3～6岁哮喘患儿的运动激发试验
2008/02/05
运动激发试验（ECT）在学龄期儿童是评价运动诱发的哮喘（EIA）的常用方法。但对于再小一些的儿童是否适用目前尚没有相关的报道。因此，为了评价EIA对于这部分（即3～6岁）的儿童诊断意义，Daphna Vilozni等对此进行了研究，55名3～6岁的儿童进行了6分钟，控制，自由跑测试，然后将他们进行分组：30名已经诊断为哮喘的患儿分为A组，25名咳嗽迁延的患儿分为B组。对所有儿童进行峰流速测定（测定点为自由跑前、开始跑后1, 2, 3, 5, 10, 和 20分钟后），基线FEV1或FEV0.5下降13％定义为EIA阳性。实际跑动持续时间是与年龄相关的（平均持续时间为4.8 ± 0.8 分），最低点发生时间平均为2.98 ± 1.31 分。以FEV1判断EIA阳性的患者为15名，以FEV0.5判断阳性的为34名，其中26名来自A组，仅8名来自B组。喘息和呼气延长在这34名患者中有31人存在。咳嗽在ECT测试中无论阴性还是阳性的患儿中均存在。
因此，以自由跑的形式对幼龄儿童进行EIA的判断虽然是首次，但从这项研究的结果来看是可行的，仅跑动时间受年龄的限制。运动后气流受限的持续时间在年龄小的患儿较年龄大的患儿显著提早出现并维持时间短。FEV0.5可取代FEV1作为判断幼龄患者ECT阳性的更好指标。患儿出现喘息和/或呼气延长可在缺乏肺量计时作为诊断EIA的有效手段。
因此，以自由跑的形式对幼龄儿童进行EIA的判断虽然是首次，但从这项研究的结果来看是可行的，仅跑动时间受年龄的限制。运动后气流受限的持续时间在年龄小的患儿较年龄大的患儿显著提早出现并维持时间短。FEV0.5可取代FEV1作为判断幼龄患者ECT阳性的更好指标。患儿出现喘息和/或呼气延长可在缺乏肺量计时作为诊断EIA的有效手段。
（汤葳 上海交通大学附属瑞金医院呼吸科 200025 摘译）
（Chest. 2007; 132:497-503）
（Chest. 2007; 132:497-503）
Exercise Challenge Test in 3- to 6-Year-Old Asthmatic Children
Rationale: The exercise challenge test (ECT) is a common tool to assess exercise-induced asthma (EIA) in school-aged children. EIA has not been explored in the early childhood setting.
Objective: To assess the existence of EIA in children in this age group.
Measurements and main results:A 6-min, controlled, free-run test was performed in 55 children (age range, 3 to 6 years old) who were classified into the following groups: 30 children in whom asthma had been previously diagnosed (group A); and 25 children with prolonged coughing (group B). Spirometry measurements were obtained before the run, and at 1, 2, 3, 5, 10, and 20 min after the run. A positive finding of EIA was defined as a 13% decrease from baseline FEV1 or baseline forced expiratory volume in the first 0.5 s (FEV0.5). The actual duration of each run was age-related (mean [± SD] duration, 4.8 ± 0.8 min). The nadir in indexes occurred after a mean time of 2.98 ± 1.31 min. A positive EIA finding determined by FEV1 was present in 15 children, and by FEV0.5 in 34 children. Twenty-six children were from group A, but only 8 children were from group B. Wheezing and/or prolonged expiration were associated with a positive test result in 31 of 34 children. Coughing was frequent in children with both negative and positive ECT findings.
Conclusion: The present study documents for the first time the presence of EIA in response to a free-run test in early childhood. Our findings suggest that a free-run test for the presence of EIA is suitable, but that the running duration is limited by age. The duration of airflow limitation after exercise is significantly earlier and shorter in young children with asthma compared with older children. FEV0.5 is a better index than the traditional FEV1 for describing positive ECT results in young children. The association of wheezing and/or prolonged expiration may help in defining EIA in early childhood in the absence of a spirometer.
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职业性哮喘和工作诱发哮喘发作患者的呼气峰流速变异率的比较
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呼出气一氧化氮（NO）测定对哮喘管理的指导作用研究
