小气道指标下降率在儿童运动激发试验中的应用

Application of small airway parameters decline rates in children's exercise challenge test

目的探讨小气道指标下降率对儿童运动激发试验结果的预测价值。方法回顾性分析在我院就诊的哮喘及疑诊哮喘患儿共60例,分析患儿小气道指标下降率与FEV_(1)下降率的相关性,使用受试者工作特征(ROC)曲线评估小气道指标下降率与运动激发试验结果的关系。结果运动激发试验阳性组小气道指标FEF_(50)、FEF_(75)、MMEF下降率均明显高于阴性组,差异有显著统计学意义(P均<0.001)。FEF_(50)、FEF_(75)、MMEF下降率与FEV_(1)下降率呈正相关(r=0.640、0.657、0.740,P均<0.001)。FEF_(50)、FEF_(75)、MMEF下降率评判运动激发试验阳性的曲线下面积分别为0.926、0.955、0.985(P均<0.001),最佳截断值分别为21.00%(灵敏度和特异度分别为0.818和0.878),29.50%(灵敏度和特异度分别为0.818和1.000),17.50%(灵敏度和特异度分别为0.909和0.980)。结论运动激发试验阳性患儿小气道指标下降率显著升高,小气道指标下降率与FEV_(1)下降率呈正相关,并对预测运动激发试验结果具有一定参考意义。

Objective To evaluate the predictive value of small airway parameter decline rates on the result of the exercise challenge test(ECT)in children.Methods A retrospective analysis was conducted on 60 cases of asthma and suspected asthma children treated in our hospital.The relationship between small airway parameters decline rates and FEV_(1) decline rate was analyzed,and the receiver operating characteristic(ROC)curves were used to evaluate the relationship between small airway parameters decline rates and the result of ECT.Results The decline rates of small airway parameters FEF_(50),FEF_(75),and MMEF in the ECT positive group were significantly higher than those in the negative group,and the differences were statistically significant(P<0.001 for all).The decline rates of FEF_(50),FEF_(75),and MMEF were positively correlated with the decline rate of FEV_(1)(r=0.640,0.657,0.740,respectively,P<0.001 for all).The areas under the curves of FEF_(50),FEF_(75) and MMEF decline rates for a positive ECT were 0.926,0.955,and 0.985,respectively(P<0.001 for all),optimal cut-off values were 21.00%(with sensitivity 0.818,specificity 0.878),29.50%(with sensitivity 0.818,specificity 1.000),and 17.50%(with sensitivity 0.909,specificity 0.980).Conclusion The decline rates of small airway parameters in children with positive ECT are significantly increased.Small airway parameters decline rates are positively correlated with the decline rate of FEV_(1) and have a good predictive value for ECT results.