治療により安定した成人気管支喘息患者における強制オッシレーション法を用いた気流制限の評価  [in Japanese] USE OF FORCED OSCILLATION TECHNIQUE TO DETECT AIRFLOW LIMITATIONS IN ADULT JAPANESE ASTHMATICS  [in Japanese]

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Author(s)

    • 粒来 崇博 Tsuburai Takahiro
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 大友 守 Otomo Mamoru
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 前田 裕二 [他] Maeda Yuji
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 谷口 正実 Taniguchi Masami
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 秋山 一男 Akiyama Kazuo
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 釣木澤 尚実 Tsurikisawa Naomi
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 三井 千尋 Mitsui Chihiro
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 東 憲孝 Higashi Noritaka
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 福冨 友馬 Fukutomi Yuma
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 谷本 英則 Tanimoto Hidenori
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 関谷 潔史 Sekiya Kiyoshi
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital
    • 押方 智也子 Oshikata Chiyako
    • 国立病院機構相模原病院臨床研究センター Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital

Abstract

【背景,目的】強制オッシレーション法は被験者に努力を行わせることなく呼吸抵抗,呼吸リアクタンスといったメカニクスの指標を測定し,スパイロメトリーと違い努力呼気が必要でないことから注目される.近年,本邦より強制オッシレーション法の測定機械としてモストグラフ(チェスト社,東京)が販売され,気管支喘息の診断や治療の指標としての応用が期待されている.そこで,成人の治療中の喘息におけるモストグラフの指標の判定の目安について考察する.【方法】当院外来で治療により安定した気管支喘息患者151症例について同時にFeNO,モストグラフ,スパイログラムを評価,比較した.【結果】%FEV_1,%MMFとモストグラフの各指標は有意な相関を認めたが,Fresと最も強い相関を認めた.%FEV_1予測式は,%FEV_1=-3.174×Fres+115.7であった.また,年齢とX5,Fres,ALX,BMIと全ての指標に有意な相関を認め,年齢や体格によるこれらの指標に対する影響を示唆した.そこで,モストグラフ各指標におけるFEV_1,年齢,BMI,FeNOの関与を評価する目的で重回帰分析を行ったところ,Fresに主たる影響があるのはFEV_1(p<0.001)であるが,BMI(p<0.001)も有意な影響があると考えられた.【考察】モストグラフ法による測定は成人の治療中喘息における気道閉塞を検出するのに優れていた.%FEV_1=60%相当のFresは17.5,%FEV_1=80%相当のFresは11.3,%FEV_1=100%相当は4.94と想定された.

Background: The forced oscillation technique (FOT) is a noninvasive method that is used to measure respiratory mechanics, including respiratory resistance and reactance at multiple frequencies. The advantage of FOT over spirometry is that FOT does not require forced expiratory maneuvers. Moreover, a new FOT machine called MostGraph (Chest Co. Ltd., Tokyo, Japan), has been developed in Japan, and can be used clinically to diagnose and monitor asthma. The purpose of this study is to show the standard of FOT measured with MostGraph in adult Japanese asthmatics. Methods: From our outpatient clinic, we recruited 151 stable asthmatics who were being treated with inhaled corticosteroids at the time of the study. For each subject, we measured the fraction of exhaled nitric oxide (FeNO) by using a chemiluminescent nitric oxide analyzer (Sievers280, GE, Boulder, Co); we determined the levels of forced expiratory volume in 1s (%FEV_1) and maximum midexpiratory flow rate (%MMF) by using spirometory; and we measured resistance at 5Hz (R5), resistance at 20Hz (R20), R5-R20, reactance at 5Hz (X5), frequency of resonance (Fres), and low-frequency reactance area (ALX), by using a MostGraph FOT machine. Results: Each of the FOT parameters measured by using the MostGraph machine was significantly correlated with %FEV_1 and %MMF (p<0.001), with Fres showing the strongest association. Three of the FOT parameters, X5, Fres, and ALX, were significantly associated with the subject's age (p=0.01, p<0.001, p<0.001, respectively), and all FOT parameters were significantly associated with the subject's body mass index (BMI) (p<0.001 to p=0.018). The results of multiple regression analyses between FOT parameters and FEV_1, age, BMI, and FeNO, showed that Fres was significantly associated with FEV_1 (p<0.001) and BMI (p<0.001). From the results of the simple linear regression between Fres and FEV_1, we estimated that Fres values of 17.5Hz corresponded to %FEV_1 values of 60%; Fres values of 1l.3Hz corresponded to %FEV_1 values of 80%; and Fres values of 4.94Hz corresponded to %FEV_1 values of 100%. Conclusion: FOT parameters measured by using a MostGraph machine can be used successfully to assess the level of airflow limitation in adult stable asthmatics.

Journal

  • Japanese Journal of Allergology

    Japanese Journal of Allergology 61(2), 184-193, 2012

    Japanese Society of Allergology

References:  22

Cited by:  2

Codes

  • NII Article ID (NAID)
    110009425600
  • NII NACSIS-CAT ID (NCID)
    AN00012583
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0021-4884
  • NDL Article ID
    023575739
  • NDL Call No.
    Z19-32
  • Data Source
    CJP  CJPref  NDL  NII-ELS  J-STAGE 
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