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目的:分析运动性哮喘(EIA)患者过度通气冷空气后FEV1和脉冲震荡肺功能(IOS)指标的变化,探讨外周气道病变在EIA发病中的作用。方法:EIA组20例,35.8±10.3岁,男11例,女9例;健康对照组10例,33.0±8.3岁,男女各5例。按照入选和排除标准选取研究对象,签署知情同意书后进入试验。受试者先行IOS和常规肺功能测定。然后行冷空气气道激发试验,在过度通气冷空气结束后第5、10、15、20、30分钟分别行常规肺功能检测(FEV1等)和IOS检测(R20、R5-R20等),以冷空气激发后FEV1下降≥10%作为冷空气激发试验阳性标准,计算激发前后中心气道阻力变化(ΔR20)和外周气道阻力变化[Δ(R5-R20)]。结果:(1)EIA组与健康对照组受试者在冷空气激发试验中达到的分钟通气量无明显差异;EIA组冷空气激发后FEV1降低百分比显著高于健康对照组;EIA组中有15例(占75%)患者冷空气激发试验阳性,健康对照组有1例(占10%)阳性。(2)冷空气激发试验前,EIA组受试者R5-R20显著高于健康对照组,而两组间R20无显著性差异。冷空气激发试验前后对比,激发后EIA组R5-R20、R20均较激发前显著升高;健康对照组激发后R5-R20较激发前显著升高,而R20无明显变化。冷空气激发后EIA组受试者Δ(R5-R20)与ΔR20相比差异显著,健康对照组受试者ΔR20和Δ(R5-R20)相比无显著差异。结论:冷空气激发试验对于EIA是一种敏感的辅助诊断方法;EIA患者普遍存在外周气道病变,稳定期患者中心气道阻力接近正常,而其外周气道阻力仍高于正常;EIA患者激发试验时外周气道反应强于中心气道,外周气道病变在EIA的发病中发挥着重要作用。
OBJECTIVE: To analyze the changes of FEV1 and IOS in hyper-ventilated cold air after exercise-induced asthma (EIA) and to explore the role of peripheral airway disease in the pathogenesis of EIA. Methods: EIA group consisted of 20 patients (35.8 ± 10.3), 11 males and 9 females, 10 healthy controls (33.0 ± 8.3 years) and 5 males and 5 females. According to the inclusion and exclusion criteria select the research object, signed the informed consent before entering the trial. Subjects pre-IOS and routine lung function tests. Then cold air airway stimulation test was performed. Conventional pulmonary function tests (FEV1, etc.) and IOS tests (R20, R5-R20, etc.) were performed on the 5th, 10th, 15th, 20th and 30th minutes after hyperventilation of cold air FEV1 decreased by ≥10% after cold air challenge. As the positive standard of cold air challenge test, changes in central airway resistance (ΔR20) and changes in peripheral airway resistance [Δ (R5-R20)] were calculated before and after stimulation. Results: (1) There was no significant difference in minute ventilation between EIA group and healthy control group in cold air challenge test. The percentage of FEV1 decreased significantly in EIA group after cold air challenge compared with healthy control group. In EIA group, 15 Cases (75%) were positive in cold air challenge test, and 1 (10%) was positive in healthy control group. (2) Before cold air challenge test, R5-R20 in EIA group was significantly higher than that in healthy control group, while R20 had no significant difference between the two groups. Before and after the cold air challenge test, R5-R20 and R20 in EIA group were significantly higher than those in EIA group after stimulation. R5-R20 in EIA group was significantly higher than that before challenge, but R20 did not change significantly. There was a significant difference in Δ (R5-R20) between subjects in the EIA group and ΔR20 after cold air challenge, with no significant difference between ΔR20 and Δ (R5-R20) in healthy subjects. Conclusion: Cold air stimulation test is a sensitive auxiliary diagnostic method for EIA. Peripheral airway disease is common in patients with EIA, central airway resistance is near normal in stable patients, and resistance of peripheral airway is still higher than normal in EIA patients. The test of peripheral airway reaction stronger than the central airway, peripheral airway disease in the pathogenesis of EIA plays an important role.