第1秒用力呼气容量百分比指标有助于对哮喘患儿进行严重度分级

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第1秒用力呼气容量百分比指标有助于对哮喘患儿进行严重度分级

译者：崔小嘴

Forced expiratory volume in 1 second percentage improves the classification of severity among children with asthma.

Pediatrics 2006 Aug;118(2):e347-55                                    PMID:16864642

Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. anne.fuhlbrigge@channing.harvard.edu

文献类型：其他

关键词：高血压卒中
主要主题词：Asthma; Forced Expiratory Volume; Severity of Illness Index

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摘要
目的:目的 开展肺量测定法检查是美国国家哮喘教育和预 防计划 (National Asthma Education and Prevention Program) 指南中的一项重要内容。但是，就目前已发表的数据来看，第 1秒用力呼气容量百分比 (forced expiratory volume in 1 second percentage, FEV1%) 预测值与哮喘症状及医疗资源利用情况之间的关系尚无一致的结论。本研究选择特定的哮喘儿童，旨在探寻这些儿童的FEV1％值与其未来哮喘 急性发作危险度之间的相关性。

OBJECTIVE:Spirometry is an important component of the National Asthma Education and Prevention Program guidelines for asthma, yet published data show variable associations between forced expiratory volume in 1 second percentage (FEV1%) predicted, symptoms and health care utilization. The objective of this analysis was to examine the association between FEV1% and future risk of exacerbations among a well-characterized population of children with asthma.

方法:方法 我们利用儿童哮喘管理计划(Childhood Asthma Management Program) 中的数据，分析支气管舒张药物治疗之前的FEV1 %值与重要临床结局之间的相关性。对每例患儿均进行多次的FEV 1检测。采用总体估计方程法 (general estimating equation approach) 以控制个体重复测量数据与潜在混杂因素之间的关系。FEV 1%值属连续性变量，分为4个等级。观察结局指标包括在治疗之后 4mo的随访期内患儿的平均症状评分(0～3)、缓解天数以及发 生哮喘相关事件(口服激素、急诊和住院)的情况。本次研究仅对安慰剂组 (n=417)的资料进行了分析。

METHODS:Using data that are available from the Childhood Asthma Management Program, we examined the relationship between prebronchodilator FEV1% and important clinical outcomes. Multiple observations of FEV1 were available for each patient; multivariate regression analysis, using a general estimating equation approach, was used to control for the correlation between repeated measurements among individuals and potential confounders. FEV1% was categorized into 4 levels and as a continuous variable. Outcomes of interest included mean symptom score (0-3), episode-free days, and asthma-related events (oral steroid use, emergency department visits, and hospitalizations) during the ensuing 4-month period. Our analysis was limited to the placebo group (N = 417).

结果:结果 结果发现，使用支气管舒张药物之前的FEV 1%值与重要临床结局之间存在明显相关性。采用多元回归模型对协变量包括基线年龄、时间、既 往哮喘发作史以及夜间发作情况等进行了统计学分析，结果发现 FEV1%值与哮喘症状及严重的急性发作 (口服激素、急诊和住院) 之间存在显著相关。在4mo的随访期内，FEV1%值为80%～99%、 60%～79%及＜60%的患儿出现严重哮喘发作的概率分别是FEV 1%值为100%者的1.3、1.8和4.8倍。
结论轻、中度哮喘患儿的FEV1%预测值与其未来的哮喘症状及医疗资源利用情况之间具有独立相关 性。既往与哮喘相关的住院史及夜间症状与未来发生不良事件的危险性之间也存在独立相关性。 FEV1是评估哮喘患儿健康状态及进行哮喘严重度分级的重 要指标。

RESULTS:We observed a clear relationship between prebronchodilator FEV1% and important clinical outcomes. In multivariable models that simultaneously controlled for covariates of interest, age at baseline, time, previous event history, and nocturnal awakenings, a significant relationship between FEV1% and asthma symptoms and serious asthma exacerbations (oral steroids, emergency department visits, and hospitalizations) was observed. Compared with children with an FEV1% > or = 100%, children with FEV1% 80% to 99%, 60% to 79%, and < 60% were 1.3, 1.8, and 4.8, respectively, more likely to have a serious asthma exacerbation during the ensuing 4 months. CONCLUSIONS. In children with mild to moderate asthma, FEV1% predicted is independently associated with future asthma symptoms and health care utilization. Previous asthma-related hospitalizations and nocturnal symptoms also were independently associated with risk for future adverse events. FEV1 is an important component of asthma health status and asthma severity classification.