学龄儿童支气管肺发育异常（BPD）与哮喘的临床特点异同
2017/07/12
摘要
背景：患支气管肺发育异常（以下简称BPD）的早产儿长期的呼吸系统症状特点尚未被明确。
目的：本研究的目的是为了描述支气管肺发育异常的儿童与特应性哮喘儿童相比所具有的标志性特点。
方法：本研究是基于医院背景的横断面描述性对比研究。研究对象是30名确诊BPD的学龄儿童（平均年龄10.4岁，平均出生于孕26.6周）及30名年龄、性别匹配的对空气过敏原敏感的哮喘患儿（过敏原IgE >0.35kU A /L）。测量内容包括： FeNO（ ppb）, 动态及静息肺功能,支气管舒张实验（分别采用乙酰甲胆碱PD20及甘露醇PD15） 以及使用C-ACT进行呼吸道症状评估。
结果：BPD组的肺通气功能及弥散功能均较哮喘组低（FEV1/预计值：BPD组 77% 哮喘组84%； FEV1/FVC：BPD组85% 哮喘组91%； DLCO/预计值：BPD组81% 哮喘组88%；P <0.042）。BPD组FeNO值明显低于哮喘组(BPD组12 哮喘组23,P =0.019)。两组乙酰甲胆碱激发试验阳性率相当(BPD组74% 哮喘组93%,P = 0.14)。BPD组对甘露醇的反应性(BPD组19% 哮喘组 61%, P = 0.007)及呼吸道症状(C-ACT, BPD组中位评分26 哮喘组 24, P =0.003)较哮喘组低。
结论：BPD患者学龄期突出的呼吸道表现是肺通气功能减低、对非直接激动剂甘露醇反应性有限但对直接激动剂乙酰甲胆碱具有高反应性，同时存在弥散量减低。与特应性哮喘患者相比，BPD患者存在气道炎症的证据不足。
Differences and similarities between bronchopulmonary dysplasia and asthma in school children
Björn Nordlund PhD,Anna James PhD,Christina Ebersjö MSc ,Gunilla Hedlin MD, PhD,Eva B. Broström MD, PhD
Abstract
BACKGROUND:The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia(BPD)are not established.
OBJECTIVE:The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma.
METHODS:This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty school children diagnosed with BPD (10.4 years/born at 26.6 weeks’gestation) and 30 age-and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35kU A /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT).
RESULTS:Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values<0.042). FENO values were also significantly lower in children with BPD(12vs23,P =0.019).The proportion of positive methacholine tests (74% vs93%,P = 0.14)was comparable between BPD and asthma.However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P =0.003) were found in the BPD group.
CONCLUSIONS:Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment indiffusion capacity.Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
背景：患支气管肺发育异常（以下简称BPD）的早产儿长期的呼吸系统症状特点尚未被明确。
目的：本研究的目的是为了描述支气管肺发育异常的儿童与特应性哮喘儿童相比所具有的标志性特点。
方法：本研究是基于医院背景的横断面描述性对比研究。研究对象是30名确诊BPD的学龄儿童（平均年龄10.4岁，平均出生于孕26.6周）及30名年龄、性别匹配的对空气过敏原敏感的哮喘患儿（过敏原IgE >0.35kU A /L）。测量内容包括： FeNO（ ppb）, 动态及静息肺功能,支气管舒张实验（分别采用乙酰甲胆碱PD20及甘露醇PD15） 以及使用C-ACT进行呼吸道症状评估。
结果：BPD组的肺通气功能及弥散功能均较哮喘组低（FEV1/预计值：BPD组 77% 哮喘组84%； FEV1/FVC：BPD组85% 哮喘组91%； DLCO/预计值：BPD组81% 哮喘组88%；P <0.042）。BPD组FeNO值明显低于哮喘组(BPD组12 哮喘组23,P =0.019)。两组乙酰甲胆碱激发试验阳性率相当(BPD组74% 哮喘组93%,P = 0.14)。BPD组对甘露醇的反应性(BPD组19% 哮喘组 61%, P = 0.007)及呼吸道症状(C-ACT, BPD组中位评分26 哮喘组 24, P =0.003)较哮喘组低。
结论：BPD患者学龄期突出的呼吸道表现是肺通气功能减低、对非直接激动剂甘露醇反应性有限但对直接激动剂乙酰甲胆碱具有高反应性，同时存在弥散量减低。与特应性哮喘患者相比，BPD患者存在气道炎症的证据不足。
(中日友好医院医院呼吸与危重症医学科 张科文摘译 林江涛审校)
（Pediatric Pulmonology. 2017;9999:1–8.）
（Pediatric Pulmonology. 2017;9999:1–8.）
Differences and similarities between bronchopulmonary dysplasia and asthma in school children
Björn Nordlund PhD,Anna James PhD,Christina Ebersjö MSc ,Gunilla Hedlin MD, PhD,Eva B. Broström MD, PhD
Abstract
BACKGROUND:The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia(BPD)are not established.
OBJECTIVE:The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma.
METHODS:This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty school children diagnosed with BPD (10.4 years/born at 26.6 weeks’gestation) and 30 age-and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35kU A /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT).
RESULTS:Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values<0.042). FENO values were also significantly lower in children with BPD(12vs23,P =0.019).The proportion of positive methacholine tests (74% vs93%,P = 0.14)was comparable between BPD and asthma.However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P =0.003) were found in the BPD group.
CONCLUSIONS:Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment indiffusion capacity.Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
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误吸在哮喘患者气道中的潜在作用
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客观咳嗽频率，气道炎症和哮喘疾病控制
