脉冲振荡肺功能与黏附分子在儿童哮喘中的临床意义

Values of impulse oscillometry for pulmonary function and adhesion molecules in childhood asthma

目的脉冲振荡肺功能是近年来开展的一项肺功能测定新技术，特别适用于学龄前儿童，但目前有关报道不多，且尚无统一正常值。可溶性细胞间黏附分子-1（sICAM-1）、内皮细胞黏附分子-1（sVCAM-1）是已明确的反映哮喘严重程度的指标，该文旨在探讨上述指标在儿童哮喘中的临床意义。方法应用Master Screen系列肺功能测定系统，对25例健康儿童、40例哮喘发作期儿童用脉冲振荡法（IOS）进行肺功能检测，其中23例患儿激素治疗达缓解期后再次检测；同时对部分上述儿童（发作期23例，缓解期20例，对照组16例）进行sICAM-1、sVCAM．1水平检测。结果IOS肺功能测试发作期R5，1／20，R5-1／20，X5，Fres，Zrs均高于对照组和缓解组，差异均有显著性（q=2．91-15、61，P〈0．01或P〈0．05），缓解期与对照组比较，R5，R5-1120，Fres，Zrs差异有显著性（q=3．08-9、19。P〈0．01或P〈0．05）。发作期血清sICAM-1，sVCAM-1明显高于缓解期及对照组（q=6．23-26．15，P〈0．01），而缓解期仍高于对照组（q=16．86，12．46，P〈0．01）。发作期sICAM-1，sVCAM-1与R5-1／20呈正相关（r=0．45，0．57 P〈0．05）结论IOS肺功能和sICAM-1、sVCAM-1都可以作为儿童哮喘病情严重程度和治疗效果的评价指标，两者之间有一定的相关性，IOS肺功能测定简便、无创，适合于学龄前儿童。

Objective Impulse oscillometry （IOS） is a novel technique for the evaluation of pulmonary function. Soluble intercellular adhesion molecule-1 （ sICAM-1 ） and soluble vascular cell adhesion molecule-1 （ sVCAM-1 ） are definitive indicators for the severity of asthma. This study aimed to explore the relationship of IOS pulmonary function with sICAM-1 and sVCAM-1, and their values in childhood asthma. Methods IOS via Master Screen System for pulmonary function was performed in 40 children with acute asthma and 25 healthy children. Twenty-three of 40 children with acute asthma were re-tested for IOS pulmonary function at remission, sICAM-1 and sVCAM-1 levels were measured in 23 children with acute asthma, 20 asthmatic children at remission and 16 healthy children. Results The parameters of IOS pulmonary function, RS, R20, RS-R20, X5, Fres and Zrs in children with acute asthma were significantly higher than in asthmatic children at remission and in normal controls （ q = 2.91-15.61, P 〈 0.01 or 0.05 ）. There were significant differences in RS, RS-R20, Fres and Zrs between the asthmatic children at remission and normal controls （ q = 3.08- 9.19 ,P 〈 0.01 or 0.05）. sICAM-1 and sVCAM-1 levels in children with acute asthma were significantly higher than in asthmatic children at remission and in normal controls （q = 6.23-26.15 ,P 〈 0.01 ）. The asthmatic children at remission had higher levels of sICAM-1 and sVCAM-1 than the normal controls （q = 16.86,12.46, P 〈 0.01 ）. RS-R20 positively correlated with sICAM-1 and sVCAM-1 in children with acute asthma （ r =0.45,0.57, P 〈 0.05）. Condusions IOS for pulmonary function and sICAM-1 and sVCAM-1 may be used to evaluate the severity and therapeutic effects of childhood asthma. A correlation exists between IOS pulmonary function and sICAM-1 and sVCAM-1.