肺段内隔绝激发对运动性哮喘机制的研讨.pdfVIP

摘 要 目的:采用肺段内隔绝激发技术探讨运动性哮喘的发病机制，研究气道血管通透性、静 息肺功能指标FEF25-7s/^JFVC与运动性哮喘的关系。方法:选择支气管哮喘患者(简称哮喘) 21例，其中运动性哮喘患者[EIA(+)组〕10例，非运动性哮喘患者[EIA(-)组]I1例，对照组 10例。所有受试者行静息肺功能检查及肺段内高渗盐激发试验，观察激发后肺段内压力变 化，测定灌洗液及外周血白蛋白并计算肺血管通透性，检查灌洗液嗜酸性粒细胞百分率。 结果:高渗激发后EIA(+)组的肺段内压力明显升高，与EIA(-)组、对照组比较，差异都具 有显著性 (P0.001,P0.001);EIA(+)组的气道血管通透性指标与EIA(-)组、对照组比较明 显升高，差异有显著性 (P0.001;P0.001);EIA(+)组的肺血管通透性指标与肺段内峰值 压力呈显著正相关，r=0.865:P=0.002;FEF2j-75^/JFVC与高渗激发后肺段内峰值压力变化 呈显著负相关，r=-0.820;P-0.004，但是未发现嗜酸性粒细胞%与肺段内压力变化的关系。 结论:提示肺血管通透性增加与运动性哮喘支气管反应强度明显相关:FEFZS_13,JFVC有可 能是预测运动性哮喘严重性的良好指标。 关〔键词〕 运动性哮喘 高渗盐 激发 气道血管 通透性 [中图分类号〕R562.2 StudyontheMechanismofExercise-inducedAsthmabythe solatedAirwaySegmentChallenge IAbstract]OBJECTIVE:Toinvestigatethemechanismsofexercise-inducedasthma(EIA)by theisolatedairwaysegmentchallenge,Toexploretherelationbetweenexercise-inducedasthma (EIA)andairwayvascularpermeability,FEF25_75,JVC.METHODS:In21asthmas(10EIA and11non-EIA)and10controls,thestaticlungfunctionandlocalchallengewithhypertonic Salineinisolatedlungsegmentwereconducted.Thepressurechangeinisolatedlungsegment wasobserved,andairwayvascularpermeabilityindex(ratioofalbuminconcentrationsinlavage andserum)wereexamined,eosinophiliccelldifferentialcountsinlavagewerealsoperformed. RESULTS:AfterhypertonicSalinechallenge,thepressureinisolatedlungsegmentsignificant raisedinEIAgroupwhencomparedwithnon-EIAgroupandcontrols(P0.OO1,P0.001);the airwayvascularpermeabilityindexinEIAgroupwerealsosignificantlyhigherthanthosein non-EIAgroupandcontrols(P0.001,P0.001);Moreover,InEIAgrouptheperkpressurein isolatedlungsegmentwassi加ficantly、correlatedwiththeairwayvascularpermeabilityindex andnegativelycorrelatedwithFEF25-75^/JFVC,However,Itwasnotsi娜ficantlycorrelatedwith magnitudeofeosinophilicinflammation.CONCLUSIONS:Airwayvascularpermeability correlateswiththebronchialresponsiveintensityinEIA;FEF2，一，5r^/.FVCmaybeagood oftheseverityofEIA. [Keywords]ex