咳嗽变异型哮喘气道反应性特点及其判定标准.docVIP

???? 咳嗽变异型哮喘气道反应性特点及其判定标准 ???? ????　摘要　目的　探讨比气道传导率（sGaw）测定咳嗽变异型哮喘（CVA）的气道反应性特点及阳性判定标准，并与慢性阻塞性肺疾病（COPD）患者进行鉴别。方法　对30例CVA、133例典型哮喘（BA）、37例COPD、52名正常健康人行最大呼气流量容积曲线（MEFV）、气道阻力（Raw）、气道反应性测定。结果　（1）缓解期CVA患者呼气流量指标［最大呼气流量（PEF）、最大呼气中段流量（MMEF）、一秒钟用力呼气容积占用力肺活量比值（FEV1/FVC）］与健康对照组比较，差异无显著性（P0.05）；多数（67%）CVA患者Raw增高，sGaw下降。与BA患者比较差异无显著性（P0.05）。（2）以35%时吸入的乙酰甲胆碱浓度(PC35sGaw)8 g/L为界，100%CVA、BA患者呈气道高反应性，其乙酰甲胆碱（MCH）均值为1.0 g/L左右；COPD组5例阳性（13.5%），阳性者MCH均值为5.24 g/L。（3）以PC35sGaw4 g/L为界，对CVA的敏感度判定为96.7%，特异度为97.3%，可信限为99%。(4)推出PC35sGaw计算公式，并与作法比较结果完全吻合。结论　以sGaw为气道反应性测定指标不但敏感，且有助于CVA与COPD的鉴别诊断，建议以PC35sGaw 8 g/L为气道反应性增高，而PC35sGaw4 g/L为高度怀疑CVA。　　关键词　咳嗽变异型哮喘　最大呼气流量-容积曲线　比气道传导率　气道反应性测定 Characteristics and criteria for bronchial responsiveness measurement in cough variant asthma YUAN Yuru,　LUO Yanjie,　WANG Zengli, et al.Department of Internal Medicine, First University Hospital, West China University of Medical Sciences, Chengdu 610041 Abstract　Objective To investigate the value of sGaw in the differentiation of CVA from COPD. Methods MEFV, airway resistance(Raw) and bronchial responsiveness were measured in 30 cases with CVA, 133 cases with typical bronchial asthma(BA) and 37 cases with COPD. Results (1) The expiratory-flow parameters (PEF, MMEF, FEV1/FVC) in MEFV curve in remission period of CVA were largely normal, but most patients with CVA (67%) have　increased Raw and decreased sGaw, characteristics similar with typical bronchial asthma(BA). (2) If PC35sGaw 8 g/L was set as the positive limit, 100% of CVA and BA patients showed bronchial hyperresponsiveness(BHR), the average positive MCH concentration being about 1.0 g/L. 5 cases with COPD (13.5%) also showed BHR, but the average MCH concentration　was 5.24 g/L. (3)If PC35sGaw 4 g/L was set as the positive limit for the diagnosis of CVA, the sensitivity was 96.7%, specificity 97.3%, confidence limit 99%. (4) A equation for PC35sGaw was deduced, and its calculation values showed the same results with the ones from diagrammatization. Conclusi