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目的深入研究支气管哮喘(简称哮喘)肺功能的动态改变特点和机制。方法对50例哮喘患者分别于急性发作期、慢性持续期和缓解期进行肺通气功能、肺容量、体积描记法和脉冲振荡法(IOS)检测。结果仅DLco和胸腔内气体容积在不同分期间差异无统计学意义,余各参数在不同分期间差异均有统计学意义。FVC、FEV1/FVC、FVC%pred、FEV1、FEV1%pred、PEF、PEF%pred、FEF25、FEF50、X5在急性发作期显著低于慢性持续期和缓解期,RV、RV/TLC、Rtot、Fres、Z5、R5、R20、AX在急性发作期显著高于慢性持续期和缓解期,而在慢性持续期和缓解期之间差异无统计学意义。FEV1缓解期较急性发作期的改善值和改善率均显著高于FVC(ΔFEV1/ΔFVC>1)。R20的改善值大于R5-R20[ΔR20/Δ(R5-R20)>1],AX的改善率最高。肺容量参数IC、RV和RV/TLC缓解期较急性发作期的改善值与FVC、FEV1、FEV1/FVC、PEF的改善值均显著相关(P<0.05)。IOS各参数改善值与FVC、FEV1、PEF的改善值均显著相关(P<0.001)。结论哮喘气道阻力的增加以中心气道阻力为主,其治疗反应以流速改善型为主。IOS和肺通气功能、肺容量、体描仪检测具有良好的相关性。IOS在区分气道阻塞的部位和治疗反应类型,哮喘和COPD的鉴别诊断方面有较高的临床价值。
Objective To study the characteristics and mechanism of dynamic changes of lung function in bronchial asthma (asthma). Methods Lung function, lung volume, plethysmography and pulse oscillatometry (IOS) were performed in 50 patients with asthma at acute exacerbation, chronic duration and remission respectively. Results There was no significant difference between DLco and intrathoracic gas volume in different periods only, and there were significant differences among the various parameters in different periods. FVC, FEV1 / FVC, FVC% pred, FEV1, FEV1% pred, PEF, PEF% pred, FEF25, FEF50 and X5 in acute exacerbation were significantly lower than those in chronic duration and remission , Z5, R5, R20 and AX were significantly higher in acute exacerbation than in chronic exacerbation and remission, but no significant difference between chronic persistent exacerbation and remission. The improvement and improvement rate of FEV1 in acute phase of remission were significantly higher than that of FVC (ΔFEV1 / ΔFVC> 1). The improvement of R20 is greater than that of R5-R20 [ΔR20 / Δ (R5-R20)> 1], and the improvement rate of AX is the highest. The improvement of lung volume parameters IC, RV and RV / TLC during acute exacerbation were significantly correlated with the improvement of FVC, FEV1, FEV1 / FVC and PEF (P <0.05). The improvement of IOS parameters was significantly correlated with the improvement of FVC, FEV1 and PEF (P <0.001). Conclusion The increase of airway resistance in asthma is mainly caused by central airway resistance, and its response to treatment is mainly based on the improvement of flow rate. IOS and lung ventilation function, lung capacity, body scan instrument has a good correlation. IOS in the distinction between airway obstruction and the type of treatment response, the differential diagnosis of asthma and COPD has a higher clinical value.