Page 75 - 中国全科医学2022-11

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bronchial challenge test in the same time point of the days. However，whether there is a daily diurnal AHR variability is still not
clear. Objective To explore the characteristics and diurnal variability of AHR in asthma patients. Methods The data of 202
patients with asthma who consulted in respiratory department of the First Affiliated Hospital of Guangzhou Medical University
from January 2018 to September 2020 were included for statistical analysis. All patients completed the methacholine bronchial
provocation tests，they were divided into the morning detection group（morning group） with 81 cases and the afternoon detection
group（afternoon group） with 121 cases；according to the disease course，98 cases were divided into the initial diagnosis group
if the disease course was ≤ 6 months，and 104 cases were divided into the follow-up group if the disease course was >6 months.
The initial diagnosis group and the follow-up group were divided into the initial diagnosis morning group，the initial diagnosis
afternoon group，the follow-up morning group，and the follow-up afternoon group according to the detection time；according to
the AHR，the patients were divided into very mild，mild，moderate and severe groups. The characteristics of AHR and the main
pulmonary function indexes including FVC%pred，FEV 1 %pred，PEF%pred，MMEF%pred，MEF50%pred，MEF25%pred，
PD20-FEV 1 ，PD20-PEF，PD20-MMEF，PD20-MEF25%，PD20-MEF50% of these groups were analyzed and compared.
Results There were no significant differences of the math pulmonary function indexes and PD20 between morning and afternoon
groups（P<0.05）. FEV 1 %pred and PD20-PEF were significantly higher in initial diagnosed group than follow-up group
（P<0.05）. There was no significant difference in FVC%pred，PEF%pred，MMEF%pred，MEF50%pred，MEF25%pred，
PD20-FEV 1 ，PD20-MMEF，PD20-MEF25%，and PD20-MEF50% between the initial visit group and the follow-up visit
group （P>0.05）. In follow-up group，MMEF%pred and MEF50%pred were higher in afternoon than in morning（P<0.05）.
There were no differences of lung function and AHR between morning and afternoon in initial diagnosed group（P<0.05）. No
obvious correlations were found between disease history and PD20. There were no significant differences of PD20-FEV 1 between
the morning and afternoon，initial diagnosed and follow-up（P>0.05）. Conclusion The longer the duration of asthma，more
serious impairment of lung function found in asthma，while the AHR had no significant difference between morning and afternoon.
【Key words】 Asthma；Respiratory function tests；Lung function；Airway hyperresponsiveness；Bronchial
provocation test

支气管哮喘（以下简称哮喘）是呼吸系统最常见的 集 2018 年 1 月至 2020 年 9 月在广州医科大学附属第一
慢性疾病之一，世界上有近 20% 的人患有哮喘，特别 医院呼吸科就诊的 202 例哮喘 ［1］ 患者资料并进行统计
是近年来，哮喘发病率和死亡率持续增加 ［1］ 。流行病 分析。患者均完成乙酰甲胆碱支气管激发试验，根据其
学调查显示，我国成人哮喘发病率为 4.2% ［2］ 。哮喘严 进行支气管激发试验的时间分为上午检测组（上午组）
重影响患者的工作、学习和生活质量，会造成巨大的社 81 例和下午检测组（下午组）121 例；根据患者的病程
会和个人经济负担，已引起世界各国的极大关注，并成 分组：病程≤ 6 个月为初诊组 98 例，>6 个月为复诊组
为一个严重的公共卫生问题。 104 例，初诊组和复诊组又根据检测时间分为初诊上午
哮喘患者临床症状以反复发作的喘息、气促、胸闷 组、初诊下午组和复诊上午组、复诊下午组；参照中国
或咳嗽等为主 ［3］ ，常在夜间及凌晨发作或加重，气流 肺功能指南气道高反应性分级，根据使 FEV 1 下降 20%
受限具有可逆性，气道高反应性是其重要的病理生理特 的累积激发剂量（PD20-FEV 1 ）将患者分为极轻度组、
征之一。影响哮喘气道高反应性的因素较多，如过敏原 轻度组、中度组和重度组 ［5］ 。
暴露、呼吸道病毒感染、哮喘治疗药物等，哮喘急性发 1.2 方法 使用德国 Jaeger Mastercope 肺功能仪进行支
作时气道高反应性明显增加；哮喘患者症状及肺功能指 气管激发试验，给药装置为自动定量喷雾装置（APS 系
标呼气峰值流量（PEF）和第 1 秒用力呼气容积（FEV 1 ） 统）。操作技师均受过严格训练，测试均符合欧洲呼
具有日间或昼夜变异性，影响哮喘患者气道高反应性的 吸学会与美国胸科学会共同制订的质控标准 ［6］ 。每天
药物研究均要求患者在 1 d 中的相同时间点进行肺通气 试验前均进行机器校正。主要肺功能指标包括：用力肺
及支气管激发试验，有研究显示哮喘患者的气道高反应 活量（FVC）占预计值百分比（FVC%pred）、FEV 1 占
性与肺通气功能一样具有明显的昼夜节律性 ［4］ ，而轻 预计值百分比（FEV1%pred）、PEF 占预计值百分比
度哮喘患者气道高反应性日间差异尚不完全清楚，故本 （PEF%pred）、最大呼气中段流量（MMEF）占预计
研究探讨哮喘患者气道高反应性的特点及其日间差异 值百分比（MMEF%pred）、50% 肺容量位的用力呼气
性，旨在为临床诊疗提供理论依据。 流量占预计值百分比（MEF50%pred）、25% 肺容量位
1 对象与方法 的用力呼气流量占预计值百分比（MEF25%pred），测
1.1 研究对象 本研究为一项单中心回顾性研究，收 试最少重复 3 次（最多不超过 8 次），其中最佳 2 次