持续气流受限哮喘患儿的临床特征分析  

Clinical characteristics analysis of persistent airflow limitation in asthmatic children

作　　者：熊实秋 田春雨 陈韦 刘传合[1] Xiong Shiqiu;Tian Chunyu;Chen Wei;Liu Chuanhe(Department of Allergy,Children′s Hospital of the Capital Institute of Pediatrics,Beijing 100020,China;Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]首都儿科研究所附属儿童医院变态反应科,北京100020 [2]西安市儿童医院,西安710003

出　　处：《中华结核和呼吸杂志》2024年第9期807-814,共8页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：首都卫生发展科研专项(2022-1G-4241)。

摘　　要：目的探索持续气流受限(persistent air flow limitation,PAL)哮喘患儿的临床特征,加深对哮喘患儿PAL的认识,提高哮喘管理水平。方法回顾性分析2021年1月至2023年6月在首都儿科研究所附属儿童医院变态反应科就诊并确诊为哮喘的PAL和非PAL患儿(6~18岁)的临床资料。本研究总共纳入197例患儿,其中男153例,女44例,年龄9.0(7.0,12.0)岁。收集患儿的人口学特征、疾病特点、实验室检查和肺通气功能检测等资料。两组间比较,计量资料采用t检验或非参数检验Mann-Whitney法,计数资料采用卡方检验或Fisher精确检验。结果纳入100例非PAL和97例PAL患儿,两组的男女比例(女/男)分别为27/73和17/80。PAL患儿的年龄为11.0(10.0,13.0)岁,体重指数(BMI)为20.3(17.7,24.1)kg/m^(2),均显著大于非PAL患儿(P<0.001),且PAL患儿年龄分布以9~12岁为主(49.5%)。与非PAL相比,更多PAL患儿哮喘病程超过3年(89.7%比62.0%,P<0.001),伴肺炎病史(13.4%比4.0%,P=0.036)。在实验室检查上,呼出气一氧化氮(FeNO)水平升高(60.9%比37.6%,P=0.002)和动物致敏(50.7%比30.7%,P=0.022)的患儿在PAL中的占比显著高于非PAL。69例PAL患儿可追溯PAL发生前、后肺通气功能检测,FEV 1占预计值%、FEV 1/FVC、MMEF占预计值%在PAL发生前后呈现逐年缓慢下降的趋势,且在PAL发生前一年变化最为显著。结论PAL哮喘患儿年龄和BMI更大,绝大多数患儿病程较长,且FeNO水平更高,更易动物毛屑致敏。PAL发生前数年肺功能已有下降趋势,在长期的随访过程中,应注意肺功能趋势的观察,警惕PAL的发生。ObjectiveTo analyze the clinical characteristics of asthmatic children with persistent airflow limitation(PAL)in order to improve understanding of PAL and improve asthma management.MethodsThe clinic data of asthmatic children aged 6 to 18 years with and without PAL,who visited the Department of Allergy at Children′s Hospital of the Capital Institute of Pediatrics between January 2021 and June 2023,were analyzed retrospectively.The study included a total of 197 patients(153 males and 44 females),with a median age of 9.0(7.0,12.0)years.The analysis encompassed demographic features,disease-related factors,laboratory tests,and spirometry parameters.Quantitative data differences between the two groups were assessed using the Student′s t-test or the Mann-Whitney U test.Qualitative data comparisons were made using the Chi-square test or Fisher′s exact test.ResultsThis study included 100 non-PAL and 97 PAL patients.The female-to-male ratio in the two groups was 27/73 and 17/80,respectively.Age and BMI were 11.0(10.0,13.0)years and 20.3(17.7,24.1)kg/m^(2) in the PAL group,which was significantly higher than in the non-PAL group(P<0.001).Among the PAL group,49.5%fell within the 9-12 age group.The PAL group had a higher percentage of patients with an asthma duration of more than 3 years(89.7%vs.62.0%,P<0.001)and a history of pneumonia(13.4%vs.4.0%,P=0.036)compared to the non-PAL group.Regarding laboratory tests,a higher percentage of patients in the PAL group had an elevated FeNO level(60.9%vs.37.6%,P=0.002)and animal sensitization(50.7%vs.30.7%,P=0.022)compared to the non-PAL group.Of the 69 patients who underwent spirometry before and after PAL development,FEV 1%pred,FEV 1/FVC,and MMEF%pred values gradually decreased,with a significant decline in the year preceding PAL development.ConclusionsAsthmatic children with PAL had characteristics such as relatively older age,higher BMI,longer duration of asthma,eosinophilic inflammation,and atopy.Lung function decline occurred several years before PAL development.Long-term

关 键 词：哮喘 儿童 持续气流受限 临床特征 

分 类 号：R725.6[医药卫生—儿科]