【作者】 陈攀峰；

【导师】 陈宝元；

【作者基本信息】 天津医科大学 ， 内科学， 2008， 硕士

【摘要】 目的本研究旨在通过比较支气管舒张试验前后支气管哮喘和慢性阻塞性肺疾病（COPD）病人大小气道肺通气功能参数的变化情况,来明确两组疾病小气道的变化规律以及小气道和大气道变化程度的差别和相关性,并明确支气管哮喘患者支气管舒张试验后各参数阳性率的敏感性。方法本研究选用82例确诊的支气管哮喘病人、88例确诊的COPD病人和41例符合COPD病史支气管舒张试验阳性病人为研究对象。三组病例分别吸入沙丁胺醇气雾剂行支气管舒张试验,记录试验前后的FVC、FEV₁、PEF、MEF50%、MEF25%、MMEF值。采用SPSS11.5统计软件进行数据处理。结果1.支气管哮喘、慢性阻塞性肺疾病、符合COPD病史支气管舒张试验阳性患者支气管舒张试验后大气道和小气道参数均较试验前有明显改善（P＜0.01）,且支气管哮喘患者的改善程度大于慢性阻塞性肺疾病患者（P＜0.01）。2.支气管哮喘患者舒张试验前后FEV₁变异率、MEF50%变异率、MEF25%变异率、MMEF变异率分别为22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%,它们之间的差异有统计学意义（F=7.031,P＜0.01）,且小气道参数较大气道参数的变异率明显（MEF50%、MMEF同FEV₁的变异率比较,t值分别为2.583、2.773,P值分别为0.011、0.007）,而慢性阻塞性肺疾病病人和符合COPD病史支气管舒张试验阳性病人大小气道参数的变异率没有统计学意义（P＞0.05）。3.在支气管哮喘病人中支气管舒张试验后FEV₁、MEF50%、MEF25%、MMEF的阳性率分别为60.98%、75.61%、58.54%、76.83%。小气道参数的阳性率较大气道参数的阳性率敏感（χ²=10.352,P=0.016）,且同支气管哮喘的严重程度有关,哮喘严重程度越大,小气道参数阳性率越敏感（P＜0.01）。4.在支气管哮喘、慢性阻塞性肺疾病和符合COPD病史支气管舒张试验阳性病人中MEF50%变异率同FEV₁变异率成正相关（其中哮喘组r=0.788,P=0.000;COPD组r=0.717,P=0.000;符合COPD病史支气管舒张试验阳性组r=0.710,P=0.000）,但MMEF同FEV₁变异率变异率不相关（其中哮喘组r=0.234,P=0.136;COPD组r=0.182,P=0.225;符合COPD支气管舒张试验阳性组r=0.208,P=0.191）。结论支气管哮喘和COPD患者支气管舒张试验后小气道功能均较试验前有所改善,支气管哮喘改善程度较COPD明显。支气管哮喘和COPD支气管舒张试验后小气道的扩张规律不同,前者为逐步扩张并持续较长时间,后者扩张后迅速回缩。支气管哮喘病人中支气管舒张试验后大小气道舒张,但小气道舒张程度较大气道舒张程度明显,慢性阻塞性肺疾病病人中支气管舒张试验后大小气道扩张,但扩张程度没有差别。支气管哮喘病人支气管舒张试验后小气道参数的阳性率较FEV₁敏感,能够进一步提高诊断哮喘的阳性率。支气管舒张试验后支气管哮喘和COPD小气道的扩张程度和大气道的扩张程度呈正相关。更多还原

【Abstract】 Objective.The bronchial asthma and chronic obstructive pulmonary disease are the most common diseases in the world.The feature of those diseases is airway obstruction.We study the changes of the lung function about the bronchial asthma and COPD after bronchial dilation test and describe the regularity of the dilatation of the small airway.We also explore the difference and the correlation between the big airway and the small airway in order to identify the two diseases.Methods:We chose 82 patients with asthma and 88 patients with COPD and 41 patients with COPD but the bronchial dilation test is positive.We record the numbers of the FVC,FEV₁,PEF,MEF50%,MEF25%,MMEF before and after the bronchial dilation with the salbutamol.Throgh those numbers,we compare the changes between the small airway and the big airway.We also compare the sensitivity of the positive rate about the small airway function.Results:The small airway lung function and the big airway lung function improved after the bronchial dilation test in the patients with asthma COPD and COPD but the bronchial dilation test is positive（P＜0.01）.The lung function of the patients with asthma was better than the patients with the COPD（P＜0.01）.The variance rate in FEV₁,MEF50%,MEF25%,MMEF are 22.22%±1.48%、31.53%±3.28%、28.11%±4.18%、151.27%±46.52%.There are statistical significance between those numbers（F=7.031,P＜0.01）.The change of small airway of the patients with asthma was high than that before the test（P＜0.01）.There was no difference in the variance rate between the test before and the test after in the other two groups（P＞0.05）.In the patients with asthma the positive rate of FEV₁、MEF50%、MEF25%、MMEF was 60.98%,75.61%,58.54%,76.83%.The positive rate ofMMEF, MEF50%was more sensitive than the rate of FEV₁（x²=10.352,P=0.016）and correlate with the Severity of the asthma.The more severe the asthma is,the more sensitive the positive rate of the lung function of the small airway is（P＜0.01）.The variance rate in MEF50%correlates with the one in FEV₁ in the patients with asthma COPD and COPD but the bronchial dilation test is positive（P＜0.01）.The variance rate in MMEF does not correlates with the one in FEV₁ in the patients with asthma COPD and COPD but the bronchial dilation test is positive（P＞0.05）.Conclusions:The big and the small airway are all dilated in the patients with asthma,but the dilatation of the small airway is more than the big airway’s.In the same time,the positive rate of the small airway lung function is more sensitive than the big airway’s.The big and the small airway are all dilated in the patients with COPD.The dilatation of the small airway is no difference with the big airway’s.And the positive rate is low in the patients with COPD.The regular about the small airway is convenient to identify asthma and COPD.更多还原