潮气呼吸肺功能支气管舒张试验在5岁以内儿童喘息性疾病诊断中的作用

Bronchodilation test of tidal breathing lung function test in children under 5 years old with wheezing diseases

目的探讨潮气呼吸肺功能检测在5岁以内儿童喘息性疾病中的临床意义。方法选取2015年1月至2016年11月西安交通大学第一附属医院儿科门诊及住院部5岁以内(包括5岁)喘息患儿159例作为观察组,根据所患疾病将观察组分为肺炎组(支气管肺炎94例)、喘支组(喘息性支气管炎12例)、哮喘组(哮喘53例),另选取健康体检儿童64例作为对照组,进行潮气呼吸肺功能检测,观察喘息性疾病患儿支气管舒张试验前后肺功能指标及改善率的变化。结果观察组患儿潮气呼吸流量-容积曲线环形态以阻塞性改变为主(83.02%)。用药前,各组之间每公斤潮气量(Vt)、呼吸频率(RR)、吸气时间(Ti)、呼气时间(Te)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)差异具有统计学意义(F值分别为13.21、4.91、3.08、2.74、36.50、40.00,均P<0.05)。肺炎组吸入支气管舒张剂后的TPTEF/TE、VPTEF/VE与用药前比较差异有统计学意义(t值分别为2.86、3.14,均P<0.05)。哮喘组用药前后TPTEF/TE、VPTEF/VE差异无统计学意义(t值分别为1.36、1.18,均P>0.05)。各观察组用药前后,TPTEF/TE、VPTEF/VE改善率比较差异无统计学意义(χ~2值分别为0.02、0.91,均P>0.05)。以TPTEF/TE、VPTEF/VE任意一个改善率≥15%作为支气管舒张试验的阳性标准,灵敏度为20.75%,特异度为73.58%。结论 5岁以内喘息患儿肺功能损害以阻塞性通气障碍为主;潮气呼吸支气管舒张试验可在一定程度上反映哮喘气道可逆性特征,在5岁以内儿童中以潮气呼吸支气管舒张试验诊断哮喘的敏感性不高。

Objective To evaluate the clinical significance of tidal breathing lung function test in children under 5 years old with wheezing diseases. Methods A total of 159 children under 5 years old（including 5 years） with wheezing diseases were enrolled in observation group,and they were divided into bronchopneumonia group（94 cases）,asthmatic bronchitis group（12 cases）,and asthma group（53 cases）.Another 64 children without respiratory diseases were enrolled in control group. All the children underwent tidal breathing lung function test. Lung function and improvement rate of children with wheezing diseases were observed before and after bronchodilation test. Results The observed groups showed obstructive ventilatory disorder（83. 02%） according to tidal breathing flow volume curve（TBFV） loop.Before medication,the differences among groups were statistically significant in tidal volume per kilogram（Vt）,respiratory rate（RR）,inspiratory time（Ti）,expiratory time（Te）,ratio of time to peak tidal expiratory flow to total expiratory time（TPTEF/TE）,and ratio of volume to peak expiratory flow to total expiratory volume（VPEF/VE）（F value was 13. 21,4. 91,3. 08,2. 74,36. 50 and 40. 00,respectively,all P〈0. 05）. In bronchopneumonia group TPTEF/TE and VPTEF/VE after bronchial dilation test were significantly different from those before test（t value was 2. 86 and 3. 14,respectively,both P〈0. 05）. In asthma group differences in TPTEF/TE and VPTEF/VE before and after bronchial dilation test were not significant（t value was 1. 36 and 1. 18,respectively,both P〈0. 05）. There were no significant differences in the improvement rate of TPTEF/TE and VPTEF/VE before and after bronchodilator test among different groups（χ~2value was 0. 02 and 0. 91,respectively,both P〈0. 05）. Taking an improvement rate of higher than 15% either for TPTEF/TE or for VPTEF/VE as an indicator of positive bronchial dilation test,the bronchial dilation test had a sensitivity of 20. 75% and a specificity of 73. 58% in diagnosing asthma in children under 5 years old. Conclusion Obstructive ventilatory disorder is the main impairment of tidal breathing lung function in children under 5 years old with wheezing diseases. Tidal breathing bronchial dilation test can reflect a reversal of airway obstruction to a certain extent. But the sensitivity of bronchial dilation test for the diagnosis of asthma is not high in children under5 years old with wheezing diseases.