Page 83 - 南京医科大学学报自然科学版

第43卷第2期 南京医科大学学报（自然科学版）
2023年2月 Journal of Nanjing Medical University（Natural Sciences） ·225 ·

·临床医学·

胸闷变异性哮喘患者肺功能及炎症特点

张明强，郭文佳，徐文帅，赵丽娜，孙姝妍，牟向东 *

清华大学附属北京清华长庚医院呼吸与危重症医学科，清华大学临床医学院，北京 102218

［摘 要］ 目的：对比分析胸闷变异性哮喘（chest tightness variant asthma，CTVA）与典型哮喘（classic asthma，CA）患者的肺功
能及嗜酸性粒细胞炎症指标，进一步加深对CTVA的认识。方法：回顾性分析2019年10月—2021年10月门诊诊治的55例CT⁃
VA患者与94例CA患者（两组患者气道激发试验均为阳性，符合哮喘诊断标准的病史及临床特征），分析比较两组人群之间的
肺功能检查、呼出气体一氧化氮（fractional exhaled nitric oxide，FeNO）、血嗜酸性粒细胞，特异性IgE及总IgE水平。结果：CTVA
组与CA组患者年龄、性别比例、过敏史、过敏性鼻炎史、鼻息肉史、湿疹史、慢性荨麻疹史均无统计学差异（P > 0.05）。CTVA
组的小气道功能轻度受损情况低于CA组（27.27% vs. 43.63%，P=0.047）。两组小气道功能中-重度损、气道阻力升高、残总比
无统计学差异（P > 0.05）。两组通气功能［用力肺活量（forced vital capacity，FVC）、第 1 秒用力呼气容积占用力肺活量的比值
（forced expiratory volume in one second/forced vital capacity，FEV1/FVC）、呼气峰值流量（peak expiratory flow，PEF）］、肺储备功能
［最大通气量（maximal voluntary ventilation，MVV）］无明显差异（P > 0.05）。CTVA组外周血嗜酸性粒细胞［绝对值（0.16±0.15）×
9
9
10 个/L，百分比（2.50±2.25）%］均显著低于 CA 组［绝对值（0.27±0.25）×10 个/L，百分比（4.0±3.8）%］，差异有统计学意义［P=
0.017（绝对值），P=0.031（百分比）］。CTVA组的特性IgE检测阳性率（23.8%）低于CA组（48.5%）（P=0.043），且CTVA组外周血
总 IgE 水平［86.7（24.7，172.9）kU/L）］显著低于 CA 组［181.2（97.3，454.8）kU/L］，差异有统计学意义（P=0.009）。CTVA 组 FeNO
平均浓度（29 ppb）较其CA组（79 ppb）显著降低，差异有统计学意义（P=0.027）。结论：CTVA 患者小气道轻度阻塞率较CA患
者少，小气道中重度阻塞率和CA患者相当，外周血嗜酸性细胞水平较CA患者低。
［关键词］ 胸闷变异性哮喘；小气道功能；嗜酸性粒细胞；呼出气体一氧化氮
［中图分类号］ R562.25 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）02⁃225⁃06
doi：10.7655/NYDXBNS20230211

The characteristics of pulmonary function and inflammation in patients with chest

tightness variant asthma
ZHANG Mingqiang，GUO Wenjia，XU Wenshuai，ZHAO Lina，SHUN Shuyan，MOU Xiangdong *
Department of Respiratory and Critical Care Medicine，Beijing Tsinghua Changgung Hospital，School of Clinical
Medicine，Tsinghua University，Beijing 102218，China

［Abstract］ Objective：The current study aimed to compare and analyze the pulmonary function and eosinophil inflammation
parameters between patients with chest tightness variant asthma（CTVA）and those with typical classical（CA）for further recognition
about the atypical bronchial asthma with chest tightness as the main manifestation. Methods：A total of 55 patients with CTVA and 94
patients with CA who were diagnosed and treated in the Outpatient Department between October 2019 and October 2021 were
retrospectively analyzed（the airway provocation test was positive in both groups，and the medical history and clinical characteristics
met the diagnostic criteria of asthma）. The pulmonary function test，exhaled nitric oxide，blood eosinophils，specific and total IgE levels
were analyzed and compared between the two groups. Results：There was no significant difference in age，sex ratio，allergic history，

allergic rhinitis，nasal polyps，eczema and chronic urticarial between the CTVA and CA groups（P > 0.05）. The patients with mild
impairment of the small airway function in the CTVA group（CTVA group：CA group=27.27%：43.62%）were less than those of the CA
group（P=0.047）. There was no significant in the moderate to severe impairment of small airway function，the percentage of increased
airway resistance，and RV/TLC between the two groups（P > 0.05）. There was no significant difference in ventilatory function［forced

［基金项目］ 国家自然科学基金（81900021）
∗
通信作者（Corresponding author），E⁃mail：muxiangdong@medmail.com.cn