【作者】 孙晓丽；

【导师】 刘锦铭；

【作者基本信息】 苏州大学 ， 呼吸内科， 2010， 硕士

【摘要】 [目的]探讨容积二氧化碳(VCap)技术作为支气管激发试验和舒张试验一种新的评估方法的可行性和应用价值并与肺通气测定法做比较。评价容积二氧化碳测定技术与常规肺功能测定技术各自优缺点,探索容积二氧化碳图各参数在组胺激发试验中的反应性变化及敏感性和特异性,为临床应用提供依据。[方法]对40例健康成年人进行组胺支气管激发实验,并对60例门诊慢性咳嗽,疑诊咳嗽变异型哮喘的患者进行组胺支气管激发试验,激发试验结束后均进行支气管舒张试验,所有受试者每步均先进行容积二氧化碳图测定,随后进行肺通气功能测定。[结果]1、在健康人及疑似哮喘患者的两组实验中,肺通气测量的结果和VCap参数VDT、VDF、VDW、VDL均随组胺剂量增加的而减少,VCap参数dC3/DV随组胺剂量增加的而增加。2、40例健康成年人常规通气测定与VCap测定的参数比较,组胺剂量最大时,FEV1、PEF比基础值分别减少4%、8%(p<0.001),VDT、VDF、VDW则分别比基础值减少8%、7%、7%(p<0.001),dC3/DV比基础值增加34%(p<0.001)。线性回归分析显示组胺剂量最大时,死腔各参数与FEV1的下降没有显著相关性(P <0.05)。3、60例门诊可疑哮喘患者常规通气测定与VCap测定的参数比较,气道高反应性的阳性率为50%。激发试验阳性组FEV1、PEF及VCap参数VDT、VDF、VDW、dC3/DV在基础值和激发后值之间差异均有统计学意义(P<0.01),激发后和舒张后值之间差异也有统计学意义(P<0.05)。阴性组FEV1、PEF在基础值和激发后值之间、激发后和舒张后值之间差异无统计学意义(P>0.05) ,VDT、VDF、VDW激发后和舒张后值之间差异有统计学意义(P<0.05)。所有患者的基础值、激发后、舒张后数据,FEV1均与PEF、VCap各参数(除dC2/DV、dC3/DV、SR23外)呈显著直线相关(P<0.05)。激发试验终止时,ROC曲线提示VDT、VDF为最敏感指标,VDT较基础值增加28%、VDF较基础值增加20%,可作为VCap气道高反应性阳性判断标。4、两组实验激发试验过程中各死腔参数的下降均提前于FEV1和PEF的下降,吸入沙丁胺醇后,死腔各参数增加,dC2/DV、dC3/DV下降。[结论]1、健康成年人激发试验显示VCap技术可作为气道反应性测定可选择的肺功能方法之一,揭示激发过程中支气管的生理变化特点,死腔参数VDT、VDF是较敏感的指标。2、疑似哮喘患者激发试验显示死腔参数VDT、VDF是VCap各参数中用于诊断气道高反应性敏感性及特异性较高的指标,建议临床以VDT增加28%、VDF增加20%,作为气道高反应性的阳性判断标准。3、VCap技术可用于哮喘患者的协助诊断,预后判断及疗效判断。更多还原

【Abstract】 [Objective] To investigate the sensitivity and specificity of volumetric capnography(VCap)parameters in the measurement of bronchial hyperresponsiveness (BHR) and bronchodilator responsiveness , and compare with the routine spirometry method .[Method] Forty normal subjects and Sixty chronic cough suspect cough variation asthmatic outpatients were selected to perform bronchial challenge test with VCap and spirometry respectively , all of the subjects undertook spirometry followed by volumetric capnography ; everyone should perform bronchodilator reversibility test after bronchial challenge test .[Results]1. There were dose-dependent reductions in the spirometric measurements and VCap parameters (VDT、VDF、VDW、VDL). There was dose-dependent increasion in the VCap parameters(dC3/DV).2. In the forty normal subjects ,FEV1、PEF decreased by 4%、8% (p<0.001) from the baseline value of forced expiratory volume at the highest dose of histamine . There was a dose-dependent reduction from the baseline value of VDT、VDF、VDW by 8%、7%、7% respectively(p<0.001) and dC3/DV increased by 34% (p<0.001) compared with the baseline value at the postchallenge value.Linear regression analysis showed no significant orrelation between the reduction in FEV1 and in VCap parameters at maximum dose of histamine .3. Positive rate of BHR was 50%.In the posifive group, FEV1、PEF and1VDT、VDF、VDW、dC3/DV were significantly changed between the postchallenge value and the baseline value(P<0.01).In the negative group, FEV1、PEF were not significantly changed between the postchallenge value and the baseline value , But VDT、VDF、VDW were significantly changed between the postchallenge value and the baseline value (P<0.05).OF all subjects , FEV1 was close linear correlated with PEF and VCap parameters (except for dC2/DV、dC3/DV、SR23) in the baseline value、the postchallenge value and the postbonchodilator value (P<0.05).Changes in dead space preceded changes in PEF and FEV1 during histamine challenge. The diagnostic criteria of BHR was that VDT decreased by 28%、or VDF increased decreased by 20% or compared with the baseline value at the postchallenge value.4. Changes in dead space preceded changes in PEF and FEV1 during histamine challenge.[Conclusions]1. Volumetric capnography was an alternative method for bronchial hyperesponsiveness measurement .2. The diagnostic criteria of BHR was that VDT increased by 28% or VDF increased by 20% compared with the baseline value at the postchallenge value.3. The dead spaces measurement of VCap may have clinical value when diagnosing asthma or evaluating its severity degree.更多还原