年龄对于哮喘患儿呼出气一氧化氮与气道高反应性关系的影响
2010/01/07
关键词：氯化乙酰胆碱；气道高反应性；可信区间；25％用力肺活量时的用力呼气流速:；50％用力肺活量时的用力呼气流速；呼出气一氧化氮分数浓度；吸入激素；FEV1自基线下降20%时的乙酰胆碱激发浓度；十亿分之一
背景：很多研究探讨了呼出气一氧化氮分数浓度（Feno）与气道高反应性（AHR）的关系。本研究目的为了解年龄对于哮喘患儿呼出气一氧化氮与气道高反应性关系的影响。
方法：共测定了276名哮喘患者 的气道高反应性（年龄为5～20岁），激发药物为氯化乙酰胆碱，测定FEV1自基线下降20%时的氯化乙酰胆碱浓度（PC20）。在进行乙酰胆碱激发试验前应用网上推荐的方法测定Feno。
结果：12岁以下患儿（5～11岁）气道高反应性（PC20）下降与Feno升高显著相关(r = −0.43; β = −0.28; p < 0.001).。而对于≥ 12岁的青春期患者（12～20岁），PC20 下降与外周气道阻塞相关(FEV1: r = 0.32; β = 5.5; p = 0.002; 50％用力肺活量时的用力呼气流速: r = 0.24; β=8.4; p = 0.006; 25％用力肺活量时的用力呼气流速: r = 0.28; β=11.4; p = 0.002)。而AHR和Feno仅有微弱相关(r = −0.18; β = −0.14; p = 0.02)。
结果：12岁以下患儿（5～11岁）气道高反应性（PC20）下降与Feno升高显著相关(r = −0.43; β = −0.28; p < 0.001).。而对于≥ 12岁的青春期患者（12～20岁），PC20 下降与外周气道阻塞相关(FEV1: r = 0.32; β = 5.5; p = 0.002; 50％用力肺活量时的用力呼气流速: r = 0.24; β=8.4; p = 0.006; 25％用力肺活量时的用力呼气流速: r = 0.28; β=11.4; p = 0.002)。而AHR和Feno仅有微弱相关(r = −0.18; β = −0.14; p = 0.02)。
结论：哮喘患儿气道高反应性与气道炎症相关。哮喘患儿的气道高反应性受到多种因素的影响，但主要反映气道炎症。与此相反，青春期哮喘患者的气道高反应性与起到结构变化相关，与气道炎症仅有微弱相关。青春期患者的气道高反应性与一些慢性改变相关，主要反映气道重塑。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
（Chest August 2009 136:519-525）
（Chest August 2009 136:519-525）
Effect of Age on Relationship Between Exhaled Nitric Oxide and Airway Hyperresponsiveness in Asthmatic Children
Chikako Motomura, MD, Hiroshi Odajima, MD, PhD, Junichiro Tezuka, MD, Yoko Murakami, MD, Yoshio Moriyasu, MD,Naoyuki Kando, MD, Naohiko Taba, MD, Daisuke Hayashi, MD, Kenji Okada, MD, PhD and Sankei Nishima, MD, PhD
Background: Numerous studies have examined the relationship between the fractional concentration of exhaled nitric oxide (Feno) and airway hyperresponsiveness (AHR). Our objective was to determine the effects of age on the relationship between Feno and AHR in asthmatic children.
Methods: AHR was examined in 267 asthmatic patients (age range, 5 to 20 years). A challenge test was performed using acetylcholine chloride (Ach). We determined the provocative concentration of Ach producing a 20% decrease in FEV1 from baseline (PC20). Feno was examined using the recommended online method before the Ach challenge test.
Results: In children < 12 years of age (range, 5 to 11 years), decreasing AHR (PC20) was significantly related to higher Feno (r = −0.43; β = −0.28; p < 0.001). In adolescents ≥ 12 years of age (range, 12 to 20 years), decreasing PC20 was associated with peripheral airway obstruction (FEV1: r = 0.32; β = 5.5; p = 0.002; forced expiratory flow at 50% of the FVC: r = 0.24; β=8.4; p = 0.006; and forced expiratory flow at 25% of FVC: r = 0.28; β=11.4; p = 0.002). AHR and Feno were weakly related (r = −0.18; β = −0.14; p = 0.02).
Conclusions: In children with asthma, AHR is associated with airway inflammation. AHR in children with asthma may consist of variable components mainly reflecting airway inflammation. In contrast, in adolescents with asthma, AHR is associated with airway structural changes and weakly with airway inflammation. AHR in adolescents with asthma may consist of chronic components mainly reflecting airway remodeling.
Chest August 2009 136:519-525
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