小气道功能障碍在儿童支气管哮喘诊断中的价值  

The Value of Small Airway Dysfunction in the Diagnosis of Bronchial Asthma in Children

作　　者：张江霞 曹晨 朱静 马萍 卢俊 李婕 马冬均 ZHANG Jiangxia;CAO Chen;ZHU Jing;MA Ping;LU Jun;LI Jie;MA Dongjun(Children′s Respiratory Diagnosis and Treatment Center,Urumqi Children′s Hospital,Urumqi Xinjiang 830000,China)

机构地区：[1]乌鲁木齐儿童医院儿童呼吸诊疗中心,新疆乌鲁木齐830000

出　　处：《中国卫生标准管理》2025年第2期38-41,共4页China Health Standard Management

摘　　要：目的分析小气道功能障碍在儿童支气管哮喘诊断中的价值,比较小气道与大气道在舒张试验前后各项数值的变化。方法本研究为观察性研究,采用非随机抽样的方法收集乌鲁木齐儿童医院2022年1月—2023年3月进行肺通气功能检查的哮喘患儿,选取有阻塞性肺通气功能障碍或小气道功能障碍的哮喘患儿127例。雾化吸入0.5%硫酸沙丁胺醇15~30 min后,再次进行肺功能检查。比较大气道指标:第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1)),小气道指标:用力呼出50%肺活量时的瞬间流量(maximal expiratory flow at 50%vital capacity,FEF_(50)),用力呼出75%肺活量时的瞬间流量(maximal expiratory flow at 75%vital capacity,FEF_(75)),呼气中期流速(maximunnidexpiratory flow,MMEF)的变化。结果舒张试验前,大气道FEV_(1)实测值为(1.85±0.58)L,小气道MMEF实测值(1.51±0.52)L、FEF_(50)实测值为(1.80±0.61)L、FEF_(75)实测值为(0.71±0.27)L;进行舒张试验后,大气道FEV_(1)实测值为(2.05±0.61)L,小气道MMEF实测值为(2.04±0.60)L、FEF_(50)实测值为(2.36±0.69)L、FEF_(75)实测值为(1.03±0.33)L,各指标的绝对值均较舒张试验前增加,差异有统计学意义(P<0.05)。以大气道(FEV_(1)改善率≥12%)来判断舒张试验阳性率,则阳性率为39.37%;以小气道(MMEF改善率≥30%)来判断舒张试验的阳性率,则阳性率为56.69%,差异有统计学意义(P<0.05)。FEF_(50)、MMEF、FEF_(75)对判断支气管舒张试验阳性有一定的有诊断价值,受试者工作特性曲线(receive operating characteristic curve,ROC)下面积分别为0.78、0.83、0.78。结论小气道指标以判断气道可逆性更为敏感(即舒张试验阳性),不仅能早期识别哮喘发作、诊断哮喘,更能反映病情的严重程度。小气道功能障碍在一定程度上参与了哮喘气道高反应性的发生、发展。Objective To analyze the diagnostic value of small airway dysfunction in children with bronchial asthma,and to compare the values of small airway and atmospheric airway before and after diastolic test.Methods This study was an observational study.A total of 127 asthmatic children with obstructive pulmonary ventilation dysfunction or small airway dysfunction were selected from Urumqi Children′s Hospital from January 2022 to March 2023 by non-random sampling method.After inhaling 0.5%salbutamol sulfate for 15 to 20 minutes,the pulmonary function test was performed again.The changes of air passage index(1 second forced vital capacity,FEV_(1)),small airway index(FEF_(50),FEF_(75))and middle expiratory flow rate(MMEF)were compared.Results Before the diastole test,The measured FEV_(1) value of the large airway before the diastolic test was(1.85±0.58)L,the measured MMEF value of the small airway was(1.51±0.52)L,the measured FEF_(50) value was(1.80±0.61)L,and the measured FEF_(75) value was(0.71±0.27)L;After the relaxation test,the measured FEV_(1) of the large airway was(2.05±0.61)L,the measured MMEF of the small airway was(2.04±0.60)L,the measured FEF_(50) was(2.36±0.69)L,and the measured FEF_(75) was(1.03±0.33)L,and the absolute values of each index were significantly increased compared with those before diastolic test,and the differences were statistically significant(P<0.05).The positive rate of diastolic test was 39.37%when the improvement rate of FEV_(1) was≥12%.Small airway(MMEF improvement rate≥30%)was used to determine the positive rate of diastolic test,and the positive rate was 56.69%,the difference was statistically significant(P<0.05).FEF_(50),MMEF and FEF_(75) had certain diagnostic value in determining positive bronchodilation test,and the area under receive operating characteristic curve(ROC)curve was 0.78,0.83 and 0.78,respectively.Conclusion Small airway index is more sensitive to determine the reversibility of the airway(i.e.positive diastolic test),which can not only identify the attack

关 键 词：哮喘 小气道 舒张试验 改善率 气道重塑 儿童 

分 类 号：R725[医药卫生—儿科]