哮喘患儿早期糖皮质激素治疗并不能改善10岁时的肺功能
2011/01/27
摘要
在哮喘患儿中，早期吸入糖皮质激素（ICS）治疗对肺功能的影响仍然存在争议。本研究旨在根据出生时的肺功能，评价早期ICS治疗是否能影响10岁时患儿的肺功能。对参与奥斯陆环境与儿童哮喘研究的802名（平均年龄：10.9 +/- 0.9岁）出生时就有肺功能检测的儿童中的614名进行了为期10年的随访研究，在第2和第10年，通过与父母访谈，获得有关ICS治疗的相关信息（124名有哮喘史）。主要检测结果是第10年第一秒用力呼气体积（FEV1）和中段呼气流量最佳值（预测值的百分数和Z评分）。主要解释因素为从未、过去或目前使用ICS、出生时潮气流量/体积比（tPTEF/tE）（达到峰值流量的时间tPTEF和总的呼气时间tE）的Z评分 。11.9％的研究儿童采用ICS治疗，71.6％的研究儿童存在当前哮喘，但在出生至10岁这段时间内不会显著影响研究对象的肺功能。在未使用激素治疗的儿童以及0～3开始使用、3岁后使用的和目前使用ICS治疗的儿童之间，FEV1最佳值（以及Z评分）和中段呼气流量类似。肺功能在0～10岁间的变化基本可以用性别、哮喘史及出生时tPTEF/tE来解释。到患儿10岁时，有十分之一接受过ICS治疗哮喘，但这种治疗并不能显著改善患儿的肺功能。
（陈欣 审校）
Pediatr Allergy Immunol. 2010 Aug;21(5):814-22. Epub 2009 Nov 13.
Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children.
Lødrup Carlsen KC, Devulapalli CS, Mowinckel P, Håland G, Munthe-Kaas MC, Carlsen KH.
Department of Paediatrics, Division of Woman and Child, Oslo University Hospital, Ullevål, Oslo, Norway. k.c.l.carlsen@medisin.uio.no
Abstract
Early intervention with inhaled corticosteroid (ICS) treatment for lung function development in childhood is debated. In view of lung function at birth, we aimed to assess if early use of ICS influenced lung function at 10 yrs of age. A 10-yr follow-up study of 614/802 children (mean age 10.9 +/- 0.9 yrs) with lung function measurements at birth in the Environment and Childhood Asthma study in Oslo included information on ICS treatment (124 with history of asthma) obtained at 2 and 10 yrs by parental interviews. Main outcomes at 10 yrs were the best values (% predicted and Z-scores) of forced expiratory volume in 1 s (FEV(1)) and mid-expiratory flow. The main explanatory factors were never, past or current use of ICS and Z-scores of the tidal flow-volume ratio t(PTEF)/t(E) [time to peak expiratory flow (t(PTEF)) and total expiratory time (t(E))] at birth. ICS treatment, reported by 11.9% of children in the population sample and 71.6% with current asthma, did not significantly influence lung function from birth to 10 yrs. The best values (and Z-scores) of FEV(1), and mid-expiratory flow were similar (p > 0.1) in subjects receiving ICS during and after 0-3 yrs of age, after 3 yrs only or currently compared with steroid naïve children. Almost half of the change in lung function 0-10 yrs was explained by gender, a history of asthma and t(PTEF)/t(E) at birth. ICS treatment for asthma, reported in every eighth child by age 10 yrs, did not significantly improve lung function from birth to 10 yrs.
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成人哮喘患者每年呼吸功能的变化：多年哮喘治疗在修复气道不可逆性变化中的作用
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白三烯调节剂用于哮喘治疗
