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目的 探讨气道高反应性与慢性阻塞性肺疾病 (COPD)之间的因果关系。方法 1996年 6月 ,从北京市房山区 2 3个自然村筛查出 15 4例COPD患者和 15 4名非COPD者配对对照 ,以及 2 3名不吸烟正常对照者进行基线调查 ,以一秒钟用力呼气容积 (FEV1)比基线值下降 >2 0 %的乙酰甲胆碱浓度 (PC2 0 FEV1) <8g/L为支气管高反应性的阳性标准 ,分为气道反应性阳性组与阴性组 ,2 0 0 0年5月进行复查。结果 (1)基线病例 对照研究 :COPD病例组与吸烟非COPD组有良好均衡性。COPD组气道反应性阳性率显著高于对照组 (78%和 2 8% ,P <0 0 0 0 1)。 (2 )前瞻性研究 :复查 2 41人 ,复查率为 78 2 %。基线非COPD者中气道反应性阳性组 38名 ,复查时COPD发病率为 2 3 7% ,气道反应性阴性组 84名 ,COPD发病率为 9 5 % (RR =2 5 ,P =0 0 36 ) ;基线COPD患者气道反应性阳性组 93例 ,复查时一秒钟用力呼气容积占用力肺活量比值 (FEV1/FVC)恢复到正常范围的比率为 12 9% ,气道反应性阴性组 2 6例 ,复查时FEV1/FVC恢复到正常范围的比率为 30 8% (P =0 0 31)。结论 吸烟人群中 ,气道高反应性导致肺功能下降速度加快 ,是COPD发病的独立危险因素
Objective To investigate the causal relationship between airway hyperresponsiveness and chronic obstructive pulmonary disease (COPD). Methods In June 1996, 15 4 matched COPD patients and 15 4 non-COPD matched controls were screened from 23 villages in Fangshan District, Beijing, and 23 non-smokers were enrolled in the baseline survey. One second The forced expiratory volume (FEV1)> 20% methacholine concentration (PC2 0 FEV1) <8g / L, which is more than the baseline value, is the positive standard for bronchial hyperresponsiveness and divided into positive airway responsiveness group and negative airway responsiveness group , 2000 to review in May. Results (1) Baseline case-control study: There was a good balance between COPD patients and non-COPD smokers. The positive rate of airway reactivity in COPD group was significantly higher than that in control group (78% vs 28%, P <0 0 001). (2) Prospective study: 241 were reviewed and the review rate was 78.2%. There were 38 positive airway responders in baseline non-COPD patients. The incidence of COPD was 23.7% at the time of review and 84 patients with negative airway responders. The incidence of COPD was 95% (RR = 25, P = 0 0 36). Baseline COPD patients had 93 patients with positive airway reactivity. The ratio of forced expiratory volume occupancy force FEV1 / FVC to the normal range at the time of review was 129% and the negative of airway reactivity In the group of 26 cases, the rate of FEV1 / FVC returned to the normal range at the time of review was 30.8% (P = 0 0 31). Conclusions Among smokers, airway hyperresponsiveness leads to the decline of pulmonary function, which is an independent risk factor for COPD