支气管舒张试验评估371例哮喘患者不同肺功能阻塞程度

Bronchodilation testing to assess the different degrees of pulmonary function obstruction in 371 patients with asthma

摘要

目的 探讨支气管舒张试验(bronchodilation test, BDT)在不同通气功能障碍阻塞程度评估中的价值。方法 本研究为回顾性队列分析，纳入2022年1月1日至2024年12月31日呼吸与危重症医学科确诊的371例哮喘患者，其中男202例、女169例。根据基线一秒率，即第一秒用力呼气容积占用力肺活量的比例(forced expiratory volume in one second to forced vital capacity ratio, FEV₁/FVC%)和第一秒用力呼气容积(forced expiratory volume in one second, FEV₁)占预计值的百分比分为轻度组(FEV₁%≥70%，n=201)、中度组(FEV₁%为50%~69%，n=93)和重度组(FEV₁%<49%，n=77)。所有患者行BDT(吸入沙丁胺醇400μg)，记录舒张前后肺功能指标(FEV₁、FVC、FEV₁/FVC%)。结果 中度组(80.6%)和重度组(79.2%)阳性率显著高于轻度组(36.8%)(χ²=48.865，P<0.001；χ²=40.077，P<0.001)。按年龄分为轻度组50(37，60)岁，中度组56(46，65.5)岁、重度组53(44，63)岁，Kruskal-Wallis H检验显示组间差异有统计学意义(H=7.202，P=0.027)。男性占比54.4%，女性占比45.6%，差异无统计学意义(χ²=5.904，P=0.052)。轻度组的FEV₁改善量高于FVC(190 mL vs. 130 mL)，差异有统计学意义(Z=-4.015，P<0.001)；重度组FVC改善量高于FEV₁(340 mL vs. 200 mL)，差异有统计学意义(Z=-4.297，P<0.001)。舒张后轻度组、中度组的FEV₁/FVC%明显升高(P<0.001)。重度组FEV₁/FVC%舒张后下降(P<0.001)。结论 相较于哮喘轻度阻塞患者，中度和重度阻塞患者的BDT阳性率更高，年龄更大。轻中度阻塞的哮喘患者舒张试验以FEV₁改善为主，重度阻塞患者FVC改善明显。

Abstract

Objective To explore the value of the bronchodilation test (BDT) in assessing the severity of obstruction in the different degrees of pulmonary function obstruction. Methods This retrospective cohort study included 371 patients (202 males, 169 females) diagnosed with asthma at the Department of Respiratory and Critical Care Medicine, between January 1, 2022, and December 31, 2024. Based on baseline FEV₁/FVC% (forced expiratory volume in one second to forced vital capacity ratio) and FEV₁% (forced expiratory volume in one second) predicted values, patients were stratified into three groups: the mild group (FEV₁%≥70%, n=201), the moderate group (FEV₁% being 50%-69%, n=93), and the severe group (FEV₁%<49%, n=77). All patients underwent the BDT (inhaled salbutamol 400μg), and lung function parameters (FEV₁, FVC, FEV₁/FVC%) were recorded before and after BDT. Results Positivity rates were significantly higher in the moderate (80.6%) and severe (79.2%) groups compared to the mild group (36.8%) (χ²=48.865, P<0.001; χ²=40.077, P<0.001). The patients in the mild, moderate and severe groups were 50(37,60), 56(46,65.5), and 53(44,63) years old, respectively, with a statistically significant difference among groups (H=7.202, P=0.027). The cohort comprised 54.4% males and 45.6% females, with no statistically significant difference in sex distribution (χ²=5.904, P=0.052). In the mild group, the improvement in FEV₁(190 mL) was significantly greater than that in FVC (130 mL), Z=-4.015, P<0.001. In the severe group, the improvement in FVC (340 mL) was significantly greater than that in FEV₁(200 mL), Z=-4.297, P<0.001. After the bronchodilation, FEV₁/FVC% increased significantly in both the mild and moderate groups (P<0.01). The FEV₁/FVC% decreased in the severe group (P<0.001). Conclusion Compared with patients with mild asthma-related airway obstruction, those with moderate and severe obstruction had higher BDT positivity rates and were older. In patients with mild to moderate obstruction, the dilation test primarily results in improvement in FEV₁, whereas patients with severe obstruction show significant improvement in FVC.

关键词

哮喘 / 肺功能 / 支气管舒张试验 / 第一秒用力呼气容积 / 用力肺活量 / 一秒率

Key words

Asthma / Lung function / Bronchodilation test / Forced expiratory volume in one second / Forced vital capacity / Forced expiratory volume in one second to forced vital capacity ratio

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