第1秒用力肺活量、用力肺活量及1秒率正常的支气管哮喘患儿支气管舒张试验结果分析

目的评估肺通气功能中第1秒用力肺活量(FEV₁)、用力肺活量(FVC)及1秒率(FEV₁/FVC)正常的支气管哮喘(哮喘)患儿支气管舒张试验(BDT)阳性率,提高对FEV₁、FVC及FEV₁/FVC正常的哮喘患儿完善BDT检查重要性的认识。方法选择2018年9月至2019年8月山东大学附属省立医院门诊诊断为哮喘的患儿,年龄5~14岁,可配合肺通气功能及BDT检查,收集FEV₁、FVC及FEV₁/FVC正常的患儿肺功能资料,统计BDT阳性率并分析小气道功能状况。结果共纳入FEV₁、FVC及FEV₁/FVC正常的患儿1 631例,其中肺通气功能正常1 414例,小气道功能障碍217例。吸入支气管扩张剂15 min后,BDT阳性哮喘患儿共127例,阳性率为7.8%;男87例,女40例,其中合并小气道功能障碍患儿BDT阳性62例,BDT阳性率为28.6%。FEV₁改善率在8.0%~11.9%有132例(8.1%)。用药前FEV₁占预计值的百分比为(98.5±10.3)%;吸入硫酸特布他林15 min后,改善率为13.5%(12.5%,16.2%)。用力呼出50%肺活量的瞬间呼气流量(FEF50)、用力呼出75%肺活量的瞬间呼气流量(FEF₇₅)、最大呼气中期流量(MMEF)改善率与其基础值呈负相关[FEF50(r=-0.339,P<0.01)、FEF₇₅(r=-0.400,P<0.01)、MMEF(r=-0.375,P<0.01)];FEV₁改善率与FEV₁基础值无显著相关(r=-0.128,P=0.153),FEV₁改善率与MMEF基础值呈负相关(r=-0.231,P<0.01)。结论有部分哮喘患儿在FEV₁、FVC及FEV₁/FVC正常范围时BDT阳性。建议对症状典型或不典型哮喘患儿在诊断及随访时尽可能完善BDT检查,以明确诊断以及获取当前个人最佳值,同时结合小气道功能有助于全面评估哮喘病情及控制情况。     

Asthma treatment in schoolchildren: lung function in different therapeutic groups

Dynamic spirometry and peak expiratory flow were measured in 297 school-aged children with asthma during their control visit at the outpatient clinic in 1993. Sixty (20%) children had no maintenance drugs, 169 (57%) used cromoglycate ( n = 97) or nedocromil ( n = 72), and 68 (23%) budesonide. The treatment of each child had been selected on clinical grounds according to the principles of the international consensus statement from 1989. The mean values of peak expiratory flow (PEF), forced vital capacity (FVC) and forced expiratory volume in 1s (FEV₁) were over 95% of the height-related reference values in all treatment groups. The lower limits of the 95% confidence intervals were at the level of more than 90% of those predicted. The mean FEV₁/FVC ratio (FEV%) was over 85%, and the mean maximal mid-expiratory flow (MMEF) over 75% of the reference values. Decreased PEF values (<75%) were present in 10%, decreased FVC, FEV₁, or FEV% (<75%) values in 4–6%, and decreased MMEF ((65%) values in 18%. Only minor differences between the different therapeutic groups were observed. Our results show that the clinical selection of children between the three therapeutical groups was adequate. In our area up to 70% of children requiring maintenance therapy for asthma can be treated with cromones.     

哮喘和咳嗽变异性哮喘儿童肺常规通气功能的比较

目的：比较哮喘与咳嗽变异性哮喘（CVA）患儿肺常规通气功能的变化。方法：选择2010年 5月至2011年5月确诊为哮喘或CVA的患儿140例,分为哮喘急性发作组（发作组,50例）、哮喘缓解组（缓解组,50例）和CVA组（40例）;同期正常健康体检儿童30例作为对照组。测定4组儿童用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)、用力呼气75%流速(FEF75)、最大呼气中期流速(MMEF75/25)等7项肺功能指标。结果：发作组患儿各项肺功能指标如大气道指标FVC、FEV1、PEF、FEF25及小气道指标FEF50、FEF75、MMEF75/25的实际值/预计值平均水平均<80%,且以FEF50、FEF75、MMEF75/25等小气道指标下降为著。CVA组患儿小气道指标FEF75、MMEF75/25实际值/预计值的平均水平<80%。发作组各项肺常规通气功能指标均低于对照组;缓解组、CVA组FVC、FEV1、FEF25及 MMEF75/25实际值/预计值的平均水平低于对照组;发作组各项肺功能指标均明显低于缓解组和CVA组;CVA组与缓解组各项肺功能指标差异均无统计学意义。结论：哮喘急性发作期患儿存在大小气道功能障碍,以小气道功能障碍为主;CVA患儿以小气道功能轻微障碍为主,与哮喘缓解期相似。     

昆明市5~14岁儿童肺通气功能参数实测值与Zap

目的 研究昆明市5~14岁健康儿童肺通气功能主要参数实测值占Zapletal方程式预计值的百分比,为临床准确判断肺通气功能提供依据。方法 纳入昆明市5~14岁健康儿童702名,其中男352名,女350名。采用Jaeger肺功能仪测定用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、1秒率（FEV1/FVC）、最大中期呼气流量（MMEF）、用力呼气25%肺活量时瞬时流量（FEF25）、用力呼气50%肺活量时瞬时流量（FEF50）、用力呼气75%肺活量时瞬时流量（FEF75）、最高呼气流量（PEF）、每分钟最大通气量（MVV）,共9项指标,以肺功能仪中提供的Zalpetal预计值公式得出的数值作为所选择儿童的预计值,计算其实测值占预计值的百分比。结果 在702名儿童中,肺通气功能主要参数PEF、FVC、FEV1、FEV1/FVC、MVV实测值占预计值百分比的均值分别波动于102%~114%、94%~108%、98%~113%、98%~107%、141%~183%。气道流速指标功能参数FEF25、FEF50、FEF75、MMEF实测值占预计值百分比分别波动于98%~116%、85%~102%、71%~98%、83%~100%。各参数PEF、FVC、FEV1、FEV1/FVC、MVV、FEF25、FEF50、FEF75、MMEF实测值占Zapletal方程式预计值百分比的下限分别为88.2%、88.4%、92.0%、94.4%、118.5%、82.9%、70.0%、62.1%、70.1%。结论 昆明地区5~14岁健康儿童肺通气功能参数水平与Zapletal方程式提供的正常值存在一定差异;该地区此年龄段的健康儿童肺通气功能参数PEF、FVC、FEV、FEV1/FVC、MVV、FEF25、FEF50、FEF75、MMEF实测值占预计值百分比的正常参考值下限可考虑分别设为88.2%、88.4%、92.0%、94.4%、118.5%、82.9%、70.0%、62.1%、70.1%。     

昆明市5~14岁儿童肺通气功能参数实测值与Zap

目的 研究昆明市5~14岁健康儿童肺通气功能主要参数实测值占Zapletal方程式预计值的百分比,为临床准确判断肺通气功能提供依据。方法 纳入昆明市5~14岁健康儿童702名,其中男352名,女350名。采用Jaeger肺功能仪测定用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、1秒率（FEV1/FVC）、最大中期呼气流量（MMEF）、用力呼气25%肺活量时瞬时流量（FEF25）、用力呼气50%肺活量时瞬时流量（FEF50）、用力呼气75%肺活量时瞬时流量（FEF75）、最高呼气流量（PEF）、每分钟最大通气量（MVV）,共9项指标,以肺功能仪中提供的Zalpetal预计值公式得出的数值作为所选择儿童的预计值,计算其实测值占预计值的百分比。结果 在702名儿童中,肺通气功能主要参数PEF、FVC、FEV1、FEV1/FVC、MVV实测值占预计值百分比的均值分别波动于102%~114%、94%~108%、98%~113%、98%~107%、141%~183%。气道流速指标功能参数FEF25、FEF50、FEF75、MMEF实测值占预计值百分比分别波动于98%~116%、85%~102%、71%~98%、83%~100%。各参数PEF、FVC、FEV1、FEV1/FVC、MVV、FEF25、FEF50、FEF75、MMEF实测值占Zapletal方程式预计值百分比的下限分别为88.2%、88.4%、92.0%、94.4%、118.5%、82.9%、70.0%、62.1%、70.1%。结论 昆明地区5~14岁健康儿童肺通气功能参数水平与Zapletal方程式提供的正常值存在一定差异;该地区此年龄段的健康儿童肺通气功能参数PEF、FVC、FEV、FEV1/FVC、MVV、FEF25、FEF50、FEF75、MMEF实测值占预计值百分比的正常参考值下限可考虑分别设为88.2%、88.4%、92.0%、94.4%、118.5%、82.9%、70.0%、62.1%、70.1%。     

漏斗胸矫正术后肺功能远期随访

了解漏斗胸矫正术后肺功能的变化及肺功能能否功能否恢复到正常水平。方法随访２７例泥漏斗胸术后患儿,其中男２４例,女３例,年龄８－１６岁,平均手术年龄是４．９８岁,平均随访时间为６．８９年。     

High-resolution CT pulmonary findings in children with severe asthma

ObjectiveTo compare quantitative CT parameters between children with severe asthma and healthy subjects, correlating to their clinical features.MethodsWe retrospectively analyzed CT data from 19 school-aged children (5–17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation ≤856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). Multi-detector computed tomography (MDCT) data were correlated to the following clinical parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25–75% (FEF 25–75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma.ResultsAsthma patients presented higher mean values of AT% (23.8 ± 6.7% vs. controls, 9.7 ± 3.2%), AWT (1.46 ± 0.22 mm vs. controls, 0.47 ± ?735 ± 28 HU vs. controls, ?666 ± 19 HU). Mean AT% was 29.0 ± 4.7% in subjects with previous hospitalization against 19.2 ± 5.0% in those with no prior hospitalization (p < 0.001). AT% presented very strong negative correlations with FVC (r = ?0.933, p < 0.001) and FEV1 (r = ?0.841, p < 0.001) and a moderate correlation with FEF 25–75% (r = ?0.608, p = 0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r = ?0.184, p = 0.452, and r = ?0.363, p = 0.202)ConclusionChildren with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma.     

缓解期哮喘患儿的支气管反应性与小气道功能的关系

目的　测定缓解期哮喘患儿支气管反应性及小气道功能 ,探讨支气管反应性与小气道功能及临床缓解时间的关系。方法　对 39例缓解期哮喘患儿进行支气管激发试验 ,用传统方法测定肺通气功能。比较最大呼气中段流量 (maximalmid expiratoryflow ,MMEF) <80 %患儿和MMEF≥80 %患儿的支气管激发试验阳性率 ,以及临床缓解时间≤ 12个月和 >12个月的患儿支气管激发试验阳性率。结果　缓解期哮喘患儿 39例中 2 8例 (72 % )支气管激发试验阳性 ;15例 (38% )MMEF <80 %。在MMEF <80 %患儿和MMEF≥ 80 %患儿之间支气管激发试验阳性率差异无显著意义 (P >0 0 5 )。缓解时间≤ 12个月和 >12个月的患儿间支气管激发试验阳性率差异无显著意义 (P >0 0 5 )。结论　缓解期哮喘患儿仍然存在支气管高反应性及小气道阻塞 ,提示缓解期气道炎症仍持续存在 ;症状缓解时间超过 1年者支气管激发试验阳性率较缓解时间 1年之内者无明显改善。     

Long-term trajectories of lung function and risk factors in children with bronchial asthma北大核心CSCD

目的建立支气管哮喘(哮喘)患儿肺功能长期变化的发展轨迹, 确定哮喘患儿出现长期肺功能损伤的危险因素。方法采用回顾性队列研究, 纳入2019年1月至12月在首都儿科研究所附属儿童医院定期随诊, 并完成肺功能检测的14岁以上哮喘患儿, 收集其肺功能资料及临床信息。采用潜变量增长模型(LCGM)拟合哮喘患儿肺功能发展轨迹, 建立不同的轨迹组, 组间比较采用t检验、方差分析或χ2检验, 确定肺功能长期变化危险因素采用多分类Logistic回归分析。结果共纳入哮喘患儿173例, 年龄6~17岁, 获得肺功能测定1 160例次。拟合4条1秒率(FEV1/FVC)潜分类轨迹:持续高水平组、高于平均水平组、低于平均水平组、持续低水平组, 其病例数分别为27例(15.6%)、66例(38.1%)、66例(38.1%)、14例(8.1%)。不同轨迹组患儿的FEV1/FVC在每一年龄组间的差异均有统计学意义(均P<0.05)。持续高水平组各年龄段的FEV1/FVC均在90%以上, 其余各轨迹组FEV1/FVC随年龄变化整体呈下降趋势, 低于平均水平组的FEV1/FVC在青春期后下降至80%以下;持续低水平组的FEV1/FVC均值在学龄期后即下降至80%以下, 至青春期接近70%。最大用力呼气中段流量(MMEF)的轨迹和波动情况与FEV1/FVC相似。危险因素分析显示, 与持续高水平组相比, 典型哮喘患儿肺功能轨迹处于低于平均水平组的风险是咳嗽变异性哮喘患儿的11.940倍(P=0.008);多重致敏患儿的肺功能轨迹处于低于平均水平组的风险是单一致敏的7.462倍(P=0.015);未规律用药患儿肺功能处于持续低水平组的风险是规律用药者的6.337倍(P=0.035);男童肺功能轨迹处于低于平均水平组的风险是女童的6.186倍(P=0.002)。结论 6~17岁哮喘患儿的长期肺功能变化可确定4条不同轨迹:持续高水平、高于平均水平、低于平均水平、持续低水平;近半数患儿的长期肺功能轨迹处于低水平, 较多患儿在青春期, 少数患儿在学龄期出现持续性气流受限;典型哮喘、多重致敏、未规律用药、男性是哮喘患儿长期肺功能降低的危险因素。     

Pulmonary outcome in adolescents of extreme preterm birth: a regional cohort study

Aims: The pulmonary outcome of extreme prematurity remains to be established in adults. We determined respiratory health and lung function status in a population-based, complete cohort of young preterms approaching adulthood. Methods. Forty-six preterms with gestational age ≤28 wk or birthweight ≤1000 g, born between 1982 and 1985, were compared to the temporally nearest term-born subject of equal gender. Spirometry, plethysmography, reversibility test to salbutamol and methacholine bronchial provocation test were performed. Neonatal data were obtained from hospital records and current symptoms from validated questionnaires. Results: When entering the study at a mean age of 17.7 (SD: 1.2) y, a doctor's diagnosis of asthma and use of asthma inhalers were significantly more prevalent among preterms than controls (one asthmatic control compared to nine preterms, all but one using asthma inhalers). Peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV ₁ ) were decreased and the discrepancies relative to controls increased parallel to increased severity of neonatal lung disease. Parameters of increased neonatal oxygen exposure significantly predicted FEV ₁ . Adjusted for height, gender and age, FEV ₁ was reduced by a mean of 580 ml/s in subjects with a history of bronchopulmonary dysplasia. Fifty-six percent of preterms had a positive methacholine provocation test compared to 26% of controls.

Conclusion: A substantially decreased FEV ₁ , increased bronchial hyperresponsiveness and a number of established risk factors for steeper age-related decline in lung function were observed in preterms. A potential for early onset chronic obstructive pulmonary disease is present in subsets of this group.     

Ventilatory functions of normal children and young adults--Mexican-American, white, and black. I. Spirometry.

This is a study of the ventilatory functions of 1,805 normal Mexican-American, white, and black students of six public schools in Houston, Texas, with ages ranging from 7 to 20. A roll-seal piston type spirometer was used. The best performed forced vital capacity curve of each student was selected by the computer program from which the following measurements were extracted: FVC, FEV1, FEV1/FVC ratio, PEFR, and MMEF. Each student also had the peak expiratory flow rate measured by the Wright peak flowmeter to establish normal values with this instrument. Significant differences of lung volume and flow rate exist among the three races, and between male and female subjects. Prediction equations and prediction curves for each race and sex are presented. The results of the present study are compared with those of previously published works.     

Spirometry, bronchodilator test or symptom scoring for the assessment of childhood asthma

The value of spirometry, the bronchodilator test and 2 weeks' symptom scoring for the assessment of the severity of childhood asthma was studied in a series of 65 consecutively referred school-aged asthmatic children, with the diurnal peak expiratory flow (PEF) variability in home recordings serving as a golden standard. The amplitude of the peak expiratory flow rate (PEFR) variation could be best predicted by the baseline forced expiratory volume in 1 s (FEV₁) and the past history of the symptom rate, the correlation with FEV₁ being - 0.48, p < 0.001, Although the baseline forced expiratory flow between 25 and 75% of the forced vital capacity (FEF_25-75%) and the responses of FEV₁ and FEF_25-75% to salbutamol also showed significant correlations with the diurnal PEFR variability ( r = -0.43, r = 0.47 and 0.41, p < 0.001, respectively), these variants did not improve the regression model. The baseline FEV₁, FEF_25-75% and PEFR and their responses to salbutamol also had a slight but statistically significant correlation with the methacholine threshold, but the symptom score on the diary card did not show comparable correlations with either the diurnal PEFR variability or the methacholine threshold ( r = 0.09, NS, and r = 0.05, NS, respectively). These results indicate that both baseline lung function and the response to the bronchodilator test correlate with the severity of childhood asthma more appropriately than does the symptom score on a diary card. Since many of these correlations were rather weak, however. the assessment of the severity of childhood asthma cannot be reliably based solely on spirometry in all patients.     

Working Capacity and Pulmonary Gas Exchange in Children with Exercise-Induced Asthma

ABSTRACT. Sixteen children aged 10.1-14.3 years with a history of exercise-induced asthma (EIA) were evaluated as to their working capacity both during a maximal exercise test and during sub-maximal exercise. During submaximal exercise ventilation and alveolar gas exchange were measured. Working capacity was normal with respect to the oxygen uptake and to the maximal load. Arterial blood gases were normal before exercise but PaO₂ decreased ( p <0.01) during the submaximal exercise test. The values were, however, still within the normal limits in all but two of the children. The flow-volume data showed bronchial obstruction in the resting state, before exercise, with lower values of MEF₅₀ and MEF₂₅ ( p <0.01) than in healthy children. Following exercise, 14 of the 16 children developed clinical symptoms of asthma with increased impairment of the flow-volume curves. Most of them recovered from asthmatic symptoms within 30 min. Flow-volume curves were found to be a sensitive measurement of bronchial obstruction during the symptom-free phase and during EIA although with larger individual variations than FEV₁.     

脉冲振荡肺功能支气管舒张试验阳性标准的确定

目的探讨在使用脉冲振荡肺功能（IOS）检测时,如何判断支气管舒张试验阳性。方法随机抽取发作期哮喘患儿156例,均进行最大呼气流量一容积和IOS测定,然后进行支气管舒张试验。以第一秒用力呼气容积（FEV1）和最大呼气中段流量（MMEF）作为金标准,分别计算IOS主要参数,即呼吸总阻抗（Zrs）、气道总粘性阻力（R5）、电抗（X5）在不同改善率水平时其对诊断的敏感度与特异度,并计算两种肺功能主要参数间的回归方程。结果吸入支气管舒张剂后,患儿肺功能显著改善,两种肺功能主要参数的改善率均存在显著相关（P〈0．01）,其中X5改善率与最大呼气流量-容积曲线参数改善率相关性最强（相关系数分别为0．676、0．571）,Zrs次之。无论使用FEV1改善率≥15％,还是使用MMEF改善率≥30％作参照,IOS参数以Zrs、R5下降≥20％,X5下降≥30％作为舒张试验阳性有着较高的敏感度和特异度。回归方程结果显示,与FEV,改善15％、MMEF改善30％对应的Zrs、R5、X5的降低率分别为21．7％、21．3％;19．9％、19．5％;30．1％、29．6％。结论用IOS进行支气管舒张试验,只有在Zrs、R5下降≥20％,X5下降≥30％时,才能考虑作为试验阳性。     

不同胸部影像学表现的肺炎支原体肺炎儿童的肺功能变化特征

目的 探讨不同胸部影像学改变的肺炎支原体肺炎（MPP）患儿肺功能异常的特点。方法 根据胸部影像学结果将确诊为MPP 的215 名患儿分为支气管肺炎组（125 例）、大叶性肺炎组（69 例）和间质性肺炎组（21 例）,比较3 组间肺功能检测指标用力肺活量（FVC）、第1 秒时间用力呼出气体容量（FEV1）、最高呼气流速（PEF）和最大呼气中段流速（MMEF 25%~75%）的差异。结果 支气管肺炎组患儿急性期PEF（实测值和实测值/ 预计值）明显低于其他两组患儿;大叶性肺炎组患儿急性期MMEF 25%~75% 显著低于其他两组;间质性肺炎组患儿急性期FVC 明显低于其他两组患儿。3 组患儿恢复期肺功能与急性期比较,除大叶性肺炎组患儿FEV1 无明显好转外,其他指标均明显改善。结论 胸部影像学为支气管肺炎改变的MPP 患儿主要表现为大气道功能受损;大叶性肺炎改变者以小气道功能受损更为明显;间质性肺炎改变患儿既有阻塞性通气功能障碍,又有限制性通气功能障碍。     

Influence of genetic variants on childhood lung function – The Generation R Study

Genetic variants associated with adult lung function could already exert the effects on childhood lung function. We aimed to examine the associations of adult lung function‐related genetic variants with childhood lung function and asthma, and whether these associations were modified by atopic predisposition, tobacco smoke exposure, or early growth characteristics. In a population‐based prospective cohort study among 3347 children, we selected 7 and 20 single nucleotide polymorphisms (SNPs) associated with adult forced expiratory volume in 1 second (FEV ₁) and FEV ₁/forced vital capacity (FEV ₁/FVC ), respectively. Weighted genetic risk scores (GRS s) for FEV ₁ and FEV ₁/FVC were constructed. At age 10, FEV ₁, FVC , FEV ₁/FVC , forced expiratory flow between 25% and 75% (FEF _25‐75), and forced expiratory flow at 75% (FEF ₇₅) of FVC were measured, and information on asthma was obtained by parental‐reported questionnaires. The FEV ₁‐GRS was associated with lower childhood FEV ₁, FEV ₁/FVC , and FEF ₇₅ (Z ‐score (95% CI ): ?0.03 (?0.05, ?0.01), ?0.03 (?0.05, ?0.01), and ?0.04 (?0.05, ?0.01), respectively, per additional risk allele). The FEV ₁/FVC ‐GRS was associated with lower childhood FEV ₁/FVC and FEF ₇₅ (Z ‐score (95% CI ): ?0.04 (?0.05, ?0.03) and ?0.03 (?0.05, ?0.02), respectively, per additional risk allele). Effect estimates of FEV ₁‐GRS with FEF _25‐75, FEV ₁, FEF ₇₅, and FVC , and of FEV ₁/FVC ‐GRS with FEV ₁/FVC and FEF _25‐75 were stronger among children exposed to non‐atopic mothers, smoking during pregnancy or in childhood, or those born with a lower birthweight, respectively (P ‐values for interaction < .05). Genetic risk scores were not associated with asthma. Adult lung function‐related genetic variants were associated with childhood lung function. Maternal atopy, smoking during pregnancy or in childhood, and birthweight modified the observed effects.     

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。     

以胸闷或长叹气为主诉的不典型哮喘儿童肺功能和呼出气一氧化氮特点分析

目的 分析以胸闷或长叹气为主诉的不典型哮喘儿童的肺功能和呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)特点,并探讨FeNO在该类型哮喘患儿中的诊断价值.方法 选取2012年1月至2015年6月期间于我院儿童哮喘门诊确诊的以胸闷或长叹气为主诉的不典型哮喘儿童79例为研究对象(不典型哮喘组).该组患儿于初诊时均接受了肺功能检查、FeNO检测、血清总IgE和血清特异性IgE水平检测,且肺功能检测均存在支气管激发试验或支气管舒张试验阳性.同期选取我院完成FeNO检测的健康儿童100例作为对照组.分析不典型哮喘组初诊时肺功能特点和FeNO水平.采用受试者工作特征曲线(ROC)分析FeNO对于不典型哮喘儿童的诊断价值.结果 不典型哮喘组肺功能指标FEF50、FEF75、MMEF异常率分别为27％、43％、33％.FEV1％下降20％时吸入的乙酰甲胆碱累积剂量(PD20-FEV1)为0.41 (0.19～0.67)mg,该指标与MMEF呈显著正相关(r=0.301,P=0.007).不典型哮喘组Fe-NO值为13.0×10-9 (7.0×10-9～24.0×10-9),高于对照组且两者间存在统计学差异(P＜0.05).其Fe-NO值与总IgE水平呈显著正相关(r =0.672,P=0.001),与FEV1/FVC％、FEV1％ pred及PD20-FEV1均不存在相关性(P＞0.05).根据不典型哮喘儿童和健康儿童的FeNO值绘制ROC曲线,曲线下面积为0.60.结论 以胸闷或长叹气为主诉的哮喘儿童肺功能特点以小气道功能受损为主,其中MMEF下降明显者,其气道高反应更显著,FeNO检测对不典型哮喘诊断价值有限.     

Combined body plethysmographic, spirometric and flow volume reference values for male and female children aged 6 to 16 years obtained from “hospital normals”

Vital capacity (VC) and its subdivisions (IC and ERV), total lung capacity (TLC), residual volume (RV), peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), maximum flow volume curve (MEF₇₅, MEF₅₀, MEF₂₅, MMEF, FEF_75–85), airway resistance (R_tot, R_eff) and the thoracic gas volume at resting expiratory position (FRC) were measured in 187 girls and 213 boys (hospital normals) aged 6 to 16 years. The measurements were carried out consecutively on the same subjects in the morning using a volume-constant plethysmograph (MasterLab, E. Jaeger; programs: body plethysmography, spirometry and flow volume). Using multiple regression analysis the best fitting curves for the prediction of normal values for boys and girls were selected. Analyses of covariance were performed to compare the adjusted means of the spirometric and body plethysmographic variables of the male and female subjects. As expected, we found higher static and dynamic (FVC, FEV₁, PEF) lung volumes in boys than in girls relating to height. The flows (MMEF, MEF₅₀, MEF₂₅, FEF_75–85) were significantly lower in the male than in the female subjects of the same age justifying separate prediction equations, but the same equation for both genders may be used for the resistance variables R_tot and R_eff. Our results are compared with those of previous studies. Conclusion Lung volumes and flows differ significantly between girls and boys calling for separate reference values for female and male subjects of the same age. Received: 21 August 2000 and in revised form: 20 December 2000 / Accepted: 22 December 2000     

Lung function and bronchial hyper-responsiveness 11 years after hospitalization for bronchiolitis

AIM: Atopic infants hospitalized for wheezing not caused by respiratory syncytial virus (RSV) carry the highest risk for later asthma. In the present paper, early risk factors for later lung function abnormalities and for bronchial hyper-responsiveness (BHR) were evaluated in 81 children, hospitalized for bronchiolitis in infancy, at the median age of 12.3 years. METHODS: The basic data, including data on atopy in children and viral aetiology of bronchiolitis, had been collected on entry to the study at less than 2 years of age. Lung function was studied by flow-volume spirometry (FVS), and BHR by methacholine and exercise challenge tests 11.4 years after hospitalization during infancy. RESULTS: RSV aetiology of bronchiolitis was associated with reduced forced vital capacity (FVC; 93.65% of predicted +/- 11.05 vs. 99.57%+/- 12.59, p = 0.009). Early sensitization to inhalant allergens (OR 12.59, 95% CI 2.30-68.77) and maternal smoking during pregnancy (OR 4.58, 95% CI 1.28-16.39) were associated with BHR to exercise, and early atopic dermatitis (OR 3.48, 95% CI 1.09-11.10) was associated with BHR to methacholine. CONCLUSIONS: RSV bronchiolitis was associated with a restrictive pattern of lung function. Early atopy and maternal smoking during pregnancy may play a role in the development and persistence of BHR.