Ferrer A, Roca J, Rodriguez-Roisin R, López-Pedret J, Revert L
Dept. of Medicine, Facultat de Medicina, Universitat de Barcelona, Spain.
Eur Respir J. 1990 Apr;3(4):387-91.
We hypothesized that patients with chronic renal failure may present nonspecific bronchial hyperreactivity due to subclinical interstitial lung oedema. To assess lung function disturbances and methacholine (MTH) bronchial responsiveness in this condition, we studied 12 patients (9 men and 3 women; 41.8 +/- 13.3 yrs (SD] with chronic renal failure undergoing regular haemodialysis (HD). Before HD, mean results of conventional lung function tests were within the normal range: forced expiratory volume in one second (FEV1), 89 +/- 12.9% predicted; forced mid-expiratory flow (FEF25-75), 81 +/- 36.7% predicted; total lung capacity (TLC), 94 +/- 14.6% predicted, but 3 subjects presented mild reduction in lung volumes and 5 individuals showed mild obstructive ventilatory impairment. After HD, maximal expiratory flow rates increased significantly (FEV1, + 8.2 +/- 5.1% (p less than 0.005); FEF25-75, +26.2 +/- 25.9% (p less than 0.005]. Interestingly, these increases in FEV1 after HD correlated with body weight loss during HD (r = 0.74, p less than 0.01). In contrast, pre-HD bronchial reactivity was within the normal range (mean % change in FEV1 after MTH, -3.7 +/- 4.5%; range, +1- -14%) without significant changes in methacholine bronchial responsiveness after HD. We speculate that interstitial lung oedema may play a significant role in lung function impairment observed in patients with chronic renal failure. This study shows that nonspecific bronchial hyperreactivity is not present in clinically stable patients with this disorder.
我们推测，慢性肾衰竭患者可能因亚临床间质性肺水肿而出现非特异性支气管高反应性。为评估这种情况下的肺功能障碍和乙酰甲胆碱（MTH）支气管反应性，我们研究了12例接受定期血液透析（HD）的慢性肾衰竭患者（9例男性和3例女性；年龄41.8±13.3岁[标准差]）。血液透析前，传统肺功能测试的平均结果在正常范围内：一秒用力呼气容积（FEV1），为预测值的89±12.9%；用力呼气中期流速（FEF25-75），为预测值的81±36.7%；肺总量（TLC），为预测值的94±14.6%，但3名受试者肺容积轻度减少，5名个体有轻度阻塞性通气功能障碍。血液透析后，最大呼气流量显著增加（FEV1，增加8.2±5.1%[p<0.005]；FEF25-75，增加26.2±25.9%[p<0.005]）。有趣的是，血液透析后FEV1的这些增加与血液透析期间的体重减轻相关（r = 0.74，p<0.01）。相比之下，血液透析前支气管反应性在正常范围内（MTH后FEV1的平均变化百分比，-3.7±4.5%；范围，+1 - -14%），血液透析后乙酰甲胆碱支气管反应性无显著变化。我们推测间质性肺水肿可能在慢性肾衰竭患者观察到的肺功能损害中起重要作用。这项研究表明，患有这种疾病的临床稳定患者不存在非特异性支气管高反应性。
