小气道病变与哮喘方案.ppt

* 尽管肺功能检查已经被广泛应用于哮喘诊断中，但FEV1 和 PEF 主要检测的是中心气道功能，而在检测在哮喘中有着关键作用的小气道功能方面价值有限。 余气量和用力呼气量等参数占最大肺活量的25%-75%（FEF25–75）提示外围异常。 氮冲洗法能够分辨出周围和中心传导气道的通气不均匀性，从而反应小气道闭塞或近于闭塞的信息。 研究发现呼出一氧化氮 (eNO) 和高分辨率CT(HRCT)都是小气道炎症的生物标志物。1 脉冲振荡法 （IOS）能够测量出周围阻力的变化。2 * * * * References 1. Kraft M, et al. Alveolar tissue inflammation in asthma. Am J Respir Crit Care Med 1996;154:1505-10. 2. Kraft M, et al. Distal lung dysfunction at night in nocturnal asthma. Am J Respir Crit Care Med 2001;163:1551-6. 3. In ‘t Veen JC et al. Recurrent exacerbations in severe asthma are associated with enhanced airway closure during stable episodes. Am J Respir Crit Care Med 2000;161:1902-1906. 4. D’Amato G, et al. Outdoor air pollution, climatic changes and allergic bronchial asthma. Eur Respir J 2002;20:763-776. 5. Zeidler MR, et al. Small airways response to naturalistic cat allergen exposure in subjects with asthma. J Allergy Clin Immunol 2006;118:1075-1081. 6. Wagner EM, et al. Peripheral lung resistance in normal and asthmatic subjects. Am Rev Respir Dis 1990;141:584-8. 7. Hyde DM, et al. Anatomy, pathology, and physiology of the tracheobronchial tree: emphasis on the distal airways. J Allergy Clin Immunol 2009;124:S72-7. 8. Kaminsky DA, et al. Peripheral airways responsiveness to cool, dry air in normal and asthmatic individuals. Am J Respir Crit Care Med 1995;152:1784-90. * 小气道功能异常可能是夜间哮喘患者夜间症状增加的原因。 Reference Kraft M, et al. Distal lung dysfunction at night in nocturnal asthma. Am J Respir Crit Care Med 2001;163:1551-6. * 单次呼吸氮冲洗法检测出的闭合气量（CV）或闭合容量（CC）增加提示着小气道疾病。 重度哮喘中，这些参数的增加与重复性的哮喘发作相关。 Reference In ‘t Veen JC et al. Recurrent exacerbations in severe asthma are associated with enhanced airway closure during stable episodes. Am J Respir Crit Care Med 2000;161:1902-1906. * 与健康人相比，即使肺功能在正常范围内的中度哮喘患者小气道的阻力也是健康人的7倍 尽管对肺功能影响有限，这种小气道阻力的升高也会加剧哮喘的气道反应性。 References 1. Wagner EM, et al. Peripheral lung resistance in normal and asthmatic subjects. Am Rev Respir Dis 1990;141:584-8. 2. Hyde DM, et al. Anatomy, p