支气管哮喘患儿支气管舒张试验中肺通气和脉冲振荡肺功能的各参数敏感性与相关性研究  

Sensitivity and correlation of parameters between spirometry and pulse oscillation in bronchodilation test of child with bronchial asthma

作　　者：杨晓旭 汤贝[1,3] 潘春红 张皓[1] YANG Xiao-xu;TANG Bei;PAN Chun-hong;ZHANG Hao(Department of Respiratory,Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Pediatrics,Beihai People’s Hospital of Guangxi Zhuang Autonomous Region,Beihai,Guangxi 536000,China;Department of Pediatrics,Changsha Central Hospital,Changsha,Hunan 410000,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心呼吸科,上海200127 [2]北海市人民医院儿科,广西北海536000 [3]长沙市中心医院儿科,湖南长沙410000

出　　处：《临床肺科杂志》2023年第4期552-557,共6页Journal of Clinical Pulmonary Medicine

基　　金：上海市医学引导类(中、西医)科技支撑项目(No.19401931800);上海交通大学医学院中西医结合学科创新基金(No.18zxy007)。

摘　　要：目的比较支气管哮喘患儿在肺通气和脉冲振荡两种方法学检测的支气管舒张试验(bronchodilation test,BDT)中各参数敏感性与相关性。方法根据纳入及排除标准,选取157例哮喘患儿完成肺通气功能、脉冲振荡检查及舒张试验。按肺通气功能检查舒张试验中第1秒用力肺活量(forced expiratory volume in one second,FEV 1)改善率数值,将所有患儿分为四组,研究此两种方法学舒张试验前、后各气道参数的敏感性与各气道参数改善率之间的相关性。结果两种肺功能检查方法的舒张试验主要参数结果:四组FEV 1改善率分别为(2.94±1.54)%、(8.59±1.52)%、(15.25±2.06)%、(31.01±11.86)%,对应的呼吸总阻抗(respiratory impedance,Zrs)改善率分别为(10.83±6.71)%、(20.11±9.01)%、(27.06±10.67)%、(30.52±13.93)%,气道总阻力(respiratory resistance at 5 Hz,R5)改善率分别为(10.37±6.91)%、(18.25±7.60)%、(26.14±10.56)%、(29.05±13.56)%,外周弹性阻力(respiratory reactance at 5 Hz,X5)改善率分别为(17.36±26.60)%、(28.12±19.67)%、(36.19±17.36)%、(41.19±19.58)%;舒张试验后FEV 1与Zrs、R5、X5的相关性r值分别为0.499、0.478、0.386,存在不同程度的正相关性。结论舒张试验中,哮喘患儿的小气道参数与X5敏感性较高;脉冲振荡Zrs、R5、X5与肺通气FEV 1的改善率数值呈正相关性,脉冲振荡舒张试验中Zrs、R5、X5改善率作为衡量与推断结果的参数特异性更高,而在小气道方面,脉冲振荡R5更倾向反映总体情况。Objective To compare the sensitivity and correlation of ventilation and pulse oscillation with pulmonary function parameters in bronchodilation test(BDT)for children with bronchial asthma.Methods According to the inclusion and exclusion criteria,157 asthmatic children were taken for the research objects.All children completed spirometry and pulse oscillation with BDT.According to the improvement rate of forced expiratory volume in one second(FEV 1)in the BDT of pulmonary ventilation function,all children were divided into four groups.In BDT,we investigated the sensitivity and specificity of airway parameters,and as well as the correlation in the improvement rates of these airway parameters.Results The main parameters of the diastolic test of the two pulmonary function tests(mean±standard deviation)were as follows:the improvement rate of FEV 1 in the four groups respectively were(2.94±1.54)%,(8.59±1.52)%,(15.25±2.06)%and(31.01±11.86)%.The improvement rate of respiratory impedance(Zrs)in the four groups respectively were(10.83±6.71)%,(20.11±9.01)%,(27.06±10.67)%and(30.52±13.93)%.The improvement rate of respiratory resistance at 5 Hz(R5)in the four groups respectively were(10.37±6.91)%,(18.25±7.60)%,(26.14±10.56)%and(29.05±13.56)%.The improvement rate of respiratory reactance at 5 Hz(X5)in the four groups respectively were(17.36±26.60)%,(28.12±19.67)%,(36.19±17.36)%and(41.19±19.58)%.There were varying degrees of positive correlation between the vast majority of the parameters of the two methods.At a confidence(bilateral)level of 0.01,the correlation value P between FEV 1,Zrs,R5 and X5 respectively was 0.499,0.478 and 0.386.Conclusion In the BDT,the sensitivity is higher in the small airway parameters and X5 of child with asthma;Pulse oscillation Zrs,R5 and X5 are positively correlated with the improvement rate of pulmonary ventilation FEV1.In BDT of pulse oscillation,the improvement rates of Zrs,R5 and X5 are the most specific parameters to measure and infer the results,while in small airway,R5 of p

关 键 词：儿童支气管哮喘 咳嗽变异性哮喘 支气管舒张试验 肺通气 脉冲振荡 

分 类 号：R725.6[医药卫生—儿科]