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??Abstract?? Objective To find out the fractional exhaled nitric oxide?? FENO?? in different control level and the relationship of FENO with childhood asthma control test ??C-ACT?? and bronchial provocation test??BPT??. Methods Totally 48 asthmatic children who underwent routine checkups since March 2011 through September 2011 were enrolled in the study. The patients completed the detection of FENO?? they also underwent pulmonary function test??PFT???? bronchial provocation test ??BPT??and C-ACT. Those indexes and relationships were analyzed in different control groups. Results The geometrical mean FENO of asthmatic children was ??22.5 ± 2.0?? × 10-9 mol/L. Uncontrolled group had higher FENO than controlled group and partly controlled group?? and FENO was slightly related to FEV1% Pred??so did PC20??but no relevance had been found between FENO?? C-ACT or PC20. Conclusion FENO can be an useful tool in managing asthma when used together with C-ACT??PFT and BPT.     

支气管激发试验及小气道功能检测在咳嗽变异性哮喘诊断中的应用

目的探讨咳嗽变异性哮喘(CVA)患儿支气管激发试验及小气道功能改变的特点。方法选取2012年5月至2014年2月在三家医院门诊就诊的慢性咳嗽患儿353例,年龄(7.45±2.58)岁,分别进行常规通气肺功能检查、支气管激发试验及问卷调查,对比分析支气管激发试验阳性及阴性患儿肺功能的差异。结果在353例慢性咳嗽患儿中,支气管激发试验阳性并符合CVA诊断的患儿200例(56.66%)。支气管激发试验阳性组患儿夜间咳嗽及剧烈干性咳嗽的比例明显高于阴性组,而晨起/日间咳嗽及湿性咳嗽的比例明显低于阴性组,差异均有统计学意义(P0.01)。支气管激发试验阳性组患儿有特应性皮炎和鼻炎病史比例均高于阴性组,差异有统计学意义(P0.01)。支气管激发试验阳性组反映小气道功能的FEF75(%)明显低于阴性组,差异有统计学意义(P=0.032)。结论气道高反应性和小气道功能下降是CVA重要的病理特征,支气管激发试验及常规肺功能检测对CVA的诊断及慢性咳嗽病因的相关性分析具有重要的临床价值。     

支气管激发试验在儿童哮喘诊断和治疗中的应用

目的探讨支气管激发试验在儿童哮喘诊断和治疗中的价值及安全性。方法采用组胺支气管激发试验对103例疑诊为哮喘或哮喘缓解期患儿进行气道反应性的测定，阳性者计算其FEV1下降20％预计值时的累积吸入组胺量（PD20FEV1）。并以此判定其气道高反应性（BHR）的程度。结果观察组支气管激发试验阳性62例（60．2％）。其中极轻度BHR10例（16．2％），轻度34例（54．8％），中度18例（29．0％），重度0例（0％）。在试验过程中，有1例患儿出现气喘、咳嗽，2例患儿出现胸闷，4例出现刺激性咳嗽，对症处理后迅速消失。对照组30例中有2例为支气管激发试验阳性（阳性率6．7％），均为圾轻度BHR，无一例出现气喘、咳嗽、胸闷、声嘶等症状。结论支气管激发试验提高了临床医生对儿童哮喘的诊断水平，并且对病情评估以及疗效的判断均具有重要价值。     

支气管激发试验在儿童哮喘诊断和治疗中的应用

目的探讨支气管激发试验在儿童哮喘诊断和治疗中的价值及安全性。方法采用组胺支气管激发试验对103例疑诊为哮喘或哮喘缓解期患儿进行气道反应性的测定,阳性者计算其FEV1下降20%预计值时的累积吸入组胺量(PD20FEV1),并以此判定其气道高反应性(BHR)的程度。结果观察组支气管激发试验阳性62例(60.2%),其中极轻度BHR10例(16.2%),轻度34例(54.8%),中度18例(29.0%),重度0例(0%)。在试验过程中,有1例患儿出现气喘、咳嗽,2例患儿出现胸闷,4例出现刺激性咳嗽,对症处理后迅速消失。对照组30例中有2例为支气管激发试验阳性(阳性率6.7%),均为极轻度BHR,无一例出现气喘、咳嗽、胸闷、声嘶等症状。结论支气管激发试验提高了临床医生对儿童哮喘的诊断水平,并且对病情评估以及疗效的判断均具有重要价值。     

Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma

Background

Bronchial hyperresponsiveness (BHR) is a fundamental pathophysiological characteristic of asthma. Although several factors such as airway caliber can affect BHR, no study has established age-dependent cutoff values of BHR to methacholine for the diagnosis of asthma in children. We investigated the cutoff values of the methacholine challenge test (MCT) in the diagnosis of asthma according to age.

Methods

A total of 2383 individuals aged from 6 to 15 years old were included in this study. MCTs using the five-breath technique were performed in 350 children with suspected asthma based on symptoms by pediatric allergists and in 2033 healthy children from a general population-based cohort. We determined the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in 1 second from baseline (PC₂₀). A modified Korean version of the International Study of Asthma and Allergies in Childhood questionnaire was used to distinguish asthmatics and healthy subjects. Receiver-operator characteristic curve analysis was used to assess the cutoff value of PC₂₀ for the diagnosis of asthma.

Results

Cutoff values of methacholine PC₂₀, which provided the best combination of diagnostic sensitivity and specificity, showed an increasing pattern with age: 5.8, 9.1, 11.8, 12.6, 14.9, 21.7, 23.3, 21.1, 21.1, and 24.6 mg/mL at ages 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 years, respectively.

Conclusion

The application of different cutoff values of methacholine PC₂₀ depending on age might be a practical modification for the diagnosis of asthma in children and adolescents with asthmatic symptoms.

     

Influence of breathing pattern on transcutaneous oxygen and carbon dioxide tension during histamine provocation in children with bronchial asthma

The influence of the breathing pattern on transcutaneous blood gases was evaluated in 18 boys and 8 girls 7–18 years of age, with bronchial asthma, during bronchial provocation with histamine-HCI. Transcutaneous oxygen tension (tcPo₂), carbon dioxide tension (tcPco₂) and the breathing pattern assessed by the transthoracic impedance technique were continuously monitored during the provocation. At reaction, when the fall in the forced expiratory volume in 1 s (FEV₁) was 20% or more. the tcPo₂ fell by 15% or more below the baseline in 22/26 and by 20% or more in 14/26 children. In some children, a marked fall in the tcPo₂ was already noted after the saline inhalation and the first histamine dose steps without simultaneous changes in the FEV₁. This early fall in the tcPo₂ correlated to changes in the breathing pattern and was interpreted as a sign of compensatory hypoventilation secondary to the hyperventilation observed during the inhalations. We conclude that transcutaneous oxygen tension can be used as an indicator of a bronchial reaction during bronchial provocation tests in children only if one takes account of the fact that the breathing pattern during the inhalation of the challenge compound per se has an effect on the oxygen tension.     

支气管哮喘患儿潮气呼吸肺通气功能研究

目的了解支气管哮喘患儿肺通气功能的变化。方法用潮气呼吸流速容量环(TBFV环)测定89名3～7岁支气管哮喘急性发作期患儿肺通气功能各项指标,以93名同龄健康儿童作对照,并描绘出潮气流速容量环。结果哮喘组患儿TE、TEF25下降,与健康组比较差异有显著性(P<0.05);RR增快,TI、TPTEF、TI/TE、TPTEF/TE、VPTEF/VE、%V-PF、25/PF下降,与健康组比较差异有非常显著性(P<0.01)。健康儿童潮气呼吸流速-容量环近似椭圆形,哮喘组儿童图形呈矮胖形;气道阻塞越重,呼气相的下降支斜率越大,甚至向容量轴凹陷。结论应用潮气呼吸流速容量环(TBFV环)测定患儿肺通气功能,对评价患儿支气管哮喘的严重程度有较高的价值,为支气管哮喘的防治提供有效的依据。     

以胸闷为主诉的不典型支气管哮喘患儿激发试验前后的肺功能特点

目的 了解以胸闷为主诉的不典型支气管哮喘患儿在支气管激发试验前后的肺功能特点。方法 选取2010 年1 月至2013 年12 月在我院肺功能室进行支气管激发试验的不典型哮喘患儿34 例为研究对象(不典型哮喘组),同期选取典型哮喘患儿34 例为对照,检测不典型哮喘组患儿支气管激发试验前后的肺功能,以及典型哮喘组患儿发作期和缓解期肺功能。结果 不典型哮喘组激发前肺功能指标用力肺活量(FVC)、第1 秒最大呼气量(FEV1)、FEV1/FVC、呼气峰流速(PEF)、用力呼气25 %、50 %、75%肺活量时的呼气峰流速(FEF25、FEF50、FEF75)、最大呼气中期流量(MMEF75/25)分别为105%±12%、104%±12%、100%±7%、88% ±13%、90% ±14%、81% ±17%、73% ±25%、80%±17%,明显高于典型哮喘组患儿发作期肺功能各指标(PP>0.05)。不典型哮喘组激发后肺功能各指标与典型哮喘组发作期相比差异无统计学意义(P>0.05),但均低于典型哮喘组缓解期和不典型哮喘组激发前水平。结论 支气管激发试验有助于不典型哮喘患儿的诊断。     

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目的 研究高渗盐水激发试验及运动激发试验在哮喘儿童的临床应用,旨在寻求更适合哮喘儿童的气道反应性检测的方法方法收集中国医科大学附属盛京医院2007年5月至2008年6月符合儿童支气管哮喘防治常规诊断标准的哮喘缓解期患儿34例,年龄5～13岁,在规定时间内先后做气道高渗盐水激发试验和运动激发试验.结果 同一哮喘患儿高渗盐水激发试验的敏感性显著高于运动激发试验(P<0.01).结论 高渗盐水激发试验的敏感性和特异性高于运动激发试验,而且设备低廉,方法简单、易配合,安全,副反应少,尤其适用于在哮喘治疗期间动态观察儿童气道的反应性,对指导药物治疗有重要价值.     

哮喘患儿支气管舒张试验与哮喘控制水平的相关性分析

目的 探讨支气管舒张试验(BDT)与儿童哮喘控制水平的关系.方法 选取2016年3月至2018年3月门诊就诊的5～14岁哮喘患儿153例,根据是否为特应性体质分为过敏组(79例)和非过敏组(74例),分析两组患儿BDT与儿童哮喘控制测试量表(C-ACT)评分的相关性.结果 过敏组患儿除用力肺活量占预计值的百分比、呼气峰...     

支气管激发试验用于诊断儿童哮喘的评价

哮喘的本质是气道慢性炎症,由此导致的气道反应性增高,称为气道高反应性(airway hyperresponsiveness orairway hyperreactivity,AHR),又称支气管高反应性(bronchial hyperresponsiveness,BHR). AHR是指异常敏感的气道在吸入各种物理性、化学性或药物等刺激性物质后,较正常人的气道更易出现支气管平滑肌的收缩、黏液分泌增多及免疫炎性介质释放,从而表现为气道阻力急速短暂或较长时间的上升、肺通气功能下降的一种特质.     

气道反应性监测在儿童哮喘治疗中的指导意义

目的 探讨气道反应性检测在儿童哮喘治疗中的指导意义.方法 对38例确诊的支气管哮喘患儿,分别在治疗前,治疗后3个月、1年、2年进行常规肺功能检查,同时吸人浓度倍倍递增的乙酰甲胆碱进行支气管激发试验,测定最大呼气流量(PEF)、一秒钟用力呼气容积(FEV1)、最大呼气中段流最(MMEF)及比气道传导率下降35%或以上时吸入乙酰甲胆碱浓度(PC35 sGaw).PC35 sGaw≤8 mg/ml为激发试验阳性,观察随防时间为2年.结果 所有患儿对吸入糖皮质激素 长效β2激动剂(ICS LABA)的联合治疗反应良好,97.4%的患儿达到临床完全控制.治疗后肺功能仅2例存在轻微异常,FEV1、MMEF、PEF随治疗时间的增加明显升高,较治疗前差异有统计学意义.气道反应性测定在治疗后3个月、1年、2年PC35 sGaw浓度分别为(0.735±0.573)mg/ml、(1.47±1.289)mg/ml及(3.827±2.258)mg/ml,但至2年时仍有57.9%的患儿支气管激发试验阳性,均为轻度气道高反应.结论 哮喘临床指标达到完全控制的时间早于气道反应性达到理想水平的时间,气道反应性指标在联合治疗长期随访以及调整治疗方案中的价值优于临床症状和肺功能,PC35 sGaw可作为评价疗效、指导治疗方案调整的指标之一.     

支气管哮喘儿童皮肤点刺试验结果分析

目的 分析支气管哮喘(bronchial asthma,BA)儿童皮肤点刺试验(skin prick test,SPT)结果,并提出预防策略.方法 对2007年3月至2010年10月在我院哮喘门诊就诊的200例BA患儿进行SPT结果分析,采用SPSS 17.0软件分析过敏原分布情况及其与年龄、性别的相关性.结果 (1) 200例BA患儿SPT阳性率为72.5%(145/200例),吸入性变应原阳性率62.5%(125/200例),食入变应原阳性率14.0%(28/200例),其中粉尘螨73例(36.5%)、屋尘螨81例(40.5%)、室外霉菌38例(19.0%)、艾蒿34例(17.0%)、猫上皮34例(17.0%)、树木花粉(树Ⅰ)26例(13.0%)、鸡蛋16例(8.0%)、牛奶11例(5.5%);(2) 18种变应原中猫上皮、艾蒿、室外霉菌及树Ⅰ随年龄增加其过敏频率升高,鸡蛋、牛奶随年龄的增加其过敏频率降低,而变应原过敏频率与性别无显著相关性;(3) 18种变应原中粉尘螨、屋尘螨、豚草、藜随年龄增加其过敏严重程度增加,而变应原过敏严重程度与性别无显著相关性.结论 粉尘螨、屋尘螨、猫上皮、室外霉菌、艾蒿、树Ⅰ、鸡蛋、牛奶等是BA儿童的主要变应原.BA儿童应避免接触这些过敏因素.

Abstract：

Objective To investigate the outcome of allergen skin prick test in children with bronchial asthma,and propose prevention strategy.Methods Sensitinogen prick test on the skin was applied on 200 children who were in asthma clinic of our hospital between Mar 2007 and Oct 2010.Then,the distribution of sensitinogen and their correlation with age and sex were analysed by SPSS 17.0.Results (1) The positive rate of sensitinogen prick test in 200 children with asthma was 72.5%(145/200).The positive rate of inhalant allergen and ingestion allergen were 62.5%(125/200),14.0%(28/200),respectively,of which dermatophagoides farinae,dermatophagoides pteronyssinus,outdoor mould,mugwort,cat epidermis,tree Ⅰ,egg,milk were 36.5%,40.5%,19.0%,17.0%,17.0%,13.0%,8.0%,5.5% respectively.(2) The frequency of sensitivity to cat epidermis,mugwort,outdoor mold and tree Ⅰ increased with age and the frequency of sensitivity to egg and milk decreases with age.The sensitivity rate to all other allergens had no relation with sex.(3) The severity of sensitivity to dermatophagoides farinae,dermatophagoides,ragweed and pigweed increased with age,while severity of sensitivity had no significant relation with sex among the 18 kinds of allergens.Conclusion Dermatophagoides farinae,dermatophagoides pteronyssinus,outside mould,mugwort,tree Ⅰ,cat epidermis,egg and milk are the major allergens in children with bronchial asthma,who should avoid contact with these facters.