新型冠状病毒感染对支气管哮喘儿童肺功能的影响  

Effect of coronavirus disease 2019 on pulmonary function in children with asthma

作　　者：苗瑜 马光增 王金荣 冯绛楠 姜荷云 耿玉婷 Miao Yu;Ma Guangzeng;Wang Jinrong;Feng Jiangnan;Jiang Heyun;Geng Yuting(Department of Pediatric Respiratory,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Second Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250004,China)

机构地区：[1]山东第一医科大学附属省立医院小儿呼吸综合科,济南250021 [2]山东中医药大学第二临床医学院,济南250004

出　　处：《国际呼吸杂志》2024年第8期929-936,共8页International Journal of Respiration

基　　金：山东省自然科学基金(ZR2022MH254)。

摘　　要：目的:探讨新型冠状病毒感染(COVID-19)对支气管哮喘(哮喘)儿童肺功能的影响。方法:本研究为观察性研究,采用非随机抽样的方法选取2023年1月1日至2月28日于山东第一医科大学附属省立医院就诊,且处于COVID-19确诊后3~8周的138例哮喘患儿为研究对象。根据患儿的哮喘控制水平分为哮喘控制良好组(84例)与哮喘控制不佳组(54例)。比较2组哮喘患儿的一般资料(包括性别、年龄、身体质量指数、确诊哮喘时长、吸入过敏原阳性比例、合并其他过敏性疾病比例、过敏性疾病家族史和新型冠状病毒疫苗接种史)。分析哮喘患儿COVID-19的临床特征(包括临床分型、临床表现、治疗和影像学表现)。比较2组哮喘患儿COVID-19确诊前3个月内和就诊当日的肺功能检查结果[常规肺功能检查指标包括用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、一秒率(FEV_(1)/FVC)、呼气流量峰值、用力呼出25%肺活量的呼气流量、用力呼出50%肺活量的呼气流量(FEF_(50))、用力呼出75%肺活量的呼气流量(FEF_(75))和最大呼气中期流量(MMEF);脉冲振荡技术测定肺功能指标包括共振频率(f res)、5 Hz下的电抗(X 5)、5 Hz下的阻力(R_(5))、20 Hz下的阻力(R_(20))、5 Hz与20 Hz下的阻力差值(R_(5)-R_(20))和电抗面积(AX)]。采用多因素logistic回归分析哮喘患儿COVID-19确诊后肺功能恶化的危险因素。结果:哮喘控制良好组男60例,女24例,中位年龄7岁;哮喘控制不佳组男39例,女15例,中位年龄8岁。2组患儿一般资料比较差异均无统计学意义(均P>0.05)。133例(96.38%)为轻型COVID-19,5例(3.62%)为中型COVID-19;临床表现有发热[132例(95.65%)]、咳嗽[106例(76.81%)]、喘息[18例(13.04%)]、腹泻[14例(10.14%)]等。所有患儿治疗均以解热镇痛药和中成药对症支持治疗为主。中型COVID-19患儿影像学表现主要为肺部大小不等的斑片状磨玻璃影。哮喘控制不佳组患儿的咳嗽�Objective To investigate the effect of coronavirus disease 2019(COVID-19)on pulmonary function in children with bronchial asthma(asthma).Methods This was an observational study involving 138 children with asthma and 3-8 weeks post-COVID-19 period,who visited the Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 1 and February 28,2023 by a non-random sampling method.Participants were assigned into two groups based on asthma control status:well-controlled asthma group(84 cases)and poorly-controlled asthma group(54 cases).Demographic data,including sex,age,body mass index,duration since asthma diagnosis,positive inhalant allergen ratio,comorbid allergic diseases,family history of allergy,and history of COVID-19 vaccination were compared between the two groups.Clinical characteristics of COVID-19 in children with asthma,including clinical classification,symptoms,treatment,and radiological findings were analyzed.Pulmonary function test results three months prior to COVID-19 diagnosis and on admission were compared between the two groups,including the pulmonary function test of forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC,peak expiratory flow,forced expiratory flow at 25%of FVC exhaled,forced expiratory flow at 50%of FVC exhaled(FEF_(50)),forced expiratory flow at 75%of FVC exhaled(FEF_(75)),and maximal mid-expiratory flow(MMEF),as well as impulse oscillometry system measurements of resonant frequency(f res),reactance at 5 Hz(X 5),resistance at 5 Hz(R_(5)),resistance at 20 Hz(R_(20)),difference between R_(5) and R_(20)(R_(5)-R_(20)),and reactance area(AX).Multivariate logistic regression analysis was performed to identify risk factors for post-COVID-19 pulmonary function deterioration in children with asthma.Results The well-controlled asthma group comprised 60 males and 24 females,with a median age of 7 years;and the poorly-controlled asthma group included 39 males and 15 females,with a median age of 8 years.There were no significant

关 键 词：新型冠状病毒感染 哮喘 儿童 呼吸功能试验 

分 类 号：R725.1[医药卫生—儿科] R725.6[医药卫生—临床医学]