在哮喘或慢性阻塞性肺疾病（COPD）中，支气管高反应性是先于还是后于气道阻塞出现？

Does bronchial hyperresponsiveness precede or follow airway obstruction in asthma or COPD?

作者信息

van Schayck C P, Dompeling E, Molema J, Folgering H, van Grunsven P M, van Weel C

机构信息

Department of General Practice/Family Medicine, University of Nijmegen, Netherlands.

出版信息

Neth J Med. 1994 Oct;45(4):145-53.

PMID:7808576

Abstract

OBJECTIVE

The following hypothesis was tested: The degree of bronchial hyperresponsiveness (BHR) is a risk factor for the progression of airway obstruction in asthma, while in chronic obstructive pulmonary disease (COPD) it reflects the existing airway obstruction.

METHODS

The relationships between the (annual change in) PC20 histamine and the (annual change in) FEV1 were investigated in a 2-year prospective controlled study. The FEV1 and the PC20 histamine were assessed at 6-month intervals. 183 patients (74 asthma, 109 COPD) participated. The investigated relationships were assessed by means of multiple analysis of variance (ANOVA). Patients used bronchodilator therapy alone. No steroids were permitted during the study.

RESULTS

The results demonstrated that the PC20 at the start of the study was related to the subsequent annual decline of FEV1 in asthma (r = 0.32, p < 0.05) but not in COPD (r = -0.10, p = 0.89). Asthmatic patients with a PC20 value < or = 2 mg/ml had an average decline of 118 ml/yr, those with a PC20 value > 2 mg/ml of 27 ml/yr. The change in PC20 histamine during the 2-year study period was related to the annual change in FEV1 in COPD (r = 0.45, p < 0.05), but not in asthma (r = 0.06, p = 0.90). The disturbing influence of possible confounders was investigated and if necessary controlled for.

CONCLUSIONS

It was concluded that BHR, assessed with PC20 histamine, is probably involved in the progression of airway obstruction in asthma. In COPD, however, the degree of BHR probably only reflects the degree of existing airway obstruction. This conclusion may contribute to the ongoing debate whether it is useful to combine the diagnosis of asthma, COPD and emphysema under the umbrella-term CARA (or CNSLD = chronic non-specific lung disease). The so-called "Dutch hypothesis" which laid the foundation for this term, suggested that bronchial hyperresponsiveness plays a central role in the pathogenesis of CNSLD. The present study supports evidence that at least BHR does not seem to play the same role in the pathogenesis of asthma and COPD.

摘要

目的

对以下假设进行验证：支气管高反应性（BHR）的程度是哮喘气道阻塞进展的一个危险因素，而在慢性阻塞性肺疾病（COPD）中，它反映了现有的气道阻塞情况。

方法

在一项为期两年的前瞻性对照研究中，研究了组胺激发试验浓度反应曲线斜率（PC20组胺）的（年度变化）与第一秒用力呼气容积（FEV1）的（年度变化）之间的关系。每6个月评估一次FEV1和PC20组胺。183名患者（74例哮喘患者，109例COPD患者）参与了研究。通过多因素方差分析（ANOVA）评估所研究的关系。患者仅使用支气管扩张剂治疗。研究期间不允许使用类固醇。

结果

结果表明，研究开始时的PC20与哮喘患者随后FEV1的年度下降相关（r = 0.32，p < 0.05），但与COPD患者无关（r = -0.10，p = 0.89）。PC20值≤2mg/ml的哮喘患者FEV1平均每年下降118ml，PC20值>2mg/ml的患者FEV1平均每年下降27ml。在为期两年的研究期间，PC20组胺的变化与COPD患者FEV1的年度变化相关（r = 0.45，p < 0.05），但与哮喘患者无关（r = 0.06，p = 0.90）。研究了可能的混杂因素的干扰影响，并在必要时进行了控制。

结论

得出的结论是，用PC20组胺评估的BHR可能与哮喘气道阻塞的进展有关。然而，在COPD中，BHR的程度可能仅反映了现有的气道阻塞程度。这一结论可能有助于正在进行的关于将哮喘、COPD和肺气肿的诊断合并在“慢性气道炎症性疾病（CARA）”（或“慢性非特异性肺病（CNSLD）”）这一统称下是否有用的辩论。为这一术语奠定基础的所谓“荷兰假说”表明，支气管高反应性在CNSLD的发病机制中起核心作用。本研究支持了至少BHR在哮喘和COPD的发病机制中似乎不发挥相同作用的证据。