新型冠状病毒感染对支气管哮喘儿童肺功能的影响

Effect of coronavirus disease 2019 on pulmonary function in children with asthma

目的:探讨新型冠状病毒感染(COVID-19)对支气管哮喘(哮喘)儿童肺功能的影响。方法:本研究为观察性研究,采用非随机抽样的方法选取2023年1月1日至2月28日于山东第一医科大学附属省立医院就诊,且处于COVID-19确诊后3~8周的138例哮喘患儿为研究对象。根据患儿的哮喘控制水平分为哮喘控制良好组(84例)与哮喘控制不佳组(54例)。比较2组哮喘患儿的一般资料(包括性别、年龄、身体质量指数、确诊哮喘时长、吸入过敏原阳性比例、合并其他过敏性疾病比例、过敏性疾病家族史和新型冠状病毒疫苗接种史)。分析哮喘患儿COVID-19的临床特征(包括临床分型、临床表现、治疗和影像学表现)。比较2组哮喘患儿COVID-19确诊前3个月内和就诊当日的肺功能检查结果[常规肺功能检查指标包括用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、一秒率(FEV_(1)/FVC)、呼气流量峰值、用力呼出25%肺活量的呼气流量、用力呼出50%肺活量的呼气流量(FEF_(50))、用力呼出75%肺活量的呼气流量(FEF_(75))和最大呼气中期流量(MMEF);脉冲振荡技术测定肺功能指标包括共振频率(f res)、5 Hz下的电抗(X 5)、5 Hz下的阻力(R_(5))、20 Hz下的阻力(R_(20))、5 Hz与20 Hz下的阻力差值(R_(5)-R_(20))和电抗面积(AX)]。采用多因素logistic回归分析哮喘患儿COVID-19确诊后肺功能恶化的危险因素。结果:哮喘控制良好组男60例,女24例,中位年龄7岁;哮喘控制不佳组男39例,女15例,中位年龄8岁。2组患儿一般资料比较差异均无统计学意义(均P>0.05)。133例(96.38%)为轻型COVID-19,5例(3.62%)为中型COVID-19;临床表现有发热[132例(95.65%)]、咳嗽[106例(76.81%)]、喘息[18例(13.04%)]、腹泻[14例(10.14%)]等。所有患儿治疗均以解热镇痛药和中成药对症支持治疗为主。中型COVID-19患儿影像学表现主要为肺部大小不等的斑片状磨玻璃影。哮喘控制不佳组患儿的咳嗽时长和喘息发生率均高于哮喘控制良好组[6(4,8)d比4(3,6)d,22.22%(12/54)比7.14%(6/84),均P<0.05]。COVID-19确诊后,哮喘控制良好组FEV_(1)/FVC占预计值百分比(%pred)、FEF_(50)%pred、FEF_(75)%pred和MMEF%pred较COVID-19确诊前均降低,哮喘控制不佳组FEV_(1)%pred、FEV_(1)/FVC%pred、FEF_(50)%pred、FEF_(75)%pred和MMEF%pred较COVID-19确诊前均降低;哮喘控制良好组X 5%pred、R_(5)-R_(20)和AX较COVID-19确诊前均升高,哮喘控制不佳组f res、R_(5)-R_(20)、AX较COVID-19确诊前均升高(均P<0.05)。哮喘控制不佳组FEV_(1)、FEV_(1)/FVC、FEF_(75)和MMEF下降率均较哮喘控制良好组高,f res和R_(5)-R_(20)上升率均较哮喘控制良好组高(均P<0.05)。哮喘控制不佳组FEV_(1)下降≥8%、MMEF下降≥25%比例均高于哮喘控制良好组[35.19%(19/54)比14.29%(12/84),51.85%(28/54)比21.43%(18/84),均P<0.05]。多因素logistic回归分析结果显示哮喘控制不佳是哮喘患儿COVID-19确诊后肺功能恶化的危险因素(OR=8.000,P=0.008)。结论:COVID-19会导致哮喘患儿肺功能水平下降,且哮喘控制不佳的患儿肺功能水平下降更明显。

Objective To investigate the effect of coronavirus disease 2019(COVID-19)on pulmonary function in children with bronchial asthma(asthma).Methods This was an observational study involving 138 children with asthma and 3-8 weeks post-COVID-19 period,who visited the Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 1 and February 28,2023 by a non-random sampling method.Participants were assigned into two groups based on asthma control status:well-controlled asthma group(84 cases)and poorly-controlled asthma group(54 cases).Demographic data,including sex,age,body mass index,duration since asthma diagnosis,positive inhalant allergen ratio,comorbid allergic diseases,family history of allergy,and history of COVID-19 vaccination were compared between the two groups.Clinical characteristics of COVID-19 in children with asthma,including clinical classification,symptoms,treatment,and radiological findings were analyzed.Pulmonary function test results three months prior to COVID-19 diagnosis and on admission were compared between the two groups,including the pulmonary function test of forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC,peak expiratory flow,forced expiratory flow at 25%of FVC exhaled,forced expiratory flow at 50%of FVC exhaled(FEF_(50)),forced expiratory flow at 75%of FVC exhaled(FEF_(75)),and maximal mid-expiratory flow(MMEF),as well as impulse oscillometry system measurements of resonant frequency(f res),reactance at 5 Hz(X 5),resistance at 5 Hz(R_(5)),resistance at 20 Hz(R_(20)),difference between R_(5) and R_(20)(R_(5)-R_(20)),and reactance area(AX).Multivariate logistic regression analysis was performed to identify risk factors for post-COVID-19 pulmonary function deterioration in children with asthma.Results The well-controlled asthma group comprised 60 males and 24 females,with a median age of 7 years;and the poorly-controlled asthma group included 39 males and 15 females,with a median age of 8 years.There were no significant differences in demographic data between the two groups(all P>0.05).133(96.38%)had mild COVID-19 and 5(3.62%)had moderate COVID-19.Symptoms included fever in 132(95.65%)cases,cough in 106(76.81%)cases,wheezing in 18(13.04%)cases,and diarrhea in 14(10.14%)cases.All patients received treatment of antipyretics,analgesics,and traditional Chinese medicine.Ground-glass opacities of varying sizes in the lungs were the dominant radiological findings in patients with moderate COVID-19.The poorly-controlled asthma group had a longer duration of cough(6[4,8]d vs 4[3,6]d)and a higher incidence of wheezing(22.22%[12/54]vs 7.14%[6/84])compared to the well-controlled asthma group(both P<0.05).After COVID-19 diagnosis,in the well-controlled asthma group,FEV_(1)/FVC as a percentage of predicted(%pred),FEF_(50)%pred,FEF_(75)%pred,and MMEF%pred decreased compared to those before COVID-19 diagnosis.In the poorly-controlled asthma group,FEV_(1)%pred,FEV_(1)/FVC%pred,FEF_(50)%pred,FEF_(75)%pred,and MMEF%pred decreased after COVID-19 diagnosis.After COVID-19 diagnosis,in the well-controlled asthma group,X 5%pred,R_(5)-R_(20) and AX increased compared to those before COVID-19 diagnosis.In the poorly-controlled asthma group,f res,R_(5)-R_(20) and AX increased after COVID-19 diagnosis(all P<0.05).The poorly-controlled asthma group had significantly higher decline rates of FEV_(1),FEV_(1)/FVC,FEF_(75),and MMEF,and higher increased rates of f res and R_(5)-R_(20) than the well-controlled asthma group(all P<0.05).Patients in the poorly-controlled asthma group had significantly higher proportions of FEV_(1) decline≥8%(35.19%[19/54]vs 14.29%[12/84])and MMEF decline≥25%(51.85%[28/54]vs 21.43%[18/84])compared to the well-controlled asthma group(both P<0.05).Multivariate logistic regression analysis revealed that poorly-controlled asthma was a risk factor for post-COVID-19 pulmonary function deterioration in children with asthma(OR=8.000,P=0.008).Conclusions COVID-19 leads to a decline in pulmonary function levels in asthmatic children,with greater declines in pulmonary function observed in those with poorly-controlled asthma.