Yasuo Masanori, Kitaguchi Yoshiaki, Kinota Fumiya, Kosaka Makoto, Urushihata Kazuhisa, Ushiki Atsuhito, Yamamoto Hiroshi, Kawakami Satoshi, Hanaoka Masayuki
The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
Respir Investig. 2018 May;56(3):222-229. doi: 10.1016/j.resinv.2018.01.005. Epub 2018 Feb 23.
Pulmonary function tests (PFTs) comprise the traditional method for detecting central airway obstruction (CAO) and evaluating therapeutic effects, but are effort-dependent. By contrast, the forced oscillation technique (FOT) is performed during tidal breathing in an effort-independent mode and is universally used to assess respiratory function in patients with chronic obstructive pulmonary disease (COPD) and asthma. We used the FOT to measure airway resistance and reactance in patients with CAO before and after interventional bronchoscopy and compared the results to data obtained using PFTs.
Twelve patients with CAO were recruited from December 2013 to July 2016. The FOT, PFTs, chest computed tomography (CT), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale were employed before and after interventional bronchoscopy. The minimum airway cross-sectional area (MACSA) was calculated using a CT image calculator.
Of the 12 patients, 6 had tracheal obstruction and 6 had bronchial obstruction. All FOT measurements, except ΔX5, were significantly improved after interventional bronchoscopy in all cases. The significance of the improvement was greater with the FOT than PFTs. The MACSA, CAT, and mMRC dyspnea scale scores also significantly improved in all cases. Furthermore, only alteration of resistance at 20 Hz (R20) significantly correlated with the alteration of the MACSA after intervention. No significant correlations were found for PFTs.
The FOT is suitable and convenient for assessing therapeutic results in patients with tracheobronchial CAO. The alteration of R20 is useful for estimating the airway dilation of CAO after interventional bronchoscopy.
肺功能测试（PFTs）是检测中央气道阻塞（CAO）和评估治疗效果的传统方法，但该方法依赖于受检者的努力程度。相比之下，强迫振荡技术（FOT）在潮气呼吸过程中以非努力依赖模式进行，普遍用于评估慢性阻塞性肺疾病（COPD）和哮喘患者的呼吸功能。我们使用FOT测量介入性支气管镜检查前后CAO患者的气道阻力和电抗，并将结果与使用PFTs获得的数据进行比较。
2013年12月至2016年7月招募了12例CAO患者。在介入性支气管镜检查前后采用FOT、PFTs、胸部计算机断层扫描（CT）、慢性阻塞性肺疾病评估测试（CAT）和改良的医学研究委员会（mMRC）呼吸困难量表。使用CT图像计算器计算最小气道横截面积（MACSA）。
12例患者中，6例为气管阻塞，6例为支气管阻塞。在所有病例中，介入性支气管镜检查后，除ΔX5外，所有FOT测量值均有显著改善。FOT改善的显著性大于PFTs。所有病例中MACSA、CAT和mMRC呼吸困难量表评分也显著改善。此外，仅20Hz时的阻力变化（R20）与干预后MACSA的变化显著相关。PFTs未发现显著相关性。
FOT适用于评估气管支气管CAO患者的治疗效果，且方便易行。R20的变化有助于估计介入性支气管镜检查后CAO患者气道扩张情况。
