体重指数和儿童哮喘诊断的准确性
2009/06/24
目的：研究具有较高体重指数的儿童是否与专家的哮喘误诊相关。
方法：通过对小儿肺科医生诊断的8～18岁儿童的电子档案进行调查，研究前6年内就诊的主要哮喘症状或哮喘类似症状，如喘息、咳嗽或呼吸困难。收集肺活量检测记录、血常规，尽可能包括免疫球蛋白E（IgE）。通过上述指标判断儿童是否患有经内科医生诊断的哮喘、经专家诊断的哮喘或两者兼有。满足其余客观金标准的专家诊断的哮喘患儿被列为严格标准的哮喘。
结果：在所有哮喘患儿中，体重指数较高非常普遍，即使满足严格诊断标准的患儿也是如此。内科医生诊断的哮喘患儿中肥胖比例不高，而且这些患儿具有与专家诊断类似的哮喘客观表现。内科医生和哮喘专家对哮喘的诊断之间具有较好的诊断相关性，而且不受体重指数影响。专家诊断的哮喘患者中，体重指数的增加与第一秒用力呼气体积（FEV1）、用力中期呼气流速（FEF25–75）和FEV1/最大肺活量（FVC）的下降显著相关。在所有2258例档案中，体重指数每增加一个百分比，接受专家诊断的哮喘OR增加0.4％。
结论：内科医生不会对超重导致的儿童哮喘误诊。我们的结果证实，哮喘患儿中超重的比率非常高，并且超重能增加儿童罹患哮喘的风险。虽然我们研究不能辨别其中的因果关系，但高体重指数与较大程度的气流阻塞和系统性炎症标志物增加相关，而后两者是导致哮喘发病的潜在机制。
（林江涛 审校）
Lang JE, et al. J Asthma. 2009 Apr;46(3):291-299
Body mass index-percentile and diagnostic accuracy of childhood asthma.
OBJECTIVE: To determine whether high BMI-percentile is associated with misdiagnosis of asthma among children referred to an asthma specialist.
METHODS: We queried the electronic records of children 8 to 18 years of age seen by a Nemours pediatric pulmonologist. All visits during a 6-year period with the chief complaint of asthma, or an asthma-like symptom such as wheeze, cough, or dyspnea, were included. We collected spirometry, blood counts, and immunoglobulin E (IgE) if available. We determined whether the child had referring physician-diagnosed asthma, specialist-diagnosed asthma, or both. Specialist-diagnosed asthmatics who met additional objective "gold-standard" criterion were labeled strict-criterion asthma.
RESULTS: Prevalence of high BMI-percentile was extremely common in all defined asthma groups, even those meeting strict criteria for diagnosis. Referring physician-diagnosed asthmatics did not have higher rates of obesity, and referring physician-diagnosed asthmatics had objective indicators of asthma that were the same as asthmatics diagnosed by a specialist. There was good diagnostic correlation between referring physicians and asthma specialists that was not affected by BMI. Among specialist-diagnosed asthmatics, increased BMI-percentile associated with significantly reduced forced expiratory volume in 1 second (FEV(1)), forced expiratory flow during the middle half of the forced vital capacity (FEF(25 - 75)), and FEV(1)/forced vital capacity (FVC); and significantly increased total blood leukocytes, neutrophils, and platelets compared to leans. For all 2,258 referrals, the estimated odds ratio of receiving a specialist-diagnosis of asthma increased by 0.4% with each increasing BMI percentile.
CONCLUSIONS: Referring physicians do not appear to erroneously diagnose children with asthma due to overweight status. Our data confirm that overweight status is extremely high in children with true asthma and likely increases the risk for true asthma. Although these data cannot discern causality, high BMI-percentile is associated with greater airflow obstruction and elevated markers of systemic inflammation that could contribute to underlying mechanisms of asthma.
上一篇：
sGaw、FEF(25-75)和FEV1在乙酰甲胆碱吸入激发反应阴性的患者中对哮喘发生的预测价值
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中度至重度间歇性喘息患儿症状和体征先于喘息出现
