持续哮喘患儿中以序列特异性气道阻力增加为特点的肺功能受损：纵向研究
2010/09/14
摘要
背景：特异性气道阻力（sRaw）几乎与肺的发育、身高和性别无关，因此，可对其进行纵向随访研究。
目的：本试验旨在研究是否能采用sRaw来评价伴有肺功能下降的哮喘患儿其哮喘特异表现型。
方法：研究者认为一段时期内测定序列性sRaw能检测微妙的趋势。在4年内，对采用吸入糖皮质激素治疗的、患持续哮喘患儿的临床和功能性数据进行评价，每年至少评价3次，这些数据来自于一个数据库。
结果：114名患儿（30名女童）平均随访6.9年（5.6～7.9年）。将来自于这些患儿的1699次sRaw检测的数据与时间作图，结果显示，将4～18岁儿童合成一组分析，组内患者曲线斜率较平稳。个体曲线斜率与个体sRaw变异程度呈现正相关性（R2=0.16; p <0.0001）。皮肤针刺试验一项以上阳性的患儿其sRaw变异也较大（p =0.011）。19名儿童（19/114）中，其sRaw每年平均增加12.3％。与sRaw无显著增加的患儿相比，sRaw增加的患儿为男性（p < 0.0001），其初始气道阻力较低（p =0.008），终期气道阻力较高（p =0.025），但两组患者间其糖皮质激素吸入剂量未见差异。
结论：此项回顾性研究发现了哮喘患儿的特异表型，该表型儿童可出现肺功能受损。我们结果也证实了儿童哮喘管理计划研究中事后分析的结果。
（刘国梁 审校）
J Asthma. 2010 Jul 9. [Epub ahead of print]
Lung Function Impairment Evidenced by Sequential Specific Airway Resistance in Childhood Persistent Asthma: A Longitudinal Study.
Mahut B, Trinquart L, Bokov P, Peiffer C, Delclaux C.
1Cabinet La Berma, Antony, France.
Abstract
Background. Specific airway resistance (sRaw) is virtually independent of lung growth, height, and gender, thus facilitating longitudinal follow-up.
Objective. To assess whether a specific phenotype of asthmatic children with a decline in lung function can be evidenced using sRaw. Methods. The authors hypothesized that sequential sRaw measurements over a long period would detect subtle trends. Clinical and functional data of children with persistent asthma under inhaled corticosteroids, evaluated at least three times per year for at least 4 years, were retrieved from a database.
Results. One hundred fourteen children (30 girls) were followed for (median [interquartile range]) 6.9 years [5.6-7.9]. Data from 1699 measurements of sRaw (median 14/child) allowed the calculation of individual slopes of sRaw plotted against time demonstrating stable values in the group as a whole between 4 and 18 years. A positive correlation between individual slopes and the degree of intraindividual variation of sRaw was observed (R(2) = .16; p < .0001). Children with more than one positive skin test showed larger intrasubject variation of sRaw (p = .011). In 19/114 children (17%), a significant increase in sRaw of 12.3% per year (median) was observed. As compared to children without, those with a significant increase in sRaw were boys (p < .0001), had a lower initial (p = .008) and a higher final resistance (p = .025) but did not differ in terms of inhaled corticosteroid dose.
Conclusion. This retrospective study identifies a specific phenotype of asthmatic children that develops an impairment of lung function, confirming the results of a post hoc analysis of the Childhood Asthma Management Program study.
J Asthma. 2010 Jul 9. [Epub ahead of print]
背景：特异性气道阻力（sRaw）几乎与肺的发育、身高和性别无关，因此，可对其进行纵向随访研究。
目的：本试验旨在研究是否能采用sRaw来评价伴有肺功能下降的哮喘患儿其哮喘特异表现型。
方法：研究者认为一段时期内测定序列性sRaw能检测微妙的趋势。在4年内，对采用吸入糖皮质激素治疗的、患持续哮喘患儿的临床和功能性数据进行评价，每年至少评价3次，这些数据来自于一个数据库。
结果：114名患儿（30名女童）平均随访6.9年（5.6～7.9年）。将来自于这些患儿的1699次sRaw检测的数据与时间作图，结果显示，将4～18岁儿童合成一组分析，组内患者曲线斜率较平稳。个体曲线斜率与个体sRaw变异程度呈现正相关性（R2=0.16; p <0.0001）。皮肤针刺试验一项以上阳性的患儿其sRaw变异也较大（p =0.011）。19名儿童（19/114）中，其sRaw每年平均增加12.3％。与sRaw无显著增加的患儿相比，sRaw增加的患儿为男性（p < 0.0001），其初始气道阻力较低（p =0.008），终期气道阻力较高（p =0.025），但两组患者间其糖皮质激素吸入剂量未见差异。
结论：此项回顾性研究发现了哮喘患儿的特异表型，该表型儿童可出现肺功能受损。我们结果也证实了儿童哮喘管理计划研究中事后分析的结果。
（刘国梁 审校）
J Asthma. 2010 Jul 9. [Epub ahead of print]
Lung Function Impairment Evidenced by Sequential Specific Airway Resistance in Childhood Persistent Asthma: A Longitudinal Study.
Mahut B, Trinquart L, Bokov P, Peiffer C, Delclaux C.
1Cabinet La Berma, Antony, France.
Abstract
Background. Specific airway resistance (sRaw) is virtually independent of lung growth, height, and gender, thus facilitating longitudinal follow-up.
Objective. To assess whether a specific phenotype of asthmatic children with a decline in lung function can be evidenced using sRaw. Methods. The authors hypothesized that sequential sRaw measurements over a long period would detect subtle trends. Clinical and functional data of children with persistent asthma under inhaled corticosteroids, evaluated at least three times per year for at least 4 years, were retrieved from a database.
Results. One hundred fourteen children (30 girls) were followed for (median [interquartile range]) 6.9 years [5.6-7.9]. Data from 1699 measurements of sRaw (median 14/child) allowed the calculation of individual slopes of sRaw plotted against time demonstrating stable values in the group as a whole between 4 and 18 years. A positive correlation between individual slopes and the degree of intraindividual variation of sRaw was observed (R(2) = .16; p < .0001). Children with more than one positive skin test showed larger intrasubject variation of sRaw (p = .011). In 19/114 children (17%), a significant increase in sRaw of 12.3% per year (median) was observed. As compared to children without, those with a significant increase in sRaw were boys (p < .0001), had a lower initial (p = .008) and a higher final resistance (p = .025) but did not differ in terms of inhaled corticosteroid dose.
Conclusion. This retrospective study identifies a specific phenotype of asthmatic children that develops an impairment of lung function, confirming the results of a post hoc analysis of the Childhood Asthma Management Program study.
J Asthma. 2010 Jul 9. [Epub ahead of print]
