支气管可逆性试验对哮喘儿童治疗的指导意义

目的：观察哮喘治疗期间不同临床症状患儿肺功能的变化，探讨支气管可逆性试验对儿童哮喘治疗的指导意义。方法：417例哮喘患儿通过吸入沙美特罗/氟替卡松治疗时间3个月以上。复诊时根据患儿症状分为无症状组（n=215）、单咳组（n=89）、阵咳组（n=72）和喘咳组（n=41）。34例正常儿童作为对照组。应用沙丁胺醇泵雾化进行支气管可逆性试验，试验前后行肺功能检测。结果：各个哮喘组沙丁胺醇雾化后肺功能异常率较雾化前均明显降低，FEV1%/预测值雾化后均较雾化前显著升高（P<0.05）。雾化前单咳组、阵咳组、喘咳组肺功能异常率均较对照组显著增高，FEV1%/预测值均较对照组显著降低（P<0.05）；雾化前各个不同症状哮喘组间肺功能异常率及FEV1%/预测值差异有统计学意义（P<0.05）。雾化后阵咳组、喘咳组肺功能异常率明显高于对照组（P<0.05），其他各组与对照组比较差异无统计学意义；雾化后喘咳组FEV1%/预测值明显低于对照组，其他各组与对照组比较差异无统计学意义。不同症状的4个哮喘组支气管可逆性试验阳性率均高于对照组（P<0.05）；各个哮喘组间可逆性试验阳性率比较，除无症状组与单咳组差异无统计学意义外，其余各组间差异均有统计学意义（P<0.05）。结论：儿童哮喘治疗期间不同症状者肺功能存在差异；支气管可逆性试验结合肺功能检查有利于哮喘控制的评估和治疗指导。

Clinical significance of bronchial reversibility test in the treatment of childhood asthma

Objective To observe changes in the lung function of asthmatic children with different symptoms during treatment,and to investigate the clinical significance of bronchial reversibility test in the treatment of asthma in children.Methods A total of 417 asthmatic children were treated by salmeterol/fluticasone inhalation for more than 3 months.These patients were divided into asymptomatic,single cough,paroxysmal cough and wheeze(cough+wheeze or wheeze alone) groups based on the symptoms when they revisited the clinic.Thirty-four healthy children were used as a control group.All children underwent bronchial reversibility test using nebulized salbutamol.Lung function testing was performed before and after the test.Results After nebulization of salbutamol,each asthma group showed significantly decreased rate of abnormal lung function and significantly increased forced expiratory volume in one second percent(FEV1%) predicted(P<0.05).Before salbutamol nebulization,the single cough,paroxysmal cough and wheeze groups had significantly higher rates of abnormal lung function and significantly lower FEV1% predicted than the control group(P<0.05).There were significant differences in the rate of abnormal lung function and FEV1% predicted among the asthma groups(P<0.05).After salbutamol nebulization,the paroxysmal cough and wheeze groups had significantly higher rates of abnormal lung function than the control group(P<0.05),but there were no significant differences between other asthma and control groups;the wheeze group had significantly lower FEV1% predicted than the control group,but no significant differences were found between other asthma and the control groups.The positive rate of bronchial reversibility test in each asthma group was significantly higher than in the control group(P<0.05).There were significant differences in the positive rate of the test between the asthma groups except between the asymptomatic and single cough groups(P<0.05).Conclusions Asthmatic children with different symptoms demonstrate different lung functions during treatment.Bronchial reversibility test combined with lung function test is useful in assessing asthma control and guiding treatment.