uncontrolled group was a subset, which was significantly different from the control group and partial control group. The logarithmic conversion PC20 (InPC20) control group, partial control group and uncontrolled group were divided into three independent subsets of bronchial asthma. The results of linear correlation analysis showed that there was a linear correlation between FeNO in control group, partial control group and uncontrolled group, and lnPC20 in bronchial provocation test, which was negatively correlated. Conclusion 1. Evaluation of asthma control needs comprehensive evaluation, can not only be assessed by exhalation nitric oxide results. 2. Bronchial provocation test is a good response to asthma control. 3. The results of exhalation nitric oxide were negatively correlated with PC20 of bronchial provocation test between 35-126.9ppb. Airway inflammation reflected by exhalation nitric oxide was positively correlated with airway reactivity reflected by bronchial provocation test. 4. In clinical diagnosis and efficacy evaluation, exhalation nitric oxide can partially replace bronchial provocation test to evaluate airway inflammation and airway hyperresponsiveness in patients with bronchial asthma.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R562.25

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本文編號(hào)：2307617