严重哮喘患者10年内气道阻塞变化的自然史和危险因素
2013/02/27
摘要
背景：有关严重哮喘的临床特征、生理学和病理学了解较少。近期，研究显示，与轻度哮喘患者相比，严重哮喘患者的FVC下降，可能与空气潴留有关。然而，严重哮喘患者气道阻塞的自然史和危险因素尚未完全清楚。
方法：对54名严重哮喘患者10年间的肺功能变化进行了回顾性分析。
结果：FEV1检测到更快的梗阻变化伴随有FVC的过度丢失(r = 0.85, p < 0.0001)，FVC下降程度是FEV1变化的1.2倍。年龄、基线FVC、哮喘发作率和口服糖皮质激素与每年FVC的变化呈明显负相关。
结论：这些结果显示，严重哮喘患者的FVC下降较FEV1更为明显，表明小气道易感性是疾病快速进展的原因。老龄化、哮喘发作和全身使用糖皮质激素与FVC过度下降有关，特别是当FVC仍然正常时。
(林江涛 审校)
Respir Med.2012 Dec7.pii: S0954-6111(12)00425-8.doi:10.1016/j.rmed.2012.11.014. [Epub ahead of print]
Natural history and risk factors of obstructive changes over a 10-year period in severe asthma.
Matsunaga K, Akamatsu K, Miyatake A, Ichinose M.
Source
Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan. Electronic address: kazmatsu@wakayama-med.ac.jp.
Abstract
BACKGROUND: The clinical features, physiology, and pathology of severe asthma are poorly understood. Recently, the forced vital capacity (FVC) has been shown to be reduced in severe asthma compared to mild asthma, possibly due to air trapping. However, the natural history and risk factors of obstructive change for such asthmatic patients have not been fully elucidated.
METHODS: We examined the data of a retrospective analysis of lung function changes over a 10-year period in 54 severe asthma patients.
RESULTS: The faster obstructive changes detected by FEV(1) (forced expiratory volume in one second) were accompanied by excessive loss of FVC (r = 0.85, p < 0.0001) and the reduction in FVC was 1.2 times larger than the FEV(1) change. Age, baseline FVC, exacerbation rate and oral corticosteroids use showed significantly negative correlations with the rate of annual change in FVC.
CONCLUSIONS: These data indicate that the decline in FVC is more evident than FEV(1) in severe asthma, suggesting that small airway susceptibility may be the cause of rapid disease progression. Aging, exacerbations of asthma, and use of systemic corticosteroids are related to excess FVC decline, particularly if FVC is still normal.
Respir Med.2012 Dec 7.pii: S0954-6111(12)00425-8.doi:10.1016/j.rmed.2012.11.014. [Epub ahead of print]
