简易运动激发试验联合小气道功能检查在咳嗽变异性哮喘早期诊断的应用价值

Application value of simple exercise provocation test combined with small airway function test in early diagnosis of cough variant asthma

目的探讨简易运动激发试验(6 min跑步试验)联合小气道功能检查对儿童咳嗽变异性哮喘(cough variant asthma,CVA)早期诊断的应用价值.方法选取2017年9月至2018年9月在徐州医科大学附属医院儿科门诊就诊的慢性咳嗽患儿94例,分别进行常规肺通气功能检查、简易运动激发试验及问卷调查,对比分析简易运动激发试验阳性及阴性患儿肺功能、临床表现及过敏原的差异.结果本组94例慢性咳嗽患儿常规肺功能检测第一秒用力呼气容积(forcedexpiratory volumein one second,FEV1)均≥70%,顺利完成运动激发试验.其中简易运动激发试验阳性32例(34.04%).阳性者中,经进一步检查及临床治疗反应并随访后确诊CVA30例(93.75%). CVA组患儿运动后FEV1(81.52±14.22)%、用力肺活量(forced vitalcapacity,FVC)(89.00±14.31)%、呼气峰值流量(peak expiratoryflow,PEF)(65.05±15.10)%、1 秒率(FEV1/FVC)(92.18±13.59)%、用力呼出50%肺活量时的瞬间流量(forcedexpiratory flowat 50%vital capacity,FEF50)(57.57±22.49)%、用力呼出75%肺活量时的瞬间流量(forced expiratory flowat75%vital capacity,FEF75)(41.15±18.28)%、最大呼气中期流量(maximal mid expiratory flow,MMEF75/25)(53.14±22.53)%均明显低于运动前[(94.07±9.69)%、(92.30±13.60)%、(80.73±17.85)%、(101.07±13.79)%、(66.71±19.29)%、(51.32±18.38)%、(63.75±19.43)%],(t值分别为8.592 、2.617 、10.246 、5.428、3.590 、3.646 、3.687 ,P均<0.05).在常规肺通气功能检查中,阳性组患儿FEF50(66.71±19.29)%和FEF75(51.32±18.38)%明显低于阴性组[(79.75±21.94)%、(69.08±29.28)%],(t值分别为-2.841 、-3.123 ,P均<0.01).阳性组夜间咳嗽、晨咳、重度干咳的比例显著高于阴性组,而白天咳嗽、湿咳的比例显著低于阴性组(P<0.01).阳性组患儿中,湿疹病史的比例明显高于阴性组(P<0.01).结论 CVA患者存在气道高反应性,并出现小气道功能下降,联合运用简易运动激发试验及小气道功能检查,对CVA的早期诊断具有重要的临床价值.

Objective To explore the value of simple exercise provocation test (6-minute running test)combined with small airway function test in early diagnosis of cough variant asthma (CVA)in children. Methods Ninety-four children with chronic cough from September 2017 to September 2018 in the pediatric clinic of the Affiliated Hospital of Xuzhou Medical University were selected for routine pulmonary ventilation function examination, simple exercise stimulation test and questionnaire survey.The differences of pulmonary function, clinical manifestations and allergens between positive and negative children with simple exercise stimulation test were compared and analyzed. Results The forced expiratory volume in one second (FEV1)of 94 children with chronic cough were all more than 70% by routine pulmonary function test, and the exercise provocation test was successfully completed.Among them, 32 (34.04%)were positive in simple exercise provocation test.Among the positive patients, 30 cases (93.75%)were diagnosed as CVA after further examination, clinical treatment and follow-up.In CVA group, FEV1 (81.52±14.22)%, forced vital capacity (FVC)(89.00±14.31)%, peak expiratory flow (PEF)(65.05±15.10)%, one-second rate (FEV1/FVC)(92.18±13.59)%, and instantaneous flow at 50% forced expiratory flow were observed after exercise.The vital capacity (FEF50)(57.57±22.49)%, forced expiratory flow at 75% vital capacity (FEF75)(41.15±18.28)%, maximum expiratory flow (MMEF75/25)(53.14±22.53)% were significantly lower than those before exercise ((94.07±9.69)%,(92.30±13.60)%,(80.73±17.85)%,(101.07±13.79)%,(66.71±19.29)%,(51.32±18.38)%,(63.75±19.43)%),(t values were 8.592 , 2.617 , 10.246 , 5.428, 3.590 , 3.646 , 3.687 , respectively, all P<0.05))In routine examination of pulmonary ventilation function, FEF50 (66.71±19.29)% and FEF75 (51.32±18.38)% in the positive group were significantly lower than those in the negative group ((79.75±21.94)%、(69.08±29.28)%),(t values were -2.841,-3.123, all P<0.01). The proportion of night cough, morning cough and severe dry cough in positive group was significantly higher than that in negative group, while the proportion of day cough and wet cough was significantly lower than that in negative group (P<0.01). The proportion of eczema history in positive group was significantly higher than that in negative group (P<0.01). Conclusion Patients with CVA have high airway responsiveness and small airway dysfunction.Combination of simple motor stimulation test and small airway function test has important clinical value in the early diagnosis of CVA.