组胺诱导的支气管过度收缩及容量变化史对支气管哮喘患者的影响

Department of Medicine, National University Hospital, Singapore.

Respirology. 1997 Jun;2(2):107-12. doi: 10.1111/j.1440-1843.1997.tb00062.x.

The aim of this study was to examine the inter-relationships between the different effects of deep breaths and histamine provocation on airway function in patients with bronchial asthma. Group 1 consisted of 38 consecutive out-patients with newly diagnosed mild asthma, group 2 consisted of 20 patients with bronchial asthma of varying severity who were studied during clinical remission. We measured bronchial responsiveness (BR) to histamine inhalation as the dose of histamine which provoked a 20% fall in FEV1 (PD20). The fall in forced vital capacity (FVC) after inhaling the highest dose of histamine during each BR test was calculated and expressed as percentage of the value measured at baseline (delta FVC in percentage). We studied the effects of deep breaths on airway caliber in group 2 patients by comparing isovolumic flow rates on partial (P) and maximal (M) forced expiratory flow volumes curves expressed as the M/P ratio. The changes in residual volume (RV) after deep breaths (delta RV) were expressed as a percentage of the largest VC measured on the composite M and P curves. The patients in group 1 had significantly higher PD20 and lower delta FVC than patients in group 2. There was, however, no significant correlation between PD20 and delta FVC measurements in individual patients (r < 0.1, P > 0.05). The M/P ratio was significantly related to delta FVC (r = -0.6, P < 0.006). There was also a significant positive relation between the magnitude of increase in residual volume following deep breaths (delta RV) and the degree of fall in FVC following histamine inhalation (delta FVC) (r = 0.65, P = 0.001). This significant relationship between the degree of airway closure after a deep breath and airway closure after histamine challenge is a new finding. In patients with bronchial asthma, the effects of a deep breath on airway function may be indicative of the tendency for airway closure during BR testing.

本研究旨在探讨深呼吸和组胺激发对支气管哮喘患者气道功能的不同影响之间的相互关系。第一组由38例新诊断的轻度哮喘门诊患者组成，第二组由20例不同严重程度的支气管哮喘患者组成，这些患者在临床缓解期接受研究。我们将吸入组胺后支气管反应性（BR）定义为引起第一秒用力呼气容积（FEV1）下降20%的组胺剂量（PD20）。计算每次BR测试中吸入最高剂量组胺后用力肺活量（FVC）的下降幅度，并表示为基线测量值的百分比（FVC下降百分比）。我们通过比较部分用力呼气流量（P）和最大用力呼气流量（M）曲线上的等容流速（以M/P比值表示），研究了深呼吸对第二组患者气道管径的影响。深呼吸后残气量（RV）的变化（RV变化量）表示为综合M和P曲线上测量的最大肺活量的百分比。第一组患者的PD20显著高于第二组患者，而FVC下降百分比则显著低于第二组患者。然而，个体患者的PD20和FVC下降百分比测量值之间无显著相关性（r < 0.1，P > 0.05）。M/P比值与FVC下降百分比显著相关（r = -0.6，P < 0.006）。深呼吸后残气量增加幅度（RV变化量）与组胺吸入后FVC下降程度（FVC下降百分比）之间也存在显著正相关（r = 0.65，P = 0.001）。深呼吸后气道闭合程度与组胺激发后气道闭合程度之间的这种显著关系是一项新发现。在支气管哮喘患者中，深呼吸对气道功能的影响可能预示着BR测试期间气道闭合的倾向。