Association of body composition and lung function in children with cystic fibrosis

Survival in cystic fibrosis has improved significantly in the last 30 years, with major therapeutic goals of delaying the progressive loss of pulmonary function and maintaining normal growth. Dual-energy X-ray absorptiometry (DEXA) was performed in children with cystic fibrosis (CF) to assess both bone mineral density and body composition. We hypothesised that there would be an association between body composition and pulmonary function in children with CF. Fifty subjects with CF (28 males), mean age 12.7 years, participated in the study. Body composition was determined by DEXA. Body mass index (BMI) was calculated from the ratio of weight/height2 (kg/m2). Lung function was assessed by spirometry. Most patients (78%) had mild lung disease. The mean forced expired volume in 1 sec percent predicted (FEV1% predicted) for the 50 patients was 79.2% (range, 24-117%). There was a strong association between FEV1% predicted and BMI (R=0.59, P=0.0001). Fat-free mass had positive association with pulmonary function tests (R=0.30, P=0.03). Although fat mass showed a positive correlation with pulmonary function, this association did not reach statistical significance. In our group of children with CF and mild lung disease, pulmonary function was more strongly associated with BMI than with fat and fat-free mass.     

Non-infectious interstitial alveolitis and foreign body pulmonary vasculitis in a child treated for acute lymphoblastic leukemia

We report a case of a 14-month-old girl who was treated for acute lymphoblastic leukemia but died from interstitial alveolitis associated with foreign body vasculitis. This respiratory complication arose 3 months after an allogenic bone marrow transplant. No infectious agents (bacteria, virus, or parasite) were isolated from bronchial or lung tissue samples. Respiratory complications after chemotherapy are reviewed as well as the potential origin of the intravascular foreign bodies. Pediatr. Pulmonol. 1997; 23:382–385. © 1997 Wiley-Liss, Inc.     

Gas trapping in normal infants and in infants with cystic fibrosis

Two different methods for estimating trapped gas volume have been described in the literature. The purpose of this study was to use both of these methods to estimate and compare trapped gas volumes in normal infants and infants with cystic fibrosis (CF). Thirty normal infants and 29 infants with CF, ages 1 month to 3 years, were studied. Pulmonary function tests, including raised volume forced expiratory flows, plethysmographic functional residual capacity (FRC(pleth)), and fractional lung volumes, were measured. Then functional residual capacity was measured by nitrogen washout (FRC(nitrogen)). Following nitrogen washout, lungs were then inflated three times to 30 cm H(2)O, using 100% oxygen. This process was repeated until no further nitrogen could be washed from the lungs. The volume of trapped gas (tg) was calculated from the total additional amounts of nitrogen expired following lung inflations. The difference between FRC(pleth) and FRC(nitrogen) provided a second estimate of trapped gas volume (delta V). Mean tg and delta V values for normal infants were 2.5 +/- 3.5 ml and 15.6 +/- 30.4 ml, respectively. Mean tg and delta V values for infants with CF were 5.8 +/- 7.7 ml and 33.2 +/- 43.8 ml, respectively. Both tg and delta V did not differ significantly between normal infants and infants with CF. Measured following raised volume forced expiratory maneuvers, delta V and tg do not distinguish infants with CF from normal infants as well as do other currently available tests of infant lung function.     

Prospective Study of Short Stature and Newly Diagnosed Asthma in Women

The authors tested the hypothesis that short stature predicts adult-onset asthma independent of obesity among women in the Nurses' Health Study. Height, weight, and physician-diagnosed asthma were assessed with validated questionnaire items. Proportional hazard models adjusted separately for weight and body mass index. The rate of newly diagnosed asthma was 1.55 times greater in the shortest versus the tallest quintile after adjustment for weight (95% CI, 1.26–1.91). After adjustment for body mass index, the rate ratio was 1.16 (95% CI, 0.94–1.42). Short stature predicted adult-onset asthma in a large cohort of women, but this association was not independent of obesity.     

慢性阻塞性肺疾病的炎症反应与体重指数密切相关

目的探讨COPD患者局部及全身炎症反应与体重指数（BMI）的关系。方法2007年9月～2009年2月在我院就诊的稳定期COPD患者74例和健康体检者（对照组）30例。常规行肺功能、动脉血气分析及诱导痰炎症细胞分类计数,ELISA法测定血清C反应蛋白（CRP）、自细胞介素-8（IL-8）、IL_6、IL一10与肿瘤坏死因子-α（TNF-α）。分析以上各指标与BMI之间的关节。结果低体重组COPD患者诱导痰细胞总数与中性粒细胞计数明显高于正常体重组与对照组（P〈0．05）。低体重组COPD患者第一秒用力呼气量占预计值％（FEV1％）、PEV1与用力肺活量（FVC）比值及动脉血氧分压（PaO2）明显低于正常体重组（P〈0．05）,动脉血二氧化碳分压（PaC02）明显高于正常体重组（P〈0．05）。低体重组COPD患者BMI与诱导痰细胞总数、中性粒细胞数、CRP、IL-8、IL-及TNF-α呈负相关,相关系数分别为-0．515,-0．468,-0．453,-0．394,-0．462,-0．497,均P〈0．05。结论稳定期COPD患者的气道和全身炎症反应与BMI密切相关。     

甲羟孕酮在低体质量慢性阻塞性肺疾病急性加重期患者中应用的疗效评价

目的探讨甲羟孕酮在低体质量慢性阻塞性肺疾病急性加重期(AECOPD)患者中的疗效。方法将60例低体质量AECOPD患者随机分为2组,研究组30例,对照组30例。2组均予以抗感染、吸氧、解痉、平喘、化痰、纠正酸碱失衡及电解质紊乱等综合治疗。研究组给予甲羟孕酮0.5 mg,一次/d口服,疗程10 d。在研究前1 d、研究后10 d分别对两组患者进行血气分析指标、血脂、血清白蛋白水平测定。记录2组患者住院时间及住院总费用。结果治疗后研究组和对照组患者p H值(7.42±0.05 vs.7.35±0.05)、氧分压(74.83±7.19 vs.68.10±8.19)mm Hg、二氧化碳分压(55.57±6.94 vs.61.60±8.32)mm Hg、总胆固醇(3.67±0.34 vs.3.52±0.36)mmol/L、甘油三酯(1.49±0.49 vs.1.27±0.46)mmol/L、白蛋白(30.44±3.04 vs.26.27±1.83)g/L。研究组患者的血气指标、血脂及血清白蛋白水平较对照组患者有较明显改善(P0.05),研究组患者住院时间[(12.20±2.86)d]缩短,住院费用[(9 031.41±2 457.67)元]减少,与对照组患者相比有显著性差异(P0.05)。结论甲羟孕酮可改善低体质量AECOPD患者的食欲、增加进食量、改善肺通气、促进病情恢复。     

肺泡蛋白沉积症的影像学诊断与临床分析

目的通过肺泡蛋白沉积症(PAP)的X线、CT影像学表现与临床特点,提高对本病的认识。方法回顾分析7例经病理证实的肺泡蛋白沉积症患者的X线、CT影像学及临床表现。结果影像学表现多样化,主要为地图样表现、碎石路样表现、肺实变表现(支气管充气征)、肺水肿样表现及肺间质纤维化样表现等,肺部阴影明显而且相对稳定,但是临床症状较轻。典型的影像学表现与临床症状常不相称是PAP的特点。结论肺泡蛋白沉积症影像学表现具有一定的特征性,结合临床症状,基本能作出正确诊断,确诊有赖病理。     

Vitamin D deficiency, bone mineral density and weight in patients with advanced pulmonary disease

OBJECTIVE: To study the influence of underweight, body composition and vitamin D deficiency on bone mineral density in patients with advanced pulmonary disease. DESIGN: Cross-sectional study with time span for inclusion set at 5 years. SETTING: The clinical work and biochemical analyses were carried out at Rikshospitalet University Hospital, Norway. Analyses for vitamin D metabolites and bone markers were carried out at Aker University Hospital, and bone measurements at Clinic of Osteoporosis. SUBJECTS: Seventy-one candidates for lung transplantation (63% chronic obstructive pulmonary disease, 42 underweight and 29 normal weight) were included. MAIN OUTCOME MEASURES: Body composition, bone mineral density at lumbar spine and femur neck, serum concentration of calcidiol and vitamin D intake. RESULTS: Subnormal calcidiol levels were present in 52% of the underweight patients and 69% of the normal-weight patients. The resulting models of linear regression showed that for the lumbar spine T scores model, the total variation of 16.7% was explained by group (underweight/normal weight), sex and age. For the femur neck T scores model, the total variation of 20.4% was explained by the interaction of underweight and vitamin D deficiency (with borderline significance) and by arm muscle circumference percentage of standard. In patients with normal calcidiol levels, the median intake of vitamin D was 17 microg in the underweight patients and 11 microg in the normal-weight patients. CONCLUSIONS: Vitamin D deficiency was common in both underweight and normal-weight patients, but only in the underweight patients, an association between vitamin D deficiency and reduced femur neck T scores was indicated.     

Functional residual capacity (FRC) measurements by plethysmography and helium dilution in normal infants

Comparative measurements of functional residual capacity (FRC) made by plethysmography (FRC_pleth) and by helium dilution (FRC_He) were obtained on 27 infants and young children without known pulmonary disease (14 males, 13 females; 4 weeks–26 months; mean age 32.2 weeks) while under chloral hydrate sedation. Clinical histories, clinical examinations, and pulmonary functions were normal for all members of the group. FRC_pleth, whether measured near end expiration (EE) or near end inspiration (EI), and corrected to mean expiratory levels of at least 3 breathing cycles, was consistently and significantly greater than FRC_He. Comparative values for mean (± standard deviation) were FRC_pleth EE, 182.0 (±79.7) mL and FRC_pleth El, 171.8 (±77.4) mL vs. FRC_He 154 (±72.2) mL, P < 0.0001 and P < 0.005, respectively. Normalizing values by weight, FRC_pleth EE was 23.8 mL/kg (±5.3) vs. FRC_he 20.2 (±4.7) mL/kg, mean (+ standard deviation). The difference between FRC_pleth and FRC_he, expressed as FRC_pleth – FRC_He/FRC_pleth × 100, was 9% for occlusions at end inspiration and 16% for occlusions at end expiration. The following equations describe our FRC results in relation to length: In The difference between FRC_pleth and FRC_He was more marked when occlusions were performed at end expiration than at end inspiration. We conclude that normal infants and young children, at least when studied supine and sedated, have a small but significant amount of airway closure. © 1995 Wiley-Liss, Inc.