代谢性酸中毒能改善哮喘患者的气道传导率
2009/11/16
本试验研究急性代谢性酸中毒是否会导致哮喘患者支气管舒张。
12例哮喘患者（8例女性，平均年龄39±12岁；第1秒用力呼气量（FEV1）93±9％为预测值，PC（20）1.9±1.0 mg/mL）参与该项双盲、安慰剂-对照试验。对患者进行随机分组，酸中毒组患者服用已知剂量的氯化铵诱导酸中毒，对照组患者饮用生理盐水，每2天1次。以气道阻力（Raw）、比气道传导率（sGaw）、FEV1和呼气峰值流速（PEF）作为主要检测指标。为评价支气管收缩性变化对气道反应性的影响，我们采用组胺激发试验（PC（20））作为次要指标。
氯化铵干预致使剩余均值（SD）下降-0.5±1.4至 -3.9±1.1 mmol/L（p < 0.01），PH值从7.41±0.02降至7.36±0.02 （p < 0.01），从而导致sGaw从1.15±0.16增至1.26±0.13 1/kPa.s（p < 0.05）。PEF（从7.79 ±2.2 增至8.09±1.9，p = 0.10）和FEV1（从2.98±0.9增至3.06±0.9，p = 0.15）存在增加趋势，但无显著性差异。
因此，急性代谢性酸中毒对哮喘患者的支气管舒张作用的影响不大。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):656-658.
Metabolic acidosis improves airway conductance in patients with asthma.
Brijker F, Van Den Elshout FJ, Bosch FH, Heijdra YF, Folgering HT.
The objective was to investigate whether acute metabolic acidosis could cause bronchodilation in patients with asthma. Twelve patients with asthma (8 females, mean age 39 (+/- SD 12) years, forced expiratory volume in 1 second [FEV(1)] 93 [+/-9] % predicted, PC(20) 1.9 (+/-1.0) mg/mL) participated in a double-blind, placebo-controlled trial. Subjects ingested calculated amounts of ammonium chloride to induce acidosis or saline as placebo, in random order, each on a separate day. Airway resistance (R(aw)), specific airway conductance (sG(aw)), FEV(1), and PEF were measured as primary variables. To evaluate the consequences of alterations in bronchial contractility on the airway responsiveness, the histamine provocation test (PC(20)) was measured as secondary variable. The intervention resulted in a mean (SD) decrease in base excess from -0.5 (+/-1.4) to -3.9 (+/-1.1) mmol/L (p < 0.01) and a decrease in pH from 7.41 (+/-0.02) to 7.36 (+/-0.02) (p < 0.01). This caused a statistically significant increase in sG(aw) from 1.15 (+/-0.16) to 1.26 (+/-0.13) 1/kPa.s) (p < 0.05). Tendencies towards increase were found in PEF (7.79 (+/-2.2) versus 8.09 (+/-1.9) (NS, p = 0.10) and in FEV(1) (2.98 (+/-0.9) versus 3.06 (+/-0.9) (NS, p = 0.15). PC(20) did not change significantly. It was concluded that acute metabolic acidosis has a modest bronchodilating effect in patients with asthma.
Brijker F, et al. J Asthma. 2009 Sep;46(7):656-8.
12例哮喘患者（8例女性，平均年龄39±12岁；第1秒用力呼气量（FEV1）93±9％为预测值，PC（20）1.9±1.0 mg/mL）参与该项双盲、安慰剂-对照试验。对患者进行随机分组，酸中毒组患者服用已知剂量的氯化铵诱导酸中毒，对照组患者饮用生理盐水，每2天1次。以气道阻力（Raw）、比气道传导率（sGaw）、FEV1和呼气峰值流速（PEF）作为主要检测指标。为评价支气管收缩性变化对气道反应性的影响，我们采用组胺激发试验（PC（20））作为次要指标。
氯化铵干预致使剩余均值（SD）下降-0.5±1.4至 -3.9±1.1 mmol/L（p < 0.01），PH值从7.41±0.02降至7.36±0.02 （p < 0.01），从而导致sGaw从1.15±0.16增至1.26±0.13 1/kPa.s（p < 0.05）。PEF（从7.79 ±2.2 增至8.09±1.9，p = 0.10）和FEV1（从2.98±0.9增至3.06±0.9，p = 0.15）存在增加趋势，但无显著性差异。
因此，急性代谢性酸中毒对哮喘患者的支气管舒张作用的影响不大。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):656-658.
Metabolic acidosis improves airway conductance in patients with asthma.
Brijker F, Van Den Elshout FJ, Bosch FH, Heijdra YF, Folgering HT.
The objective was to investigate whether acute metabolic acidosis could cause bronchodilation in patients with asthma. Twelve patients with asthma (8 females, mean age 39 (+/- SD 12) years, forced expiratory volume in 1 second [FEV(1)] 93 [+/-9] % predicted, PC(20) 1.9 (+/-1.0) mg/mL) participated in a double-blind, placebo-controlled trial. Subjects ingested calculated amounts of ammonium chloride to induce acidosis or saline as placebo, in random order, each on a separate day. Airway resistance (R(aw)), specific airway conductance (sG(aw)), FEV(1), and PEF were measured as primary variables. To evaluate the consequences of alterations in bronchial contractility on the airway responsiveness, the histamine provocation test (PC(20)) was measured as secondary variable. The intervention resulted in a mean (SD) decrease in base excess from -0.5 (+/-1.4) to -3.9 (+/-1.1) mmol/L (p < 0.01) and a decrease in pH from 7.41 (+/-0.02) to 7.36 (+/-0.02) (p < 0.01). This caused a statistically significant increase in sG(aw) from 1.15 (+/-0.16) to 1.26 (+/-0.13) 1/kPa.s) (p < 0.05). Tendencies towards increase were found in PEF (7.79 (+/-2.2) versus 8.09 (+/-1.9) (NS, p = 0.10) and in FEV(1) (2.98 (+/-0.9) versus 3.06 (+/-0.9) (NS, p = 0.15). PC(20) did not change significantly. It was concluded that acute metabolic acidosis has a modest bronchodilating effect in patients with asthma.
Brijker F, et al. J Asthma. 2009 Sep;46(7):656-8.
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