【摘要】 目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)和支气管哮喘(简称哮喘)患者在组胺支气管激发试验中气道高反应性(airwayhyperresponsiveness,AHR)的不同。方法将我院2008～2010年间诊断为COPD和哮喘的并经随访一年处于稳定期的患者共80例,其中COPD组39例,哮喘组41例,均行支气管组胺激发试验,观察FEF25%～75%/FVC(肺活量为25%～75%时最大呼气流量与用力肺活量的比值)在两组患者的变化。结果 COPD组FEF25%～75%和FEF25%～75%/FVC均明显低于哮喘组(P值均<0.01);以激发试验阳性的两组患者为对象分别进行简单相关分析,在COPD组和哮喘组中FEF25%～75%/FVC与Log10DRS呈负相关(r分别为-0.510和-0.466,P<0.05),与PD20FEV1呈正相关(r分别为0.518和0.487,P<0.05),说明相对于肺容积而言,气道容积越小,气道收缩性越强,反应性越高。随后在以气道收缩性指标Log10DRS为因变量,以年龄、体表面积、FEV1%及FEF25%～75%/FVC为自变量进行线性回归分析,在COPD组FEV1%对Log10DRS较FEF25%～75%/FVC影响大(P<0.05),而哮喘组不存在这情况。结论在COPD中AHR患者并不少见,其发生机制与哮喘是不同的。更多还原

【Abstract】 Objective The study was designed to explore airway hyperresponsiveness (AHR) with histamine in patients with chronic obstructive pulmonary disease (COPD) and asthma.Methods AHR was examined in a sample of 41 patients with asthma and 39 with COPD diagnosed between 2008 and 2010 and followed up 12 months, and compared during continuous inhalation of histamine. The ratio between forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) and FVC (FEF25-75/FVC) was measured to reflect AHR.Results The mean values of the FEF25-75 and the FEF25-75/FVC ratio in COPD patients were significantly lower than those of asthma patients(P<0.05). In a simple correlation analysis of the positive challenges, the relationship between FEF25-75/FVC ratio and Log10DRS was negatively in patients with COPD and asthma. By contrast, FEF25-75/FVC was positively related to PD20FEV1. This imply airway size relative to lung size, the smaller the airway size, the stronger the airway contraction, the higher the reactivity. In a multiple linear regression model that included age, body surface area, percentage of predicted FEV1(FEV1%), and FEF25-75/FVC, FEV1% was significantly related to the degree of histamine airway responsiveness as measured by Log10 dose response slope in the COPD group(P<0.05), while the asthma did not exist.Conclusions AHR is not uncommon in COPD, and it has different mechanism from that happening in asthma.更多还原