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关键词：哮喘；嗜酸粒细胞增多；呼吸功能试验
摘要 目的 探讨老年人哮喘发病机制、临床特点及其与慢性支气管炎的区别。 方法 对20例60岁以后发生哮喘的患者(晚发老年哮喘)和15例60岁以前发生哮喘的患者(早发老年哮喘)与16例60岁以上的慢性支气管炎患者进行了对比研究。全部患者进行肺功能和支气管舒张试验，测定血及痰中嗜酸性粒细胞百分比计数、血浆皮质醇水平。 结果 晚发老年哮喘临床特征如下：(1)肺功能下降严重，吸入喘乐宁气雾剂后一秒钟用力呼气容积(FEV1.0 )改善率明显高于慢性支气管炎组(P<0.05)；(2)痰嗜酸性粒细胞百分比计数显著高于慢性支气管炎组(P<0.05)；(3)血浆糖皮质激素水平明显低于慢性支气管炎组(P<0.05)。 结论 (1)晚发老年哮喘患者肺功能损伤严重，吸入β2 -受体激动剂后FEV1.0 可获较大改善；(2)晚发老年哮喘患者气道内嗜酸性粒细胞增加在气道炎症及发病中起重要作用，痰嗜酸性粒细胞的检测可用于老年人哮喘的辅助诊断。
Mechanism andclinical characteristics of asthma in the elderly
Zhang Qing, HeQuanying, Ding Dongjie, et al. People's Hospital, Beijing Medical University, Beijing100044
Abstract Objective Toinvestigate the mechanism and clinical characteristics of asthma in the elderly and itsdifference from chronic bronchitis. Methods Twenty patients with late-onset asthma (LOA) and 15 patients withearly-onset astma (EOA) were studied in comparison with 16 patients (≥60 years) with chronic bronchitis (CB). In all patients, pulmonaryfunction and bronchodilator testing were performed, the percentages of differential countsof eosinophil in peripheral blood and sputum were detected, and plasma cortisolconcentrations were measured at 8∶00. Results LOAin the elderly had the following features. The improvement rate of FEV1.0 afterinhaling salbutamol and the percentages of differential counts of eosinophil in sputumwere both significantly higher (both P<0.05) in LOAthan in CB, but plasma cortisol concentrations in LOA was significantly lower (P<0.05) than that in CB. Conclusions Reversibility of airflow obstruction in LOA is as great as that in EOA. Measurement of the percentage of differential counts of eosinophil is an effectivemethod for assessment of airway inflammation of asthma as well as for supplementarydiagnosis of asthma in the elderly.
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