脉冲振荡法在支气管激发试验中的应用价值

发布时间：2018-05-21 03:01

本文选题：支气管激发试验 + 哮喘　；参考：《中国全科医学》2015年06期

【摘要】：目的探讨脉冲振荡(IOS)法在气道反应性测定中的价值,研究IOS法对支气管哮喘诊断有意义的参数。方法选取2012年3—10月于北京友谊医院及北京房山区良乡医院门诊部就诊的符合纳入与排除标准的患者52例。采用IOS法及肺通气功能法进行支气管激发试验。根据支气管激发试验结果,分为阳性组23例,阴性组29例。将试验前后IOS与肺通气功能各参数进行比较,分析IOS与肺通气功能各参数的相关性,建立回归方程,分析IOS法在支气管激发试验中有诊断意义的参数;同时对患者进行随访,根据随访结果将患者分为哮喘组与非哮喘组,使用受试者工作特征曲线(ROC曲线)研究IOS法对支气管哮喘诊断有意义的参数,比较IOS法与肺通气功能法诊断支气管哮喘的检出率。结果试验后,阴性组呼吸道总黏性阻力(R5)、外周气道黏性阻力(R5-20)、5 Hz频率时的周边惯性阻力(X5)、共振频率(Fres)、低频电抗面积(Alx)、第1秒用力呼气末容积(FEV1)、第1秒用力呼气末容积占预计值百分比(FEV1%Pred)、第1秒用力呼气末容积占用力肺活量百分比(FEV1/FVC)、峰流速(PEF)、最大呼气中期流速(MMEF)与阳性组比较,差异有统计学意义(P0.05)。两组试验后R5、R5-20、X5、Fres、Alx、FEV1、FEV1%Pred、FEV1/FVC、PEF、MMEF分别与试验前比较,差异均有统计学意义(P0.05)。试验前,R5、中心气道黏性阻力(R20)、R5-20、Fres、Alx均与用力肺活量(FVC)、FEV1、MMEF呈负相关,X5与FVC、FEV1、PEF呈正相关(P0.05)。试验后R5、R20、R5-20、Fres、Alx均与FVC、FEV1、FEV1%Pred、FEV1/FVC、PEF、MMEF呈负相关,X5与FVC、FEV1、FEV1%Pred、FEV1/FVC、PEF、MMEF呈正相关(P0.05)。试验结束时,R5、X5、Alx变化倍数与FEV1变化率呈正相关(P0.05)。回归分析显示,X5、呼气相X5(e X5)与肺通气功能法行支气管激发试验的结果有回归关系。R5、X5、Fres、Alx、FEV1、PEF、MMEF诊断支气管哮喘的ROC曲线下面积(AUC)分别为0.902〔95%CI(0.798,1.000)〕、0.905〔95%CI(0.810,1.000)〕、0.795〔95%CI(0.626,0.965)〕、0.902〔95%CI(0.802,1.000)〕、0.883〔95%CI(0.748,1.000)〕、0.758〔95%CI(0.576,0.939)〕、0.754〔95%CI(0.567,0.940)〕。两种方法的阳性率分别为61.5%、44.2%,差异有统计学意义(χ2=11.258,P0.05)。两种方法阳性率的吻合度差异有统计学意义(κ=0.438,P0.05)。随访时间18个月时,IOS法诊断支气管哮喘的检出率高于常规肺通气功能法(P0.05)。结论采用IOS法进行支气管激发试验,可以对气道反应性增高的诊断提供帮助。在支气管激发试验中,参数X5、e X5的诊断意义最大,R5、X5、Alx对支气管哮喘诊断有较高的准确性;IOS法可以提高诊断支气管哮喘的灵敏度,并可对其早期诊断提供帮助。
[Abstract]:Objective to investigate the value of pulsed oscillatory IOSmethod in the determination of airway reactivity and to study the parameters of IOS method in the diagnosis of bronchial asthma. Methods 52 patients who met the criteria of inclusion and exclusion were selected from the outpatient department of Beijing Friendship Hospital and Beijing Fangshan District Liangxiang Hospital from March to October 2012. Bronchial provocation test was performed by IOS method and pulmonary ventilation function method. According to the results of bronchial provocation test, 23 cases in positive group and 29 cases in negative group were divided into two groups. The parameters of IOS and pulmonary ventilation function were compared before and after the test, the correlation between IOS and pulmonary ventilation function parameters was analyzed, the regression equation was established, the diagnostic parameters of IOS method in bronchial provocation test were analyzed, and the patients were followed up. According to the follow-up results, the patients were divided into asthmatic group and non-asthmatic group. The IOS method was used to study the diagnostic parameters of bronchial asthma by using the operating characteristic curve (ROC curve), and to compare the detection rate between IOS method and pulmonary ventilation function method in the diagnosis of bronchial asthma. Results after the experiment, In negative group, the respiratory tract total viscous resistance (R5), peripheral airway viscous resistance (R5-20), peripheral inertial resistance (R5-20) at 5 Hz, resonance frequency (Freso), low-frequency reactance area (LF-R), forced end-expiratory volume (FEV1) in the 1st second and forced end-expiratory volume in the 1st second (FEV1) were predicted. The percentage of FEV1, FEV1, FEV1 / FVC+, peak flow rate (PEFV), maximum mid-expiratory flow (MMEF) were compared with those of the positive group, and the percentage of FEV1 / FVCV at the end of the second forced expiratory volume occupied by forced expiratory volume was compared with that of the positive group. The difference was statistically significant (P 0.05). After the two groups, there were significant differences in MMEF between the two groups after R5 / R5-20 X _ (5) F _ (5) F _ (5) F _ (5) Al _ (x) FV _ (1) and FEV _ (1) pred _ (1) FEV _ (1) / FV _ (1) / (P _ (0.05) compared with those before the trial. Before the test, there was a negative correlation between the central airway viscosity resistance and the forced vital capacity (RV) and FEV _ 1 (MMEF). There was a positive correlation between R20 and FEV _ (1) PEF (P _ (0.05) and forced vital capacity (RV _ (1) and FEV _ (1) (P _ (0.05). After the trial, R5 / R20 / R5-20 / Fres / Alx was negatively correlated with FEV1 / FEV1 / FEV1 / FEV1 / FEV1 MMEF and positively correlated with FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1, respectively. At the end of the experiment, there was a positive correlation between the multiple of Alx change and the change rate of FEV1. Regression analysis showed that there was a regression relationship between X 5, X 5 exhalation X 5) and the results of pulmonary ventilation function test. The area under the ROC curve for diagnosis of bronchial asthma was 0.902v 95 CI 0.90595 CI 0.810101.000 0. 79595 CI 0.79595 CI 0.79595 CI 0.79595 CI 0.79595 CI = 0.79595 CI 0.79595 CI 0.79595 CI = 0.79595 CI = 0.79595 CI = 0.79595 CI = 0.79595 CI = 0.79595 CI = 0.90295CI 0.90295CI = 0.90295CI0.90295 CI 0.90295CI = 0.90295CI = 0.90295CI = 0.90295CI = 0.79595 CI = 0.79595 CI = 0.79595 CI = 0.79595 / 0. The CIQ is 0.7480.7481.000, 0.5760.39C and 0.7545CI0.5670.5670.900. The positive rate of the two methods was 61.5 / 44.2.The difference was statistically significant (蠂 ~ 2 / 11.258 / P 0.05). There was significant difference in the coincidence of positive rate between the two methods (魏 0.438P 0.05). The diagnostic rate of bronchial asthma by iOS method was higher than that by routine pulmonary ventilation function method (P 0.05) at 18 months follow-up. Conclusion bronchial provocation test with IOS method can be helpful in the diagnosis of airway reactivity. In the bronchial provocation test, the diagnostic significance of the parameter X _ 5N _ e _ X _ 5 is the most significant. The diagnosis of bronchial asthma by iOS method can improve the sensitivity of diagnosis of bronchial asthma, and may be helpful to its early diagnosis.
【作者单位】：首都医科大学附属北京友谊医院呼吸科;北京房山区良乡医院呼吸科;
【分类号】：R562.25

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