Ip M, Lam W K, So S Y, Liong E, Chan C Y, Tse K M
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Lung. 1991;169(1):43-51. doi: 10.1007/BF02714140.
Nonspecific bronchial hyperreactivity (BHR) has been reported to occur in patients with bronchiectasis. To evaluate this further, we studied 77 patients with stable bronchiectasis (noncystic fibrosis) with special reference to the prevalence of BHR to methacholine (MCh), and its relation to lung function, sputum characteristics, concommitant asthma, and atopy. The concentration of MCh required to produce a fall of 20% in forced expiratory volume in 1 s (FEV1), PC20, was determined by Wright's nebulization tidal breathing method. BHR defined by a PC20 greater than or equal to 8 mg/ml was found in 21 of 47 (45%) subjects who underwent bronchial challenge. Presence of BHR was positively associated with low baseline spirometric values, diagnosis of asthma, long duration of disease, and elevated total IgE on univariant analysis, and was significantly related to FEV1/forced vital capacity (FVC) ratio and asthma on multiple regression analysis. Ten of the 21 hyperreactive subjects did not have clinical asthma, whereas all 11 of 22 subjects with clinical asthma who underwent bronchial challenge were hyperreactive. Among those with BHR, there was a positive correlation between PC20 and baseline FEV1. When patients were further classified into asthmatic and nonasthmatic subjects, a positive correlation between PC20 and FEV1 was seen only in those without asthma. Frequency of infective episodes and inflammatory score of sputum assessed by average daily volume, purulence, and leukocyte count did not differ significantly in the groups with and without BHR. These results suggest that BHR in patients with bronchiectasis is associated with coexistent asthma and worse spriometric values, and not with the severity of bronchial sepsis.
据报道，支气管扩张症患者会出现非特异性支气管高反应性（BHR）。为进一步评估这一情况，我们研究了77例稳定期支气管扩张症（非囊性纤维化）患者，特别关注了对乙酰甲胆碱（MCh）的BHR患病率及其与肺功能、痰液特征、合并哮喘和特应性的关系。采用赖特雾化潮气呼吸法测定使第1秒用力呼气容积（FEV1）下降20%所需的MCh浓度，即PC20。在47例接受支气管激发试验的受试者中，有21例（45%）的PC20大于或等于8 mg/ml，被判定为存在BHR。单因素分析显示，BHR的存在与低基线肺量计值、哮喘诊断、疾病持续时间长和总IgE升高呈正相关，多因素回归分析显示，BHR与FEV1/用力肺活量（FVC）比值和哮喘显著相关。21例高反应性受试者中有10例无临床哮喘，而在22例接受支气管激发试验的临床哮喘受试者中，全部11例均为高反应性。在有BHR的受试者中，PC20与基线FEV1之间呈正相关。当患者进一步分为哮喘组和非哮喘组时，仅在无哮喘的患者中观察到PC20与FEV1之间呈正相关。有BHR组和无BHR组在感染发作频率以及通过日均痰液量、脓性程度和白细胞计数评估的痰液炎症评分方面差异无统计学意义。这些结果表明，支气管扩张症患者的BHR与并存的哮喘和较差的肺量计值相关，而与支气管脓毒症严重程度无关。
