气道反应性测定在婴幼儿咳嗽变异性哮喘诊断中的价值  

Value of airway responsiveness measurement in the diagnosis of infant cough variant asthma

作　　者：刘莎[1] 刘芳君[1] 符州[1] 龚财惠[1] 刘铮[1] Liu Sha;Liu Fangjun;Fu Zhou;Gong Caihui;Liu Zheng(Department of Respiratory Medicine,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorder,Chongqing Key Laboratory of Pediatric,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸中心,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,400014

出　　处：《中华实用儿科临床杂志》2020年第21期1624-1628,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨潮气肺功能检测结合支气管激发试验(BPT)测定婴幼儿咳嗽变异性哮喘(CVA)患者的气道反应性在CVA婴幼儿诊断中的应用价值,为CVA婴幼儿临床诊断提供依据。方法回顾性分析2018年1月至2018年9月在重庆医科大学附属儿童医院哮喘专科门诊就诊的131例慢性咳嗽患儿的潮气肺功能检测及BPT检测结果,其中CVA组70例,非CVA组61例,对2组结果进行比较。结果CVA组与非CVA组患儿基础潮气肺功能检测结果比较,差异无统计学意义(P>0.05)。CVA组BPT阳性率(98.6%),明显高于非CVA组(27.9%),差异有统计学意义(χ^2=30.757,P<0.01)。BPT阳性患儿中,CVA组表现为中度及重度阳性反应的患儿比例(40.0%、15.7%)均明显高于非CVA组(3.3%、0),差异均有统计学意义(χ^2=24.894、20.464,均P<0.01)。BPT过程中,CVA组患儿出现喘息及血氧饱和度(SpO2)明显下降的比例(50.0%、91.4%)均高于非CVA组(0、45.9%),差异均有统计学意义(χ^2=32.169、36.544,均P<0.01);而CVA组出现气促和剧烈咳嗽的比例与非CVA组接近,差异均无统计学意义(均P>0.05)。给予支气管扩张剂或氧气吸入以后,所有患儿气促、喘息等症状均消失,SpO2数值均恢复至95%以上,达峰时间比、达峰容积比均恢复到基础值80%以上。结论潮气呼吸肺功能检测结合BPT对于CVA婴幼儿的诊断和鉴别诊断有一定意义;BPT定性结果结合反应程度和试验过程中患儿的临床表现可更好地协助CVA的诊断。Objective To explore the value of airway responsiveness measurement by the tidal lung function test combined with the bronchial provocation test(BPT)in the diagnosis of infant cough variant asthma(CVA),and to provide evidence for clinical diagnosis of CVA.Methods The tidal lung function test and BPT test results of 131 cases of chronic cough(including 70 CVA cases and 61 non-CVA cases)treated in the Asthma Specialist Clinic of Children's Hospital Affiliated to Chongqing Medical University from January 2018 to September 2018 were retrospectively analyzed.The results between CVA group and non-CVA group were compared.Results There was no significant difference in the basal tidal lung function detection results between the CVA group and non-CVA group(P>0.05).The positive rate of BPT in the CVA group was significantly higher than that in the non-CVA group(98.6%vs.27.9%,χ^2=30.757,P<0.01).Among the patients with positive BPT,the proportion of patients with moderate and severe positive reactions in the CVA group was significantly higher than that in the non-CVA group(40.0%vs.3.3%,15.7%vs.0,χ^2=24.894,20.464,all P<0.01).During BPT test process,a significantly greater number of patients showed wheezing and a significant decrease in oxygen saturation(SpO2)in the CVA group than in the non-CVA group(50.0%vs.0,91.4%vs.45.9%,χ^2=32.169,36.544,all P<0.01),while the number of patients with severe cough and shortness of breath was similar in both groups(all P>0.05).After the application of bronchodilator or oxygen inhalation,the symptoms of polypnea and wheezing disappeared in all children.The values of the ratio of the time to reach peak tidal expiratory flow to total expiratory time[(TPTEF/TE)%]and the ratio of the volume required to reach peak tidal expiratory flow to total expiratory volume[(VPTEF/VE)%]recovered to more than 80%of the basic values and SpO2 up to 95%.Conclusions The tidal lung function test combined with the BPT test is of certain significance for the diagnosis and differential diagnosis of CVA infants.CVA

关 键 词：潮气肺功能 支气管激发试验 婴幼儿 咳嗽变异性哮喘 气道反应性 

分 类 号：R725.6[医药卫生—儿科]