长程治疗管理哮喘儿童的肺功能轨迹特征分析

doi:10.3969/j.issn.1006-7795.2022.06.019

摘要/Abstract

摘要： 目的分析经长程治疗管理的5~17岁支气管哮喘患儿肺通气功能的轨迹特征,探讨形成不同肺功能轨迹类型的影响因素,早期识别持续肺功能受损表型。方法本研究为回顾性队列研究。收集2018年11月1日至2020年11月30日在首都医科大学附属北京儿童医院过敏反应科门诊确诊哮喘并治疗管理3年以上的157例5~17岁患儿,采集临床信息(包括人口学特征、病史、控制治疗级别、哮喘控制水平评估和过敏原结果),溯源患儿定期复诊时应用最大呼气流量-容积曲线(maximal expiratory flow-volume curve,MEFV)方法的肺功能检查结果,纳入5项参数进行轨迹分析,包括第1秒用力呼气容积占预计值的百分比(forced expiratory volume in one second,FEV1%pred)、用力肺活量占预计值的百分比(forced vital capacity,FVC%pred)、第1秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second to forced vital capacity, FEV1/FVC)、最大呼气流量占预计值的百分比(peak expiratory flow,PEF%pred)、最大呼气中期流量占预计值的百分比(maximum mid-expiratory flow,MMEF%pred);纳入管理2年时限患儿的肺功能检查结果进行轨迹分析,并先后经单因素分析和多因素Logistics回归分析。结果 157例患儿共计471例次肺功能检查结果可用于轨迹分析。FVC%pred、FEV1%pred和FEV1/FVC均可分为2种轨迹:低轨迹和高轨迹。PEF%pred和MMEF%pred所拟合轨迹均无统计学意义(P＞0.05)。多因素Logistic回归分析显示,FVC%pred呈现低轨迹的危险因素为控制不稳定(OR=4.878;95%CI:1.714~13.882)。FEV1%pred呈现低轨迹的危险因素为首次肺功能异常(OR=4.911,95%CI:2.137~11.287)。FEV1/FVC呈现低轨迹的危险因素为首次肺功能异常(OR=18.472,95%CI:5.182~65.850)和男性(OR=3.774,95%CI:1.125~12.658)。结论在对患儿2年时点肺功能的轨迹和影响因素分析中,FVC%pred、FEV1%pred、FEV1/FVC均可分为2组:低轨迹组和高轨迹组,其中男性、首次可分析肺功能异常以及控制不稳定为其易呈现低轨迹的危险因素。

关键词: 儿童, 支气管哮喘, 管理, 肺功能, 轨迹分析

Abstract: Objective To analyze the trajectory characteristics of pulmonary function in 5 to 17 years old children with asthma after long-term treatment management in a single center and explore the factors influencing pulmonary function trajectories and to identify early persistent pulmonary function impairment phenotypes. Methods This is a retrospective cohort study. We enrolled 5 to 17 years old children with bronchial asthma who were diagnosed in the Department of Allergy, Beijing Children's Hospital from November 1,2018 to November 30,2020, and have been treated for 3 years or more. The clinical information was collected, which included demographic characteristics, medical history, steps of control treatment drugs, assessment of asthma control level and allergen results. The result of pulmonary function tests with maximum expiratory flow-volume curve (MEFV) was retrospectively analyzed. The parameters contain the percentage of the forced expiratory volume in the first second to the predicted value (FEV1%pred), forced vital capacity as a percentage of predicted value (FVC%pred), forced expiratory volume in one second to forced vital capacity (FEV1/FVC), the percentage of the maximum expiratory flow to the predicted value (PEF%pred), and the percentage of the maximum mid-expiratory flow to the predicted value (MMEF%pred). The pulmonary function data after 2-year managment were sorted out for trajectory analysis with univariate analysis and multivariate Logistics regression analysis. Results Out of 157 children, a total of 471 cases of pulmonary function data were used for trajectory analysis. FVC%pred, FEV1%pred and FEV1/FVC were divided into 2 types of trajectories: low trajectory and high trajectory. The trajectories fitted by PEF%pred and MMEF%pred were not statistically significant (P>0.05). Multivariate Logistic regression analysis showed that the risk factor for the low trajectory of FVC%pred is control instability (OR=4.878; 95%CI: 1.714-13.882). The risk factor for the low trajectory of FEV1%pred was the first abnormal lung function (OR=4.911; 95%CI: 2.137-11.287), and those for the low trajectory of FEV1/FVC was first-time abnormal lung function(OR=18.472;95%CI:5.182-65.850)and males (OR=3.774; 95%CI: 1.125-12.658). Conclusions The males, the first analyzable abnormal lung function and unstable control was risk factors that was prone to result in low trajectories.

Key words: children, bronchial asthma, management, pulmonary function, trajectory analysis

中图分类号:

R725.6

李昂, 皇惠杰, 杨世青, 侯晓玲, 向莉. 长程治疗管理哮喘儿童的肺功能轨迹特征分析[J]. 首都医科大学学报, 2022, 43(6): 940-947.

Li Ang, Huang Huijie, Yang Shiqing, Hou Xiaoling, Xiang Li. Analysis of characteristics of lung function trajectory in long-term treatment and management of children with asthma[J]. Journal of Capital Medical University, 2022, 43(6): 940-947.

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