第1秒用力肺活量、用力肺活量及1秒率正常的支气管哮喘患儿支气管舒张试验结果分析  

Analysis of the bronchodilation test in asthmatic children with normal forced expiratory volume in 1 second,forced vital capacity and 1-second rate

作　　者：马俊国 陈星[1] 王珂 张晶[1] 许阳光 王金荣[1] 郭春艳[1] 刘奉琴[1] Ma Junguo;Chen Xing;Wang Ke;Zhang Jing;Xu Yangguang;Wang Jinrong;Guo Chunyan;Liu Fengqin(Department of Pediatric Respiratory,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院小儿呼吸科,济南250021 [2]烟台毓横顶医院儿内科,山东烟台264000

出　　处：《中华实用儿科临床杂志》2021年第4期275-278,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：山东省科技发展计划(2014GSF118010)。

摘　　要：目的评估肺通气功能中第1秒用力肺活量(FEV_(1))、用力肺活量(FVC)及1秒率(FEV_(1)/FVC)正常的支气管哮喘(哮喘)患儿支气管舒张试验(BDT)阳性率,提高对FEV_(1)、FVC及FEV_(1)/FVC正常的哮喘患儿完善BDT检查重要性的认识。方法选择2018年9月至2019年8月山东大学附属省立医院门诊诊断为哮喘的患儿,年龄5~14岁,可配合肺通气功能及BDT检查,收集FEV_(1)、FVC及FEV_(1)/FVC正常的患儿肺功能资料,统计BDT阳性率并分析小气道功能状况。结果共纳入FEV_(1)、FVC及FEV_(1)/FVC正常的患儿1 631例,其中肺通气功能正常1 414例,小气道功能障碍217例。吸入支气管扩张剂15 min后,BDT阳性哮喘患儿共127例,阳性率为7.8%;男87例,女40例,其中合并小气道功能障碍患儿BDT阳性62例,BDT阳性率为28.6%。FEV_(1)改善率在8.0%~11.9%有132例(8.1%)。用药前FEV_(1)占预计值的百分比为(98.5±10.3)%;吸入硫酸特布他林15 min后,改善率为13.5%(12.5%,16.2%)。用力呼出50%肺活量的瞬间呼气流量(FEF50)、用力呼出75%肺活量的瞬间呼气流量(FEF_(75))、最大呼气中期流量(MMEF)改善率与其基础值呈负相关[FEF50(r=-0.339,P<0.01)、FEF_(75)(r=-0.400,P<0.01)、MMEF(r=-0.375,P<0.01)];FEV_(1)改善率与FEV_(1)基础值无显著相关(r=-0.128,P=0.153),FEV_(1)改善率与MMEF基础值呈负相关(r=-0.231,P<0.01)。结论有部分哮喘患儿在FEV_(1)、FVC及FEV_(1)/FVC正常范围时BDT阳性。建议对症状典型或不典型哮喘患儿在诊断及随访时尽可能完善BDT检查,以明确诊断以及获取当前个人最佳值,同时结合小气道功能有助于全面评估哮喘病情及控制情况。Objective To evaluate the positive rate of the bronchodilation test(BDT)in asthmatic children with normal forced expiratory volume in 1 second(FEV_(1)),forced vital capacity(FVC)and FEV_(1)/FVC,so as to improve the recognition of the importance of the BDT test in asthmatic children with normal FEV_(1),FVC and FEV_(1)/FVC.Methods Children aged 5-14 who were diagnosed with asthma in the outpatient clinic of Shandong Provincial Hospital Affiliated to Shandong University from September 2018 to August 2019 and willing to receive pulmonary function and BDT examinations were enrolled.Data of pulmonary function of children with normal FEV_(1),FVC and FEV_(1)/FVC were collected to analyze the rate of positive BDT results and the status of small airway function.Results A total of 1631 asthmatic children with normal FEV_(1),FVC and FEV_(1)/FVC were enrolled in this study,including 1414 children with normal pulmonary function and 217 children with small airway dysfunction.Fifteen minutes after the bronchodilator was inhaled,127 children(87 males and 40 females)showed positive BDT results,accounting for 7.8%.Among these children,62 cases(28.6%)with co-existing small airway dysfunction showed positive BDT results.The improvement rate of FEV_(1)was 8.0%to 11.9%in 132 cases(8.1%).The FEV_(1)before bronchodilator inhalation accounted for(98.5±10.3)%of the predicted value.Fifteen minutes after terbutaline sulfate inhalation,the improvement rate was 13.5%(12.5%,16.2%).The improvement rates of forced expiratory flow at 50%of FVC exhaled(FEF50,r=-0.339,P<0.01),forced expiratory flow at 75%of forced vital capacity exhaled(FEF_(75),r=-0.400,P<0.01),maximum mid-expiratory flow(MMEF,r=-0.375,P<0.01)were negatively correlated with their baseline values.The improvement rate of FEV_(1)was not associated with its baseline value(r=-0.128,P=0.153),but negatively correlated with the baseline value of MMEF(r=-0.231,P<0.01).Conclusions BDT results are positive in some asthmatic children with normal FEV_(1),FVC and FEV_(1)/FVC.It is recommended t

关 键 词：支气管哮喘 儿童 肺功能 支气管舒张试验 个人最佳值 小气道功能 

分 类 号：R725.6[医药卫生—儿科]