心房间隔缺损和哮喘样呼吸困难的关系：介入封堵术的影响
2016/10/09
摘要
背景:心房间隔缺损（ASD）患者常被误诊为哮喘患者，相应地要接受错误的支气管扩张剂治疗。为了描述他们自己呼吸困难的症状来解释这种临床观察，我们研究了
成功接受了经皮闭合术的继发孔型心房间隔缺损患者中哮喘样症状的患病率。
方法:共有80例心房间隔缺损患者（74%为女性，平均年龄46.7±16.8年，中位随访3.0年[2.0-5.0]）回顾性地完成了呼吸困难问卷调查，在ASD关闭之前和之后，用7点规模来确定咳嗽、喘息、胸闷，努力呼吸困难的存在和程度，以及支气管扩张剂的使用（0 =无，6 =最大）。管理迷你哮喘生活质量（Mini-AQLQ）和哮喘控制问卷-支气管扩张剂的使用（ACQ6）。
结果：共有48例（60%）患者报告有咳嗽、27例（34%）有喘息，26例（33%）有胸闷，62例（78%）努力呼吸困难。64例（80%）患者房间隔缺损封堵术后症状消失或减少。在Mini-AQLQ和ACQ6上哮喘症状评分下降显著（P均＜0.001）。不经常使用的支气管扩张剂（P = 0.015）使用心房间隔缺损封堵术后（P = 0.039），使用支气管扩张剂的患者从16例（20%）下降到8例（10%）。
结论：在心房间隔缺损患者中出现了哮喘样症状和支气管扩张剂使用的高发生率，在本研究中超过了支气管哮喘的低患病率。未来的前瞻性研究是必要的，以确认这种现象。一个心房间隔缺损患者应与哮喘样症状患者进行差别化鉴别诊断，之后通过心房间隔缺损封堵术能显著缓解症状。
关键词：哮喘；心房性呼吸困难；支气管高反应性；设备关闭；心间隔缺损
（杨冬 审校）
Neth Heart J. 2016 Aug 25. [Epub ahead of print]
Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure.
Nassif M1, Heuschen CB1, Lu H1, Bouma BJ1, van Steenwijk RP2, Sterk PJ2, Mulder BJ1,3, de Winter RJ4.
Author information
Abstract
BACKGROUND:Patients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence ofasthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure.
METHODS:A total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0-5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered.
RESULTS:A total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015).
CONCLUSIONS:A high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.
KEYWORDS:Asthma; Atrial Dyspnoea; Bronchial hyperreactivity; Device closure; Heart septal defects
Neth Heart J. 2016 Aug 25. [Epub ahead of print]
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