脉冲振荡法检测哮喘患儿对甘露醇的气道反应性
2009/10/15
以往我们采用多次用力呼气来检测支气管对甘露醇的反应，但该方法在儿童中难以实施。本试验旨在确定是否可用脉冲振荡法（IOS）在儿童中检测气道对甘露醇的反应性。
对8～21岁的哮喘患儿进行甘露醇支气管激发试验。检测基线及各剂量甘露醇激发后的IOS阻力（R5和R20）值和FEV1。
15％的FEV1下降或两个剂量之间的FEV1下降值≥10%为甘露醇激发试验阳性。FEV1变化与IOS R5变化显著相关。试验阳性患者FEV1平均下降18.4%±5.9%， R5平均增加34.8%±15%，R20未见显著变化。对于试验阴性患者，与基线状态相比，FEV(1), R5和R20未见显著变化。因此，采用省力的IOS来评价甘露醇激发试验中气流阻塞对于那些难以完成肺活量检测任务的患者，是继FEV1后的另一个较好选择。R5值增加≥25%表明试验阳性。
（林江涛 审校）
Horsman TA, et al. J Asthma. 2009 Aug;46(6):600-603.
Airway response to mannitol challenge in asthmatic children using impulse oscillometry.
Horsman TA, Duke RK, Davenport PW.
Bronchial responsiveness to mannitol has been assessed using multiple forced expiratory maneuvers which are difficult for many children. We determined if responsiveness to mannitol can be assessed in children using effort-independent impulse oscillometry (IOS). Subjects with asthma, 8-21 years old, underwent a mannitol bronchial provocation test. IOS resistance (R5 and R20) values and FEV(1) were measured at baseline and after each dose of mannitol. The mannitol challenge was positive with a 15% fall in FEV(1) or a > or = 10% fall in FEV(1) between doses of mannitol. There was a significant correlation between the change in FEV(1) and the change in IOS R5. Subjects with a positive challenge had a mean decrease in FEV(1) of 18.4% +/- 5.9% had a mean increase in R5 of 34.8% +/- 15%. There was no significant change in R20. Subjects with a negative challenge had no significant change in FEV(1), R5, or R20 from baseline. Using effort-independent IOS to assess airflow obstruction with a mannitol challenge is a useful alternative to FEV(1) in patients that have difficulty with spirometry tasks. A > or = 25% increase in R5 indicates a positive challenge.
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3分钟呼吸运动试验对呼吸困难的感知可预测哮喘加重：前瞻性队列研究
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哮喘患者中炎症亚型与对甘露醇的气道高反应性及呼出NO相关
