儿童胸闷变异性哮喘肺功能改变的特征

目的探讨胸闷变异性哮喘患儿肺功能改变的特点,为临床诊断和管理提供依据。方法选取2018年8月至2019年5月确诊为胸闷变异性哮喘的44例患儿为研究对象,选取同期初诊的非急性发作期的典型哮喘患儿62例及健康体检儿童46例为对照组。所有入组儿童在初诊或体检时进行呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和肺通气功能的检测,胸闷变异性哮喘组和典型哮喘组行支气管激发试验。分析对比不同组患儿的FeNO水平、肺通气功能改变及气道高反应性严重程度。结果胸闷变异性哮喘组FeNO中位数值为14.0(8.0,24.0)ppb,其水平明显低于典型哮喘组[31.0(12.0,51.0)ppb,P<0.05],高于健康儿童组[9.0(7.0,18.5)ppb,P<0.05];胸闷变异型哮喘儿童肺通气功能参数中FEV1/FVC[0.998(0.967~1.079)]、PEF[(94.41±12.91)]、FEF50[79.15(64.78~93.75)]、FEF75[66.50(53.10~95.90)]均显著低于健康儿童组[1.080(1.039~1.103),P<0.01]、[(106.38±14.14),P<0.01]、[86.17(79.05~97.67),P<0.05]、[72.29(66.14~81.90),P<0.05],但与典型哮喘组无明显差异(P>0.05);胸闷变异性哮喘组第1秒用力呼气容积(FEV1)下降20%时吸入的乙酰甲胆碱累积剂量(PD20-FEV1)均值为(0.855±0.691)mg,显著高于典型哮喘组[(0.321±0.213)mg,P<0.01]。结论胸闷变异性哮喘患儿FeNO水平高于健康儿童,通气功能FEV1/FVC、PEF及小气道功能指标均低于健康儿童;胸闷变异性哮喘患儿肺通气功能与非急性发作期的典型哮喘患儿接近,但其FeNO水平及气道高反应性的程度均显著低于后者。

Characteristics of pulmonary function in children with chest tightness variant asthma

Objective To investigate the characteristics of pulmonary function changes in children with chest tightness variant asthma(CTVA),providing basis for clinical diagnosis and management.Methods 44 atypical asthma children were selected as subjects in CTVA group since August 2018 to May 2019,whose sole presenting manifestation was chest tightness.Meanwhile,62 children who were newly diagnosed as non-acute attack of asthma and 46 healthy children were selected as control groups.All children in 3 groups had finished FeNO measurement and spirometry detection.Results of bronchial challenge test were positive in both CTVA and typical asthma group.The data of FeNO,spirometry and airway responsiveness of the 3 groups were analyzed.Results The median value of FeNO was 14.0(8.0,24.0)ppb in CTVA group,which was significantly lower than that of non-acute attack of typical asthma group[31.0(12.0,51.0)ppb,P<0.05],but much higher than healthy children[9.0(7.0,18.5)ppb,P<0.05].The parameters of lung function of CTVA group including FEV1/FVC[0.998(0.967-1.079)],PEF(94.41±12.91),FEF50[79.15(64.78-93.75)]and FEF75[66.50(53.10-95.90)]were significantly lower than those of healthy children[1.080(1.039-1.103),P<0.01],[(106.38±14.14),P<0.01],[86.17(79.05-97.67),P<0.05]and[72.29(66.14-81.90),P<0.05].The differences of lung function parameters were not significant statistically between CTVA and non-acute attack of asthma group(P>0.05).The accumulated provocative dose of methacholine resulted in a 20%drop in FEV1(PD20-FEV1)was(0.855±0.691)mg and(0.321±0.213)mg in CTVA and non-acute attack of typical asthma group respectively.PD20-FEV1 of CTVA group was significantly higher than that of non-acute attack of typical asthma group(P<0.01).Conclusions The FeNO value of CTVA group was higher than that of healthy children,and parameters of FEV1/FVC,PEF and small airway function of ventilation function were lower than healthy children.The parameters of pulmonary ventilation function of CTVA group were similar with those of children with typical asthma,but the FeNO value and severity of airway hyperresponsiveness were significantly lower than children with typical asthma.