【摘要】 目的　探讨气道高反应性与慢性阻塞性肺疾病 (COPD)之间的因果关系。方法　 1996年 6月 ,从北京市房山区 2 3个自然村筛查出 15 4例COPD患者和 15 4名非COPD者配对对照 ,以及 2 3名不吸烟正常对照者进行基线调查 ,以一秒钟用力呼气容积 (FEV1)比基线值下降 >2 0 %的乙酰甲胆碱浓度 (PC2 0 FEV1) <8g/L为支气管高反应性的阳性标准 ,分为气道反应性阳性组与阴性组 ,2 0 0 0年5月进行复查。结果　 (1)基线病例 对照研究 :COPD病例组与吸烟非COPD组有良好均衡性。COPD组气道反应性阳性率显著高于对照组 (78%和 2 8% ,P <0 0 0 0 1)。 (2 )前瞻性研究 :复查 2 41人 ,复查率为 78 2 %。基线非COPD者中气道反应性阳性组 38名 ,复查时COPD发病率为 2 3 7% ,气道反应性阴性组 84名 ,COPD发病率为 9 5 % (RR =2 5 ,P =0 0 36 ) ;基线COPD患者气道反应性阳性组 93例 ,复查时一秒钟用力呼气容积占用力肺活量比值 (FEV1/FVC)恢复到正常范围的比率为 12 9% ,气道反应性阴性组 2 6例 ,复查时FEV1/FVC恢复到正常范围的比率为 30 8% (P =0 0 31)。结论　吸烟人群中 ,气道高反应性导致肺功能下降速度加快 ,是COPD发病的独立危险因素更多还原

【Abstract】 Objective To explore the relationship between bronchial hyperresponsiveness and chronic obstructive pulmonary disease (COPD) Methods 154 smokers with COPD (FEV 1/FVC<70%) served as a study group and 154 smokers without COPD as a control group and 23 never smokers as a healthy control group from 23 villages in Fangshan Distract, Beijing in June,1996 The patients with self reported and doctor diagnosed asthma were excluded from participants Those subjects were divided into a positive group and a negative group based on methacholine bronchial responsiveness All subjects were worked up in May, 2000 Results (1) Baseline case control study:The positive rate of bronchial hyperresponsiveness was 78% in the study group, PC 20 =(1 4±1 6) g/L; however 28% of the matched group were positive,PC 20 =(2 7±2 3) g/L,( P <0 001);(2) Prospective study:Of 154 pairs case controls 241 subjects were followed up in May 2000 The rate of following up was 78 2% The incidence of COPD was 23 7% in 38 subjects without COPD with positive hyper responsiveness,however incidence of COPD was 9 5% in 84 subjects without COPD with negative hyper responsiveness ( P =0 036),the relative risk ( RR )=2 5 The rate of FEV 1/FVC≥70% was 12 9% in 93 patients with COPD and positive hyperresponsiveness, however it was 30 8% in 26 patients with COPD and negative hyperresponsiveness ( P =0 031) Conclusion In smoking population, the bronchial hyperresponsiveness lead to more chronic obstructive pulmonary disease and it may be one of the susceptible risk factors for COPD更多还原