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目的探讨哮喘预测指数在婴幼儿喘息转归评估中的临床意义。方法选择2007年4月至2008年4月温州医学院附属育英儿童医院哮喘专科门诊就诊的婴幼儿喘息患儿129例,分为哮喘预测指数阳性组43例、哮喘预测指数阴性组86例,选择健康体检儿童69例为对照组,喘息缓解期测定潮气呼吸肺功能。比较各组每分通气量(MV),潮气量(VT/kg),呼吸频率(RR),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间比(TPEF/TE),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%、50%、75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%)。67例随访到4岁,其中哮喘预测指数阳性组26例,哮喘预测指数阴性组23例和对照组18例,测定脉冲震荡肺功能。比较各组呼吸总阻抗(Z5)、肺弹性阻力(X5)、共振频率(Fres)、总气道阻力(R5)及中心气道阻力(R20)。结果哮喘预测指数阳性组TPEF/TE、VPEF/VE、TI/TE、TEF25%、TEF50%、TEF75%均比哮喘预测指数阴性组和对照组下降,TE升高(P<0.01);哮喘预测指数阴性组TPEF/TE、VPEF/VE比对照组下降(P<0.05)。随访患儿中,哮喘预测指数阳性组X5比哮喘预测指数阴性组和对照组下降,Fres升高(P<0.01);哮喘预测指数阳性组Z5比哮喘预测指数阴性组升高(P<0.05)。结论婴幼儿喘息患儿早期出现肺功能损害,哮喘预测指数阳性患儿损害持续存在,日后可发展为哮喘,应早期干预治疗。

The effect of asthma predictive index in assessing prognosis of infant with recurrent wheeze.

Objective To study the effect of asthma predictive index in assessing prognosis of infant with recurrent wheeze.Method Totally 129 recurrent wheeze children were enrolled in the study in random,of whom43 infants were assigned asthma predictive index positive(A group),86 to asthma predictive index negative(B group),and 69 to control group(C group).They were tested tidal breathing pulmonary function in remission.Compare minute ventilation(MV),tidal volume/kg(VT/kg),respiratory rate(RR),inspiratory time(Ti),expiration time(Te),ratio Ti to Te(Ti/Te),ratio of time taken to reach peak tidal expiratory flow to total expiratory time(TPEF /TE),ratio of volume taken to reach peak tidal expiratory flow to total expiratory volume(VPEF /VE),peak expiratory flow(PTEF)and ratio of tidal expiratory flow respectively at 25%,50% and 75% remaining expiration to peak expiratory flow(TEF25%、TEF50%、TEF75%)between groups.Totally 67 children completed the 4 years of follow-up.Among these children,A group had 26,B group had 23 and C group had 18.They all used impulse oscillometry to test.Compare impedance at 5Hz(Z5),reactance at 5Hz(X5),resonant frequency(Fres),resistance at 5Hz(R5) and resistance at 20Hz(R20)between groups.Result In comparison with B group and C group,TPEF /TE,VPEF /VE,Ti/Te,TEF25%,TEF50% and TEF75% were significantly lower,TE was higher in A group,which had significant statistical difference(P<0.01);compare B group with C group,B group had much lower TPEF /TE and VPEF /VE,which had significant difference(P<0.05).In the follow-up children,in comparison with B group and C group,X5 was lower,Fres was higher in A group,which had statistical significant difference(P<0.01).Compared to B group,A group had much higher Z5,which had statistical difference(P<0.05).Conclusion Recurrent wheeze infant can result in lung function impairment at an early age.In asthma predictive index positive children,lung function impairment will continue to preschool age,which may develop into asthma later and need an early intervention.