气道反应性检测在儿童及青少年哮喘管理中的临床应用  

Clinical application of airway responsiveness assessment in the management of asthma in childrenand adolescents

作　　者：司宝婧 刘长山[1] Si Baojing;Liu Changshan(Department of Pediatrics,the Second Hispital of Tianjin Medical University,Tianjin 30021l,China;Department of Pediatrics,Tianjin Jinnan Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学第二医院儿科,300211 [2]天津市津南医院儿科,300350

出　　处：《国际儿科学杂志》2024年第5期341-345,共5页International Journal of Pediatrics

摘　　要：目的探讨在儿童及青少年哮喘的规范化药物治疗管理中,应用乙酰甲胆碱激发试验(methacholine challenge testing,MCT)检测气道反应性的作用。方法选取2020年8月至2021年5月于天津医科大学第二医院儿科哮喘门诊确诊为中-重度持续性哮喘并接受规范化药物治疗2年的患儿共64例,分为停药组(31例)和未停药组(33例),分析两组治疗前后的肺功能指标、呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)值及治疗满2年MCT结果对评估及预测儿童及青少年哮喘治疗效果的临床价值。结果治疗前停药组第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))占预计值百分比高于未停药组,差异有统计学意义(F=7.283,P=0.009)。经规范化药物治疗6个月、1年、2年FEV_(1)占预计值百分比停药组(F=3.045,P=0.036)及未停药组(F=17.485,P<0.001)均较治疗前升高,差异均有统计学意义。治疗前两组FeNO差异无统计学意义(F=0.298,P=0.587),治疗6个月、1年、2年未停药组FeNO均明显高于停药组,差异有统计学意义(F=6.568、4.317、8.737,均P<0.05)。治疗2年停药组PD_(20)值为(1.702±0.906)mg,未停药组PD_(20)值为(1.184±0.924)mg,两组结果差异有统计学意义(t=2.263,P=0.027)。结论哮喘患儿的气道高反应性持续存在,哮喘达临床症状控制及炎症改善的时间早于气道反应性达到理想水平的时间。在哮喘长期治疗管理中,气道反应性评估具有重要的临床价值。Objective To explore the role of using methacholine challenge test(MCT)to detect airway responsiveness in standardized drug treatment management of asthma in children and adolescents.Methods A total of 64 children diagnosed with moderate to severe persistent asthma from August 2010 to May 2021 at the Pediatric Asthma Clinic of the Second Hospital of Tianjin Medical University,who received standardized pharmacotherapy for 2 years,were selected and divided into a discontinued group(31 cases)and a continued group(33 cases).The clinical value of lung function indicators,fractional exhaled nitric oxide(FeNO)values,and MCT results for evaluating and predicting the treatment effect of asthma in children and adolescents before and after treatment were analyzed.Results The percentage of the expected value of forced expiratory volume in one second(FEV_(1))before treatment discontinued group was higher than that in the continued group,and the difference was statistically significant(F-7.283,P=0.009).After standardized treatment for 6 months,1 year,and 2 years,the percentage of the expected value of FEV_(1)in the discontinued group(F=3.045,P=0.036)and continued group(F=17.485,P<0.001)was significantly higher than that before treatment.There was no statistically significant difference in FeNO between the two groups before treatment(F=0.298,P=0.587).By treated for 6 months(F=6.568,P=0.013),1 year(F=4.317,P=0.042),and 2 years(F=8.737,P=0.004),the FeNO levels of continued group were significantly higher than those of the discontinued group,with statistical significance.After treatment for 2 years,the PD_(20) of the discontinued group was(1.702±0.906)mg,while the PD_(20) of the continued group was(1.184±0.924)mg.The result was a significant difference between the two groups(t=2.263,P=0.027).Conclusion Airway hyperresponsiveness of asthma patients persists,and the time for asthma to achieve clinical symptom control and inflammation improvement is earlier than that when airway responsiveness reaches the ideal level.In the long-te

关 键 词：儿童 哮喘 气道高反应性 支气管激发试验 哮喘管理 

分 类 号：R725.6[医药卫生—儿科]