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目的探讨难治性哮喘患者的临床特征,为诊断和治疗提供依据。方法 2009年1月-2010年12月第三军医大学新桥医院全军呼吸内科研究所收治的41例难治性哮喘患者,均行肺功能检测,对其中37例行诱导痰细胞分类和计数,对其中34例行胸部高分辨率CT(HRCT)扫描。结果肺功能检查结果显示,41例患者的气流受限均不完全可逆,吸入支气管扩张剂后FEV1/FVC<70%。诱导痰细胞学分类和计数结果显示,37例患者中,25例(67.6%)嗜酸粒细胞增多(>0.03),13例(35.1%)中性粒细胞比例增高(>0.61),6例(16.2%)嗜酸粒细胞和中性粒细胞比例均增高,仅1例患者的嗜酸粒细胞和中性粒细胞比例正常。胸部HRCT扫描结果显示,34例患者中,28例(82.3%)可见段支气管壁增厚,22例(64.7%)以亚段支气管壁增厚为主,同时伴支气管管腔狭窄;7例患者可见支气管扩张,以柱状支气管扩张为主,5例患者伴不同程度的小叶中心型肺气肿。结论难治性哮喘患者多存在不同程度气道重塑、不完全可逆的气流受限和气道炎症。结合病史,联合肺功能测定、诱导痰细胞学分类和计数、胸部HRCT检查有助于难治性哮喘的临床评估。
Objective To investigate the clinical features of patients with refractory asthma and provide the basis for diagnosis and treatment. Methods From January 2009 to December 2010, 41 cases of refractory asthma patients admitted to the Institute of Respiratory Medicine, Xinqiao Hospital, Third Military Medical University underwent pulmonary function tests. 37 cases were induced sputum cell sorting and counting , Of which 34 cases of chest high resolution CT (HRCT) scan. Results The results of pulmonary function tests showed that airflow limitation in 41 patients was not completely reversible, and FEV1 / FVC <70% after bronchodilator inhalation. Among the 37 patients, eosinophilia (> 0.03) was found in 25 cases (67.6%), neutrophils in 13 cases (35.1%) were increased (> 0.61), and in 6 cases (16.2%) increased the proportion of eosinophils and neutrophils, and only one patient had a normal proportion of eosinophils and neutrophils. Thoracic HRCT scan results showed that in 34 patients, bronchial wall thickening was seen in 28 cases (82.3%), bronchial wall thickening in 22 cases (64.7%) and bronchial stenosis in 22 cases, and in 7 patients Visible bronchiectasis to columnar bronchiectasis based, 5 patients with varying degrees of lobular heart-shaped emphysema. Conclusion There are many airway remodeling, incomplete reversible air flow restriction and airway inflammation in patients with refractory asthma. Combined with medical history, combined with pulmonary function test, induced sputum cytology classification and counting, chest HRCT examination contribute to the clinical evaluation of refractory asthma.