肥胖对哮喘儿童治疗效果及肺功能的影响

Impact of obesity on response to therapy and pulmonary function in children with asthma

目的探讨肥胖对哮喘患儿规范化吸入疗法疗效及肺功能的影响。方法 129例哮喘患儿分为正常体重哮喘组(n=64)和哮喘伴肥胖组(n=65),比较两组患儿接受规范化吸入治疗1年后的肺功能和哮喘控制情况,其中肺功能采用第1秒用力呼气容积占预计值的百分比(FEV1%)、用力肺活量占预计值百分比(FVC%)、呼气峰流速(PEF)、用力呼气25%流速(PEF_(25))、用力呼气50%流速(PEF_(50))表示。另选取68例健康儿童作为健康对照组。结果治疗前3组间肺功能各指标比较差异均有统计学意义(P<0.01),其中健康对照组肺功能测定值最优,哮喘伴肥胖组测定值最差。治疗1年后正常体重哮喘组FEV1%、FVC%的改善均明显优于哮喘伴肥胖组(P<0.01),但两组间PEF、PEF_(25)、PEF_(50)的改善差异无统计学意义。治疗1年后,正常体重哮喘组哮喘完全控制率、部分控制率、未控制率分别为72%、19%、9%;哮喘伴肥胖组完全控制率、部分控制率、未控制率分别为28%、51%、22%,正常体重哮喘组哮喘控制率优于哮喘伴肥胖组(P<0.01)。结论哮喘伴肥胖患儿治疗后大气道功能改善及哮喘控制状况较正常体重哮喘患儿差。

Objective To investigate the effects of obesity on response to therapy and pulmonary function in children with asthma who receive inhaled corticosteroid（ICS） treatment. Methods A total of 129 children with asthma were divided into two groups according to their body mass index： normal weight group（n=64） and obese group（n=65）. The asthma control status and pulmonary function were compared between the two groups after one year of ICS treatment. The pulmonary function was expressed as percent forced expiratory volume in 1 second（FEV1%）, percent predicted forced vital capacity（FVC%）, peak expiratory flow（PEF）, peak expiratory flow at 25% of vital capacity（PEF_（25））, and peak expiratory flow at 50% of vital capacity（PEF_（50））. The asthma control status was expressed as complete control rate, partial control rate, and uncontrolled rate. Sixty-eight healthy children were selected as the healthy control group. Results There were significant differences in the indices of pulmonary function between the three groups before treatment（P0.01）; the healthy control group had the best values of pulmonary function, while the obese group had the worst values. After 1 year of treatment, the normal weight group showed significantly more improvements in FEV1% and FVC% than the obese group（P0.01）. However, there were no significant differences in improvements in PEF, PEF_（25）, and PEF_（50） between the two groups. The complete control rate, partial control rate, and uncontrolled rate in the normal weight group were 72%, 19%, and 9%, respectively, while the rates in the obese group were 28%, 51%, and 22%, respectively; the normal weight group had a significantly better asthma control status than the obese group（P0.01）. Conclusions The asthmatic children with obesity have a significantly less improvement in large airway function and a poorer asthma control status after ICS treatment than those with the normal weight.