咳嗽变异性哮喘、哮喘-慢性阻塞性肺病重叠与典型哮喘的肺通气功能及炎症指标的比较

doi:10.3969/j.issn.1006-5725.2025.13.018

Abstract

Abstract:

Objective To analyze the characteristics of spirometry and type 2 inflammation indicators of patients with CVA， ACO and CA to determine their clinical utility in identifying and distinguishing among CVA， ACO and CA patients. Methods Clinical data from 483 patients diagnosed with bronchial asthma， CVA， and bronchial asthma combined with chronic obstructive pulmonary disease in the outpatient department of the First Affiliated Hospital of Soochow University from July 2023 to June 2024 were collected and divided into CA， CVA and ACO groups according to diagnosis. Comparison of spirometry， fractional exhaled nitric oxide （FeNO）， blood eosinophil （EOS）， serum total immunoglobulin E （tIgE） and other tests between CA and CVA， CA and ACO groups. Perform logistic regression analysis on significant test results， then construct receiver operating characteristic （ROC） curves to compare the area under the curve and corresponding cut-off values. Result There was a statistically significant difference in tIgE between the CVA and CA groups （P = 0.018）， whereas no significant differences were observed in FeNO and EOS. Additionally， no notable differences were found between the ACO and CA groups in tIgE， FeNO， or EOS. Finally， FEV1%pred （OR = 1.086， P = 0.019）， FEV1/FVC （OR = 1.153， P = 0.023）， and MEF50%pred （OR = 0.922， P = 0.045） were used to construct the discriminative model between CA and CVA. ROC curves were plotted， with FEV1%pred showing an AUC of 0.680 （P < 0.001）， a Youden index of 0.358， and a corresponding cutoff value of 89.200. FEV1/FVC had an AUC of 0.684 （P < 0.001）， a Youden index of 0.334， and a cutoff value of 76.075. MEF50%pred had an AUC of 0.668 （P < 0.001）， a Youden index of 0.309， and a cutoff value of 59.800. The combined sensitivity of these three measures was 0.909， specificity was 0.514， positive predictive value was 0.600， negative predictive value was 0.873， and the AUC was 0.773 （P < 0.001）， with a Youden index of 0.423. FEV1 （OR = 0.002， P = 0.045）， FEV1%pred （OR = 1.490， P = 0.006）， and FEV1/FVC （OR = 0.749， P = 0.005） were used to construct the discriminative model between CA and ACO. ROC curves were plotted， with FEV1 showing an AUC of 0.819 （P < 0.001）， a Youden index of 0.532， and a corresponding cutoff value of 2.060. FEV1%pred had an AUC of 0.788 （P < 0.001）， a Youden index of 0.501， and a cutoff value of 75.000. FEV1/FVC had an AUC of 0.891 （P < 0.001）， a Youden index of 0.678， and a cutoff value of 68.620. The combined sensitivity of these three measures was 1.000， specificity was 0.904， positive predictive value was 0.771， negative predictive value was 1.000， and the AUC was 0.973 （P < 0.001）， with a Youden index of 0.904. Conclusions Differences exist in the spirometry among CVA， ACO and CA. The spirometry results incorporated into the discriminative models provide good discriminative value for distinguishing between CA and CVA patients with similar clinical symptoms， as well as for identifying ACO in the CA population.

Key words: classic asthma, cough-variant asthma, asthma-COPD overlap, spirometry, type-2 inflammation

CLC Number:

Zhengzhang GUI,Lu YE,Yang ZHOU,Ling WANG,Yifeng JIN. A comparative study on spirometry and type 2 inflammatory markers in cough⁃variant asthma， asthma⁃COPD overlap， and classic asthma[J]. The Journal of Practical Medicine, 2025, 41(13): 2065-2072.

Figures/Tables 8

Tab.1

The comparison of the basic line， spirometry， FeNO， tIgE and blood routine test in CA， CVA and ACO"

项目	组别			H/F值	P值^a
项目	支气管哮喘（n = 227）	咳嗽变异性哮喘（n = 182）	哮喘-慢性阻塞性肺病重叠（n = 74）	H/F值	AC与CVA	CVA与ACO	AC与ACO
年龄/岁	35.05 ± 12.66	41.36 ± 10.17	55.00 ± 11.84	86.42	1.000	< 0.001	< 0.001
身高/cm	168.00 ± 8.57	162.71 ± 9.43	164.38 ± 11.07	2.36	1.000	0.270	0.093
体质量/kg	68.89 ± 15.60	62.21 ± 9.72	69.00 ± 10.25	2.60		0.273^b
BMI［M（P₂₅，P₇₅ ）］/（kg/m²）	23.44（20.24，26.08）	23.50 ± 3.07	25.66 ± 4.41	1.49		0.475^b
症状时长［M（P₂₅，P₇₅ ）］/月	9.00（4.00，18.00）	1.38（0.75，5.25）	123.38 ± 99.88	75.16	0.016	< 0.001	< 0.001
VT［M（P₂₅，P₇₅）］/L	1.08（0.89，1.77）	1.26 ± 0.51	1.35 ± 0.69	3.24		0.198^b
VCmax/L	4.00 ± 1.02	3.63 ± 0.88	3.29 ± 1.05	11.67	0.755	< 0.001	< 0.001
ERV/L	1.31 ± 0.45	1.13 ± 0.65	1.19 ± 0.62	5.31	1.000	0.006	0.011
IC/L	2.69 ± 0.81	2.50 ± 0.57	2.10 ± 0.58	7.93	0.283	< 0.001	0.014
FVC/L	3.99 ± 1.03	3.61 ± 0.89	3.24 ± 1.04	12.22	0.855	< 0.001	< 0.001
FEV1/L	3.03 ± 0.97	2.85 ± 0.73	1.46 ± 0.60	71.68	0.001	< 0.001	< 0.001
MV［M（P₂₅，P₇₅）］/L	20.83（13.63，24.69）	21.72 ± 9.06	23.24 ± 12.21	1.72		0.423^b
FEV1%pred/%	89.28 ± 16.07	97.84 ± 8.82	52.49 ± 21.27	112.19	< 0.001	< 0.001	< 0.001
FEV1/FVC/%	75.40 ± 8.44	79.04 ± 4.56	45.14 ± 14.46	175.32	< 0.001	< 0.001	< 0.001
FEV1/VCmax/%	75.10 ± 8.72	78.45 ± 4.39	44.20 ± 13.33	175.91	< 0.001	< 0.001	< 0.001
PEF/（L/s）	7.60 ± 2.26	7.33 ± 1.69	3.83 ± 1.90	50.73	0.001	< 0.001	< 0.001
PEF%pred/%	97.38 ± 18.44	104.35 ± 10.94	51.16 ± 22.35	99.91	< 0.001	< 0.001	< 0.001
MEF75［M（P₂₅，P₇₅）］/（L/s）	6.00（4.57，8.39）	6.25 ± 1.78	1.70 ± 0.97	122.37	< 0.001	< 0.001	< 0.001
MEF75%pred/%	87.22 ± 27.71	100.27 ± 17.75	26.68 ± 17.82	149.30	< 0.001	< 0.001	< 0.001
MEF50/（L/s）	3.20 ± 1.57	3.28 ± 0.99	0.68 ± 0.32	157.26	< 0.001	< 0.001	< 0.001
MEF50%pred/%	67.78 ± 28.36	76.21 ± 15.71	16.39 ± 8.68	162.02	< 0.001	< 0.001	< 0.001
MEF25［M（P₂₅，P₇₅）］/（L/s）	0.83（0.61，1.33）	1.00 ± 0.49	0.21 ± 0.11	152.03	< 0.001	< 0.001	< 0.001
MEF25%pred/%	50.47 ± 29.85	51.54 ± 16.37	14.04 ± 11.54	146.76	< 0.001	< 0.001	< 0.001
MMEF/（L/s）	2.56 ± 1.43	2.52 ± 0.91	0.52 ± 0.23	158.37	< 0.001	< 0.001	< 0.001
MMEF%pred/%	61.04 ± 27.47	66.42 ± 14.90	15.76 ± 8.46	164.33	< 0.001	< 0.001	< 0.001
FeNO₅₀/ppb	70.26 ± 50.36	52.07 ± 41.09	39.50（19.25，83.50）	2.34		0.310^b
FeNO₂₀₀/ppb	20.05 ± 13.72	17.07 ± 12.19	12.00（6.25，24.25）	0.04		0.979^b
CaNO/ppb	3.16 ± 2.36	2.20（0.78，5.00）	2.64 ± 1.23	0.17		0.918^b
WBC/（×10⁹/L）	9.11 ± 2.89	6.98 ± 1.54	8.69 ± 3.43	1.29	0.374	0.897	1.000
EOS［M（P₂₅，P₇₅）］/（×10⁹/L）	0.20（0.08，0.48）	0.18（0.09，0.39）	0.32 ± 0.19	9.75	0.095	0.010	0.438
EOS［M（P₂₅，P₇₅）］/%	3.10（0.60，5.10）	2.60（1.63，5.18）	3.87 ± 3.29	7.66	0.154	0.029	0.657
BAS［M（P₂₅，P₇₅）］/（×10⁹/L）	0.04（0.03，0.06）	0.04 ± 0.02	0.03 ± 0.01	3.12		0.210^b
BAS［M（P₂₅，P₇₅）］/%	0.50（0.40，0.60）	0.55 ± 0.28	0.35 ± 0.28	2.28		0.320^b
CRP［M（P₂₅，P₇₅）］/（mg/L）	1.47（0.65，3.82）	0.80（0.10，2.29）	2.20（1.34，12.24）	3.89		0.143^b
tIgE［M（P₂₅，P₇₅）］/（U/L）	183.53（56.20，387.00）	69.10（28.48，288.25）	138.30（58.95，602.00）	9.45	0.018	0.038	1.000

Tab.1

Tab.2

Tab.3

Tab.4

Fig.1

Tab.5

Fig.2

Tab.6

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项目	支气管哮喘	咳嗽变异性哮喘	哮喘-慢性阻塞性肺病重叠	χ²值	P值
性别
女	132（58.1）^a	118（64.8）^a	27（36.5）^b	17.397	< 0.001
男	95（41.9）^a	64（35.2）^a	47（63.5）^b	17.397	< 0.001
小气道通气功能障碍
无	73（32.2）^a	103（56.6）^c	0（0）^b	76.139	< 0.001
有	154（67.8）^a	79（43.4）^c	74（100）^b	76.139	< 0.001

参考类别^a	研究变量	B	SE	Wald	P值	OR	95% CI
CVA组
	FEV1%pred	0.083	0.035	5.520	0.019^?	1.086	1.014 ~ 1.164
	FEV1/FVC	0.142	0.063	5.185	0.023^?	1.153	1.020 ~ 1.303
	MEF50%pred	-0.081	0.040	4.023	0.045^?	0.922	0.852 ~ 0.998

参考类别^a	研究变量	B	SE	Wald	P值	OR	95% CI
ACO组
	FEV1	-6.241	3.113	4.018	0.045^?	0.002	0.000 ~ 0.870
	FEV1%pred	0.399	0.144	7.654	0.006^??	1.490	1.123 ~ 1.977
	FEV1/FVC	-0.289	0.102	8.051	0.005^??	0.749	0.614 ~ 0.915

A comparative study on spirometry and type 2 inflammatory markers in cough⁃variant asthma， asthma⁃COPD overlap， and classic asthma

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项目	AUC	P值	约登指数	截断值	敏感度	特异度	阳性预测值	阴性预测值
FEV1%pred	0.680	< 0.001	0.358	89.200	/	/	/	/
FEV1/FVC	0.684	< 0.001	0.334	76.075	/	/	/	/
MEF50%pred	0.668	< 0.001	0.309	59.800	/	/	/	/
联合检测	0.773	< 0.001	0.423	/	0.909	0.514	0.600	0.873

项目	AUC	P值	约登指数	截断值	敏感度	特异度	阳性预测值	阴性预测值
FEV1	0.819	< 0.001	0.532	2.060	/	/	/	/
FEV1%pred	0.788	< 0.001	0.501	75.000	/	/	/	/
FEV1/FVC	0.891	< 0.001	0.678	68.620	/	/	/	/
联合检测	0.973	< 0.001	0.904	/	1.000	0.904	0.771	1.000

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