不同喘息表现型的4岁儿童肺功能和对支气管扩张剂的反应
2010/02/23
持续性喘息是儿童早期一种常见的慢性疾病，并可能进展为哮喘。但目前对学龄前儿童中使用支气管扩张剂前后的肺功能与喘息分型之间的关系尚不清楚。
该研究人群为参与一项主要研究围产期相关因素与哮喘发生和过敏症相关性的前瞻性出生队列研究（安特卫普，比利时）中的4岁儿童，采用强迫振荡技术检测人群肺的功能。采用（双）年度问卷调查评价喘息表现型。
共获得325例儿童的喘息表型和基线呼吸阻抗，其中96％进行了支气管扩张试验。当基线阻抗在4Hz时，存在早期一过性(11.0 hPa.s.L(-1), n=127)或持续性 (11.9 hPa.s.L(-1), n=54) 喘息儿童的阻抗显著高于无喘息儿童(10.3 hPa.s.L(-1), n=144)。使用支气管扩张剂后，阻抗平均下降22％，且持续性喘息儿童中的下降值显著高于无喘息儿童（3.4 vs. 2.3 hPa.s.L(-1)）。
与无喘息和存在早期一过性喘息的4岁儿童相比，持续性喘息儿童的基线肺功能更差，且对支气管扩张剂的应答更强，提示持续性喘息的儿童存在较高程度的支气管肌紧张。
（刘国梁 审校）
Eur Respir J. 2009 Nov 19. [Epub ahead of print]
Lung function and bronchodilator response in 4-year-old children with different wheezing phenotypes.
Oostveen E, Dom S, Desager K, Hagendorens M, De Backer W, Weyler J.
Antwerp University Hospital and University of Antwerp, Belgium.
Persistent wheeze is a common chronic disease in early childhood and later may progress to asthma. However, the association between the pre- and the post-bronchodilator lung function and the wheezing phenotype in preschool children is not known.Children 4 years of age involved in a prospective birth cohort study (in Antwerp, Belgium) on perinatal factors and the occurrence of asthma and allergies were invited to participate in lung function measurements with the forced oscillation technique. The wheezing phenotype was assessed via (bi)annual questionnaires.Wheezing phenotype and baseline respiratory impedance data were available for 325 children, 96% of whom underwent bronchodilation tests. The baseline resistance at 4 Hz was higher in children with early-transient (11.0 hPa.s.L(-1), n=127), or persistent wheeze (11.9 hPa.s.L(-1), n=54) than in children who never wheeze (10.3 hPa.s.L(-1), n=144). After bronchodilation, the resistance decreased on average by 22%. The decrease was greater among the persistent wheezers than among those who never wheezed (3.4 vs. 2.3 hPa.s.L(-1)).The baseline lung function was poorer and the bronchodilator response was greater in 4-year-old children with persistent wheeze than in those who never wheeze or who have early-transient wheeze, implying a higher bronchomotor tone in the former group.
Oostveen E, Dom S, Desager K, et al. Eur Respir J. 2009 Nov 19. [Epub ahead of print]
该研究人群为参与一项主要研究围产期相关因素与哮喘发生和过敏症相关性的前瞻性出生队列研究（安特卫普，比利时）中的4岁儿童，采用强迫振荡技术检测人群肺的功能。采用（双）年度问卷调查评价喘息表现型。
共获得325例儿童的喘息表型和基线呼吸阻抗，其中96％进行了支气管扩张试验。当基线阻抗在4Hz时，存在早期一过性(11.0 hPa.s.L(-1), n=127)或持续性 (11.9 hPa.s.L(-1), n=54) 喘息儿童的阻抗显著高于无喘息儿童(10.3 hPa.s.L(-1), n=144)。使用支气管扩张剂后，阻抗平均下降22％，且持续性喘息儿童中的下降值显著高于无喘息儿童（3.4 vs. 2.3 hPa.s.L(-1)）。
与无喘息和存在早期一过性喘息的4岁儿童相比，持续性喘息儿童的基线肺功能更差，且对支气管扩张剂的应答更强，提示持续性喘息的儿童存在较高程度的支气管肌紧张。
（刘国梁 审校）
Eur Respir J. 2009 Nov 19. [Epub ahead of print]
Lung function and bronchodilator response in 4-year-old children with different wheezing phenotypes.
Oostveen E, Dom S, Desager K, Hagendorens M, De Backer W, Weyler J.
Antwerp University Hospital and University of Antwerp, Belgium.
Persistent wheeze is a common chronic disease in early childhood and later may progress to asthma. However, the association between the pre- and the post-bronchodilator lung function and the wheezing phenotype in preschool children is not known.Children 4 years of age involved in a prospective birth cohort study (in Antwerp, Belgium) on perinatal factors and the occurrence of asthma and allergies were invited to participate in lung function measurements with the forced oscillation technique. The wheezing phenotype was assessed via (bi)annual questionnaires.Wheezing phenotype and baseline respiratory impedance data were available for 325 children, 96% of whom underwent bronchodilation tests. The baseline resistance at 4 Hz was higher in children with early-transient (11.0 hPa.s.L(-1), n=127), or persistent wheeze (11.9 hPa.s.L(-1), n=54) than in children who never wheeze (10.3 hPa.s.L(-1), n=144). After bronchodilation, the resistance decreased on average by 22%. The decrease was greater among the persistent wheezers than among those who never wheezed (3.4 vs. 2.3 hPa.s.L(-1)).The baseline lung function was poorer and the bronchodilator response was greater in 4-year-old children with persistent wheeze than in those who never wheeze or who have early-transient wheeze, implying a higher bronchomotor tone in the former group.
Oostveen E, Dom S, Desager K, et al. Eur Respir J. 2009 Nov 19. [Epub ahead of print]
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儿童哮喘症状的感知及肥胖
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沙美特罗/丙酸氟替卡松与双倍剂量丙酸氟替卡松对哮喘儿童肺功能和哮喘控制的作用
