哮喘患儿病情不同阶段气道功能变化的研究

Study on changes of airway function in children with asthma at different stages

目的 探讨哮喘患儿病情不同阶段气道功能指标变化情况及其检测价值.方法选取120例急性发作期哮喘患儿作为急性发作期组,均给予常规哮喘规范化治疗,治疗1个月后均进入慢性持续期（慢性持续期组）.急性发作期组和慢性持续期组的哮喘患儿均行肺功能检测,并与60例健康体检儿童（健康对照组）进行比较.结果 急性发作期组大气道肺功能指标用力肺活量（FVC）、最大呼气流量（PEF）、第1秒用力呼气容积（FEV1）和FEV1/FVC均明显低于健康对照组和慢性持续期组[（1.398 ± 0.518）L比（1.942 ± 0.557）和（1.851 ± 0.453）L、（2.701 ± 0.901）L/s比（4.102 ± 0.971）和（3.840 ± 1.001）L/s、（1.201 ± 0.316）L比（1.841 ± 0.499）和（1.690 ± 0.401）L、（86.337 ± 8.769）%比（96.589 ± 4.069）%和（94.317 ± 6.311）%],差异有统计学意义（P〈0.01）;慢性持续期组FEV1/FVC明显低于健康对照组,差异有统计学意义（P〈0.05）;慢性持续期组与健康对照组FVC、PEF和FEV1比较差异无统计学意义（P〉0.05）.急性发作期组小气道肺功能指标用力呼出25%肺活量时呼气流速（FEF25%）、用力呼出50%肺活量时呼气流速（FEF50%）、用力呼出75%肺活量时呼气流速（FEF75%）和最大中期呼气流速（MMEF）均明显低于健康对照组和慢性持续期组[（2.187 ± 0.866）L/s比（3.869 ± 0.891）和（3.489 ± 0.947）L/s、（1.291 ± 0.549）L/s比（2.871 ± 0.584）和（2.599 ± 0.701）L/s、（0.596 ± 0.231）L/s比（1.412 ± 0.461）和（1.191 ± 0.571）L/s、（1.087 ± 0.496） L/s比（2.507 ± 0.629）和（2.259 ± 0.584）L/s],慢性持续期组均明显低于健康对照组,差异有统计学意义（P〈0.05）.结论 哮喘儿童急性发作期均存在肺功能异常,进入慢性持续期后其肺功能出现好转,大气道功能指标基本恢复正常,小气道功能尚未完全恢复.小气道功能指标检测在哮喘儿童的诊断、病情严重程度判断及治疗中具有较高的应用价值.

Objective To investigate the changes of airway function in different stages of asthma and its detection value.Methods One hundred and twenty children with acute exacerbation of asthma were selected as acute exacerbation group. The children were treated with routine asthma for 1 month. After that, children went into chronic duration （chronic duration group）. The pulmonary function was measured in acute exacerbation group and chronic duration group,and the indexes were compared with those of 60 healthy children（healthy control group）. Results The pulmonary function indexes of large airway forced vital capacity（FVC）,peak expiratory flow（PEF）,forced expired volume in 1 second（FEV1） and FEV1/FVC in acute exacerbation group were significantly lower than those in healthy control group and chronic duration group：（1.398 ± 0.518）L vs.（1.942 ± 0.557）and（1.851 ± 0.453）L,（2.701 ± 0.901） L/s vs.（4.102 ± 0.971）and（3.840 ± 1.001）L/s,（1.201 ± 0.316）L vs.（1.841 ± 0.499）and（1.690 ± 0.401） L, （86.337 ± 8.769）% vs. （96.589 ± 4.069）% and （94.317 ± 6.311）%, and there were statistical differences （P〈0.05）. The FEV1/FVC in chronic duration group was significantly lower than that in healthy control group,and there was statistical difference（P〈0.05）.There were no statistical differences in FVC, PEF and FEV1between chronic duration group and healthy control group （P〉0.05）. The pulmonary function indexes of small air channel forced expired flow at 25% of FVE （FEF25%）, forced expired flow at 50% FVE （FEF50%）, forced expired flow at 75% of FVE （FEF75%） and maximal midexpiratory flow （MMEF） in acute exacerbation group were significantly lower than those in healthy control group and chronic duration group：（2.187 ± 0.866）L/s vs.（3.869 ± 0.891）and（3.489 ± 0.947）L/s, （1.291 ± 0.549）L/s vs.（2.871 ± 0.584）and（2.599 ± 0.701）L/s,（0.596 ± 0.231）L/s vs.（1.412 ± 0.461） and（1.191 ± 0.571）L/s,（1.087 ± 0.496）L/s vs.（2.507 ± 0.629）and（2.259 ± 0.584）L/s,the indexes in chronic duration group were significantly lower than those in healthy control group, and there were statistical differences （P〈0.05）. Conclusions The lung function is abnormal in asthma children with acute exacerbation.After entering the chronic duration,the lung function appears to be improved,and the large airway function indexes return to normal. The small airway function indexes do not recover completely.Therefore,the detection of small airway function has great value in the diagnosis,severity and treatment of asthmatic children.