AMP及腺苷导致的呼吸困难与哮喘患者大小气道功能障碍的关系
2019/02/19
摘要
背景：支气管激发试验通常用于确诊哮喘。然而，呼吸困难的主观感觉与FEV1值的下降之间相关性较差。激发试验仅仅应用大气道参数FEV1，尽管呼吸困难与大小气道功能障碍都具有相关性。此研究的目的是探讨腺苷5'-一磷酸（AMP）及腺苷是否引起同样的呼吸困难感觉，呼吸困难的感觉与大气管还是小气道功能障碍相关性更强一些。
方法：我们以59名具有哮喘症状且（既往）吸烟指数≥5包年者为研究目标，分别应用AMP刺激大气道、腺苷刺激小气道持续14±7天。所有受试者均进行肺功能、脉冲震荡（IOS）和Borg呼吸困难评分。在36名受试者中，另外进行多次呼吸氮冲洗技术（MBNW）。 我们使用单变量和多变量线性回归分析，分析了Borg评分的变化（Δ）与大小气道参数的变化之间的关系。并对MBNW进行单独分析。
结果：应用AMP和腺苷的诱发相似水平的呼吸困难。在单变量和多变量分析中，ΔFEV1在AMP或腺苷激发后与ΔBorg变化值无显着相关性。在多变量线性回归中，应用腺苷激发后FEF25-75降低水平与Borg值增加水平具有独立相关性。在AMP激发的多变量分析中，Borg分值与任何大或小气道参数之间未发现显着关联性。
结论：AMP和腺苷导致同等程度的呼吸困难感觉。我们的研究结果表明，腺苷诱导的呼吸困难与小气道受累有关，而大或小呼吸道功能障碍均与AMP引起的呼吸困难无关。
Associations of AMP and adenosine induced dyspnea sensation to large and small airways dysfunction in asthma.
Cox CA, Boudewijn IM
Abstract
BACKGROUND: Bronchial provocation is often used to confirm asthma. Dyspnea sensation, however, associates poorly with the evoked drop in FEV1. Provocation tests only use the large airways parameter FEV1, although dyspnea is associated with both large- and small airways dysfunction. Aim of this study was to explore if adenosine 5'-monophosphate (AMP) and adenosine evoke an equal dyspnea sensation and if dyspnea associates better with large or small airways dysfunction.
METHODS: We targeted large airways with AMP and small airways with dry powder adenosine in 59 asthmatic (ex)-smokers with ≥5 packyears, 14 ± 7 days apart. All subjects performed spirometry, impulse oscillometry (IOS), and Borg dyspnea score. In 36 subjects multiple breath nitrogen washout (MBNW) was additionally performed. We analyzed the association of the change (Δ) in Borg score with the change in large and small airways parameters, using univariate and multivariate linear regression analyses. MBNW was analyzed separately.
RESULTS: Provocation with AMP and adenosine evoked similar levels of dyspnea. ΔFEV1 was not significantly associated with ΔBorg after either AMP or adenosine provocation, in both univariate and multivariate analyses. In multivariate linear regression, a decrease in FEF25-75 during adenosine provocation was independently associated with an increase in Borg. In the multivariate analyses for AMP provocation, no significant associations were found between ΔBorg and any large or small airways parameters.
CONCLUSION: AMP and adenosine induce equally severe dyspnea sensations. Our results suggest that dyspnea induced with dry powder adenosine is related to small airways involvement, while neither large nor small airways dysfunction was associated with AMP-induced dyspnea.
背景：支气管激发试验通常用于确诊哮喘。然而，呼吸困难的主观感觉与FEV1值的下降之间相关性较差。激发试验仅仅应用大气道参数FEV1，尽管呼吸困难与大小气道功能障碍都具有相关性。此研究的目的是探讨腺苷5'-一磷酸（AMP）及腺苷是否引起同样的呼吸困难感觉，呼吸困难的感觉与大气管还是小气道功能障碍相关性更强一些。
方法：我们以59名具有哮喘症状且（既往）吸烟指数≥5包年者为研究目标，分别应用AMP刺激大气道、腺苷刺激小气道持续14±7天。所有受试者均进行肺功能、脉冲震荡（IOS）和Borg呼吸困难评分。在36名受试者中，另外进行多次呼吸氮冲洗技术（MBNW）。 我们使用单变量和多变量线性回归分析，分析了Borg评分的变化（Δ）与大小气道参数的变化之间的关系。并对MBNW进行单独分析。
结果：应用AMP和腺苷的诱发相似水平的呼吸困难。在单变量和多变量分析中，ΔFEV1在AMP或腺苷激发后与ΔBorg变化值无显着相关性。在多变量线性回归中，应用腺苷激发后FEF25-75降低水平与Borg值增加水平具有独立相关性。在AMP激发的多变量分析中，Borg分值与任何大或小气道参数之间未发现显着关联性。
结论：AMP和腺苷导致同等程度的呼吸困难感觉。我们的研究结果表明，腺苷诱导的呼吸困难与小气道受累有关，而大或小呼吸道功能障碍均与AMP引起的呼吸困难无关。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（BMC Pulm Med. 2019 Jan 28;19(1):23. doi: 10.1186/s12890-019-0783-0.）
（BMC Pulm Med. 2019 Jan 28;19(1):23. doi: 10.1186/s12890-019-0783-0.）
Associations of AMP and adenosine induced dyspnea sensation to large and small airways dysfunction in asthma.
Cox CA, Boudewijn IM
Abstract
BACKGROUND: Bronchial provocation is often used to confirm asthma. Dyspnea sensation, however, associates poorly with the evoked drop in FEV1. Provocation tests only use the large airways parameter FEV1, although dyspnea is associated with both large- and small airways dysfunction. Aim of this study was to explore if adenosine 5'-monophosphate (AMP) and adenosine evoke an equal dyspnea sensation and if dyspnea associates better with large or small airways dysfunction.
METHODS: We targeted large airways with AMP and small airways with dry powder adenosine in 59 asthmatic (ex)-smokers with ≥5 packyears, 14 ± 7 days apart. All subjects performed spirometry, impulse oscillometry (IOS), and Borg dyspnea score. In 36 subjects multiple breath nitrogen washout (MBNW) was additionally performed. We analyzed the association of the change (Δ) in Borg score with the change in large and small airways parameters, using univariate and multivariate linear regression analyses. MBNW was analyzed separately.
RESULTS: Provocation with AMP and adenosine evoked similar levels of dyspnea. ΔFEV1 was not significantly associated with ΔBorg after either AMP or adenosine provocation, in both univariate and multivariate analyses. In multivariate linear regression, a decrease in FEF25-75 during adenosine provocation was independently associated with an increase in Borg. In the multivariate analyses for AMP provocation, no significant associations were found between ΔBorg and any large or small airways parameters.
CONCLUSION: AMP and adenosine induce equally severe dyspnea sensations. Our results suggest that dyspnea induced with dry powder adenosine is related to small airways involvement, while neither large nor small airways dysfunction was associated with AMP-induced dyspnea.
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大豆异黄酮通过产生高表达PAI-1的基因型减少哮喘患者的哮喘急性发作
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