哮喘患者支气管收缩导致的潮气性气道关闭：肺容积检测的作用
2011/03/28
摘要
背景：潮气性气道关闭的出现及其严重程度在哮喘患者中尚未常规进行评价。本研究提供一种能检测哮喘患者支气管收缩时潮气性气道关闭的简单而有用的方法。
方法：在20名持续轻症哮喘患者中，采用身体体积描记法(pleth)和重复呼吸氦稀释技术(He)检测功能残气量(FRC)，然后计算基线状态下、乙酰甲胆碱(MCh)刺激后及支气管扩张剂(沙丁胺醇)处理后的残气量(RV)和总肺活量(TLC)。
检测指标和结果：尽管存在显著的支气管收缩（FEV1下降35 ± 7%），Mch刺激后TLC并不变化，但pleth过程中由于动态肺充气导致FRC持续增加(+0.68 ± 0.54 L)，因空气滞留导致RV持续增加(+0.65 ± 0.37 L)，平均增加分别为22%和46%。相反，He过程中FRC（RV和TLC）在13名受试者中增加（组1），在7名受试者中下降（组2）。因此，pleth检测和He检测的FRC差异（FRCpleth - FRCHe）在组2(1.03 ± 0.41 L)高于组1(0.22 ± 0.20 L) (P<0.01)，但两组间差异无实际临床意义，包括基线状态PD20FEV1和MCh刺激后的用力肺活量(FVC)绝对值及变化百分数。
结论：FRCpleth和FRCHe可用于鉴别MCh诱导的支气管收缩时易发生潮气性气道关闭的哮喘患者，FRCpleth和FRCHe的差值可用于检测呼气末肺容积中关闭气道上游的总体未通气肺容积。
（刘国梁 审校）
J Asthma. 2011 Feb;48(1):33-40. Epub 2010 Nov 1.
Tidal airway closure during bronchoconstriction in asthma: usefulness of lung volume measurements.
Tantucci C, Guerini M, Boni E, Corda L, Pini L.
Unit of Respiratory Medicine, Department of Medical and Surgical Sciences, University of Brescia, 1st Medicina, Spedali Civili, Brescia, Italy.
Abstract
Background. The presence and extent of tidal airway closure is not routinely assessed in asthma. The objective of this study was to provide a simple functional tool able to detect tidal airway closure during bronchoconstriction in asthma.
Methods. In 20 subjects with mild persistent asthma, we sequentially performed the measurement of functional residual capacity (FRC) by body plethysmography (pleth) and multibreath helium dilutional technique (He) and then computed residual volume (RV) and total lung capacity (TLC) at baseline, at the end of methacholine (MCh) challenge and after bronchodilator (albuterol).
Measurements and main results. Despite substantial bronchoconstriction (fall in FEV(1) = 35 ± 7%), TLC, pleth did not change following MCh challenge, but FRC, pleth because of dynamic pulmonary hyperinflation (+0.68 ± 0.54 L) and RV,pleth because of air trapping (+0.65 ± 0.37 L), invariably increased (on average by 22% and 46%, respectively). In contrast, FRC,He (and RV,He and TLC,He) could either increase, as seen in 13 subjects (Group I), or decrease, as seen in 7 subjects (Group II). Hence, the difference between FRC,pleth and FRC,He (Diff. FRC,pleth - FRC,He) was much greater in Group II (1.03 ± 0.41 L) than in Group I (0.22 ± 0.20 L) (p < .01). No functional differences were found between the two groups, including baseline PD(20)FEV(1) and absolute and percent change in forced vital capacity (FVC) at the end of the MCh challenge.
Conclusions. Comparison between FRC,pleth and FRC,He is useful to identify asthmatics prone to tidal airway closure during MCh-induced bronchoconstriction and Diff. FRC,pleth - FRC,He can be used to measure the overall unventilated lung volume upstream of the airways closed at end-expiratory lung volume (EELV).
J Asthma. 2011 Feb;48(1):33-40. Epub 2010 Nov 1.
背景：潮气性气道关闭的出现及其严重程度在哮喘患者中尚未常规进行评价。本研究提供一种能检测哮喘患者支气管收缩时潮气性气道关闭的简单而有用的方法。
方法：在20名持续轻症哮喘患者中，采用身体体积描记法(pleth)和重复呼吸氦稀释技术(He)检测功能残气量(FRC)，然后计算基线状态下、乙酰甲胆碱(MCh)刺激后及支气管扩张剂(沙丁胺醇)处理后的残气量(RV)和总肺活量(TLC)。
检测指标和结果：尽管存在显著的支气管收缩（FEV1下降35 ± 7%），Mch刺激后TLC并不变化，但pleth过程中由于动态肺充气导致FRC持续增加(+0.68 ± 0.54 L)，因空气滞留导致RV持续增加(+0.65 ± 0.37 L)，平均增加分别为22%和46%。相反，He过程中FRC（RV和TLC）在13名受试者中增加（组1），在7名受试者中下降（组2）。因此，pleth检测和He检测的FRC差异（FRCpleth - FRCHe）在组2(1.03 ± 0.41 L)高于组1(0.22 ± 0.20 L) (P<0.01)，但两组间差异无实际临床意义，包括基线状态PD20FEV1和MCh刺激后的用力肺活量(FVC)绝对值及变化百分数。
结论：FRCpleth和FRCHe可用于鉴别MCh诱导的支气管收缩时易发生潮气性气道关闭的哮喘患者，FRCpleth和FRCHe的差值可用于检测呼气末肺容积中关闭气道上游的总体未通气肺容积。
（刘国梁 审校）
J Asthma. 2011 Feb;48(1):33-40. Epub 2010 Nov 1.
Tidal airway closure during bronchoconstriction in asthma: usefulness of lung volume measurements.
Tantucci C, Guerini M, Boni E, Corda L, Pini L.
Unit of Respiratory Medicine, Department of Medical and Surgical Sciences, University of Brescia, 1st Medicina, Spedali Civili, Brescia, Italy.
Abstract
Background. The presence and extent of tidal airway closure is not routinely assessed in asthma. The objective of this study was to provide a simple functional tool able to detect tidal airway closure during bronchoconstriction in asthma.
Methods. In 20 subjects with mild persistent asthma, we sequentially performed the measurement of functional residual capacity (FRC) by body plethysmography (pleth) and multibreath helium dilutional technique (He) and then computed residual volume (RV) and total lung capacity (TLC) at baseline, at the end of methacholine (MCh) challenge and after bronchodilator (albuterol).
Measurements and main results. Despite substantial bronchoconstriction (fall in FEV(1) = 35 ± 7%), TLC, pleth did not change following MCh challenge, but FRC, pleth because of dynamic pulmonary hyperinflation (+0.68 ± 0.54 L) and RV,pleth because of air trapping (+0.65 ± 0.37 L), invariably increased (on average by 22% and 46%, respectively). In contrast, FRC,He (and RV,He and TLC,He) could either increase, as seen in 13 subjects (Group I), or decrease, as seen in 7 subjects (Group II). Hence, the difference between FRC,pleth and FRC,He (Diff. FRC,pleth - FRC,He) was much greater in Group II (1.03 ± 0.41 L) than in Group I (0.22 ± 0.20 L) (p < .01). No functional differences were found between the two groups, including baseline PD(20)FEV(1) and absolute and percent change in forced vital capacity (FVC) at the end of the MCh challenge.
Conclusions. Comparison between FRC,pleth and FRC,He is useful to identify asthmatics prone to tidal airway closure during MCh-induced bronchoconstriction and Diff. FRC,pleth - FRC,He can be used to measure the overall unventilated lung volume upstream of the airways closed at end-expiratory lung volume (EELV).
J Asthma. 2011 Feb;48(1):33-40. Epub 2010 Nov 1.
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