应用呼出气一氧化氮联合脉冲振荡肺功能评估哮喘患者小气道功能的研究

发布时间：2018-01-29 16:46

本文关键词： 支气管哮喘小气道功能异常呼出气一氧化氮脉冲振荡肺功能　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景哮喘是呼吸系统常见的慢性疾病。全球约有3亿哮喘患者,且发病率逐年上升。哮喘常见的特征是慢性炎症和气道重塑。气道炎症和重塑不仅发生在中央气道,也可发生在小气道。然而,目前常用第1秒用力呼气容积(the forced expiratory volume in one second,FEV1)等指标反映中央气道功能的肺功能指标评价哮喘严重程度以及治疗效果,而较少地评价小气道功能。虽然小气道阻力占总气道阻力不足10%,但小气道功能异常显著增加哮喘患者气流阻力,从而影响哮喘的肺功能和临床表现。临床工作中,常以最大呼气中期流量(mid forced expiratory flow,FEF25-75)等肺功能指标来评估哮喘患者的小气道功能。然而,肺功能检查需要患者一定程度的配合,不能用于年纪较小或症状较重的哮喘患者。虽然肺活检、光学相干断层扫描(optical coherence tomography,OCT)等可直接地、客观地观察患者的小气道功能状态,但它们是有创的且可重复性较差。呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和脉冲振荡肺功能(impulse oscillometry,IOS)等无创的检查可能弥补这些不足之处。然而,有关FeNO及IOS与哮喘小气道功能关系的研究较少。因此,本文拟探讨FeNO及IOS与哮喘患者小气道功能的关系,旨在为哮喘小气道功能异常的早期诊断与治疗提供依据。研究目的探讨呼出气一氧化氮(FeNO)及脉冲振荡肺功能(IOS)与哮喘患者小气道功能的关系。研究方法选取2014年7月至2015年7月在山东大学齐鲁医院呼吸科门诊就诊的140例哮喘患者为研究对象,其中小气道功能正常组69例,小气道功能异常组71例,分别测定FeNO值、外周血嗜酸性粒细胞(eosinophil,EOS)及总免疫球蛋白 E(total immunoglobulin E,IgE)、肺功能及 IOS。研究结果1.小气道功能异常组FeNO、IgE、EOS、阻抗面积(reactance area,AX)及共振频率(the resonant frequency,Fres)水平明显高于小气道功能正常组,差异有统计学意义(分别为:t =-7.24,p0.001;t =-12.42,p0.001;t =-3.20,p = 0.002;t =-7.82,p0.001;t =-7.43,p0.001)。2.小气道功能异常组FeNO、AX、Fres及EOS水平分别与FEF25-75%pred(mid forced expiratory flow of percentages of predicted values,FEF25-75%pred)具有负相关(分别为:r =-0.856,p0.001;r =-0.851,p0.001;r =-0.398,p =0.001;r=-0.288,p = 0.014)。3.多元回归分析:FeNO、AX、Fres水平分别是FEF25-75%pred的预测因子(分别为:t =-3.906,p0.001;t =-3.065,p = 0.003;t =-2.442,p = 0.017),且 FeNO、AX、Fres 均不存在多重共线关系(分别为:VIF =3.929;VIF =5.091;VIF =2.599),标准回归系数绝对值的比较:FeNOAXFresEOS(分别为:0.407;0.363;0.161;0.087)。4.FeNO、AX、Fres及EOS水平诊断哮喘小气道功能异常的预测价值:FeNO联合 AX 及 FresFeNOAXFresEOS(分别为:AUC = 0.881,p0.001;AUC = 0.830,p0.001;AUC = 0.822,p0.001;AUC = 0.816,p0.001;AUC=0.673,p0.001)。研究结论1.FeNO水平和IOS指标是诊断哮喘小气道功能异常的敏感特异性指标。2.FeNO水平联合IOS指标能更好的评估哮喘患者小气道的功能。
[Abstract]:Background Asthma is a common chronic disease of the respiratory system. There are about 300 million asthmatic patients worldwide. Asthma is characterized by chronic inflammation and airway remodeling. Airway inflammation and remodeling occur not only in the central airway, but also in the small airway. The forced expiratory volume in one second is usually used at 1 seconds. Indexes such as FEV1), which reflect central airway function, evaluate the severity of asthma and the therapeutic effect, but less evaluate small airway function, although small airway resistance accounts for less than 10% of total airway resistance. However, abnormal small airway function significantly increased the airflow resistance of asthmatic patients, thus affecting the lung function and clinical manifestations of asthma. Pulmonary function indicators such as mid forced expiratory flowrate FEF25-75) are often used to assess small airway function in asthmatic patients. Lung function tests require a degree of cooperation from patients and cannot be used in younger or more symptomatic asthmatic patients, although lung biopsies are required. Optical coherence tomography (Oct) can observe the function of small airway directly and objectively. But they were invasive and poorly reproducible. Exhaled nitric oxide fractional nitric oxide. Noninvasive examinations such as Feno) and impulse oscillatory pulmonary function (Ios) may compensate for these deficiencies. There are few studies on the relationship between FeNO and IOS and small airway function in asthma. Therefore, this paper intends to explore the relationship between FeNO and IOS and small airway function in asthmatic patients. Objective to provide evidence for the early diagnosis and treatment of asthmatic small airway dysfunction. Objective to investigate the exhalation of nitric oxide (no) and pulse-oscillating pulmonary function (IOSs). Methods from July 2014 to July 2015, 140 asthmatic patients in the Department of Respiratory Department of Qilu Hospital of Shandong University were selected as the study objects. FeNO and eosinophil in peripheral blood were measured in 69 cases of normal small airway function group and 71 cases of abnormal small airway function group. Eos and total immunoglobulin total immunoglobulin IgE, pulmonary function and IOS.Results 1. Small airway dysfunction group (FeNO). Resonant frequency. The level of Fres was significantly higher than that of the normal small airway function group, the difference was statistically significant (1: t + -7.24P 0.001, respectively); T = -12.42, p 0.001; T ~ (-3.20) p = 0.002; T = -7.82, p 0.001; T = -7.43, p 0.001. 2. FeNO-AX in small airway dysfunction group. The levels of Fres and EOS are higher than FEF25-75pred (. Mid forced expiratory flow of percentages of predicted values. There was a negative correlation between FEF25-75pred (0: r = -0.856p 0.001). R = -0.851p0.001; R = -0.398p = 0.001; R = 0.288p = 0.014. 3. Multivariate regression analysis: FeNOAX. The Fres level was the predictor of FEF25-75%pred (1: t) -3.906 (p0.001); T = 0.003; T + -2.442 (p = 0.017), and there was no multiple collinear relationship between FeNO-AXFres (3.929). VIF 5.091; Comparison of absolute values of the Standard regression coefficients between VIF and 2599, the absolute values of the standard regression coefficients are:: FeNOAX FresEOS (respectively: 0.407; 0.363; 0.161; (4) Feno AX. Predictive value of Fres and EOS levels in the diagnosis of Asthmatic small Airway dysfunction;: Feno combined with ax and FresFeNOAX FresEOS (. AUC = 0.881, respectively. P0.001; AUC = 0.830 (p 0.001); AUC = 0.822 (p 0.001); AUC = 0.816p 0.001; AUC=0.673. P0.001). Feno level and IOS index are sensitive and specific indexes for diagnosing asthmatic small airway dysfunction. 2. Feno level combined with IOS index can better evaluate the work of small airway in asthmatic patients. 2. Yes.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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