杨能学

【摘要】 目的：探討支气管舒张试验对于鉴别哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）、支气管哮喘及慢性阻塞性肺疾病（COPD）的价值。方法：本组研究纳入2018年1月-2019年1月120例在笔者所在医院呼吸内科治疗的患者，按照临床诊断将所有研究对象分成三组，即ACOS组（n=40）、哮喘组（n=40）和COPD组（n=40）。分析对比所有患者在接受支气管舒张试验前后的肺功能参数，包括支气管舒张剂后的FEV1、FEV1改善值、FEV1改善率及支气管舒张试验后的FEV1/FVC，对比三组的支气管舒张试验阳性与阴性结果，分析支气管舒张试验对于鉴别ACOS、支气管哮喘及COPD中的应用价值。结果：在吸入支气管舒张剂后，比较三组的FEV1改善率，其中ACOS组的FEV1改善率稍高于哮喘组与COPD组，差异有统计学意义（P<0.05）。比较三组的FEV1改善值，其中ACOS组的FEV1改善值明显高于COPD组，COPD组的FEV1改善值明显低于哮喘组，差异有统计学意义（P<0.05）。在患者接受支气管舒张试验后，哮喘组的FEV1/FVC均高于ACOS组和COPD组，差异有统计学意义（P<0.05）。在进行支气管试验后，ACOS组、COPD组及哮喘组的阳性率分别为60.00%（24/40）、0（0/40）及77.50%（31/40），ACOS组的支气管舒张试验阳性率比哮喘组的阳性率较低，但差异无统计学意义（P>0.05）。结论：支气管舒张试验对临床鉴别ACOS、支气管哮喘及COPD疾病有重要的应用价值，值得在临床上进行深入研究和推广。

【关键词】 支气管舒张试验; 鉴别诊断; 哮喘-慢性阻塞性肺疾病重叠综合征; 支气管哮喘; 慢性阻塞性肺疾病; 应用价值

doi：10.14033/j.cnki.cfmr.2019.27.029 文献标识码 B 文章编号 1674-6805（2019）27-00-03

The Value of Bronchial Dilation Test in Differentiating Peripheral Tracheal Spasm Narrowing and Small Airway Wall Collapse Overlapping Syndrome/YANG Nengxue.//Chinese and Foreign Medical Research，2019，17（27）：-70

【Abstract】 Objective：To explore the value of bronchial dilation test in differentiating asthma from asthma-chronic obstructive pulmonary disease overlap syndrome（ACOS），bronchial asthma and chronic obstructive pulmonary disease（COPD）.Method：A total of 120 patients with respiratory diseases were enrolled in this study.The data were collected from January 2018 to January 2019.According to the clinical diagnosis，all the subjects were divided into the ACOS group（n=40），the asthma group（n=40） and the COPD group（n=40）.The pulmonary function parameters of all patients before and after bronchial dilation test，including FEV1，FEV1 improvement value，FEV1 improvement rate after bronchodilator and FEV1/FVC after bronchial dilation test，were analyzed and compared.The positive and negative results of broncho dilation test were compared among the three groups.The bronchial dilation test was used to differentiate ACOS，bronchial asthma and COPD.Result：After inhalation of bronchodilator，the improvement rate of FEV1 in the ACOS group was slightly higher than that in the asthma group and the COPD group（P<0.05）.The improvement of FEV1 in ACOS group was significantly higher than that in the COPD group，and the improvement of FEV1 in COPD group was significantly lower than that in the asthma group（P<0.05）.After bronchial dilation test，the FEV1/FVC of the asthma group was higher than that of the ACOS group and the COPD group （P<0.05）.After bronchial test，the positive rates of the ACOS group，the COPD group and the bronchial asthma group were 60.00%（24/40），0（0/40） and 77.50%（31/40），respectively.The positive rates of bronchial relaxation test in ACOS group were lower than those in asthma group，but there was no significant difference（P>0.05）.Conclusion：Bronchial diastolic test has important application value in clinical differentiation of ACOS，bronchial asthma and COPD diseases，and is worthy of further study and promotion in clinic.

【Key words】 Bronchial relaxation test; Differential diagnosis; Asthma-COPD overlap syndrome; Bronchial asthma; Chronic obstructive pulmonary disease; Application value

First-authors address：Chongqing Construction Hospital，Chongqing 400050，China

慢性阻塞性肺疾病（COPD）和支气管哮喘（简称哮喘）是临床常见的两种气道疾病，二者在临床有不同的表现，但在临床诊断和治疗中如何正确地区分哮喘和COPD确并非易事，部分患者还有可能同时兼有两种疾病的临床特点，也就是哮喘-慢性阻塞性肺疾病重叠综合征（asthma-chronic obstructive pulmonary disease overlap syndrome，ACOS），这也增加了临床诊断鉴别的难度[1-2]。肺功能检查是当代临床检查呼吸系统功能状态的重要技术，也是临床诊断ACOS、哮喘及COPD等呼吸系统疾病重要检查方法[3-4]。……