中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (2): 150-154.DOI: 10.19538/j.ek2025020612

• 论著 • 上一篇    下一篇

持续小气道气流受限哮喘患儿临床特征及不同肺功能评估方法对比研究

  

  1. 重庆医科大学附属儿童医院肺功能室  国家儿童健康与疾病临床医学研究中心  儿童发育疾病研究教育部重点实验室  儿童代谢与炎症性疾病重庆市重点实验室，重庆  400014
  • 出版日期:2025-02-06 发布日期:2025-04-17
  • 通讯作者: 刘莎，电子信箱：lsls2628@126.com
  • 基金资助:
    重庆市科卫联合医学科研项目（2022MSXM043）

Analysis of clinical characteristics and different detection methods in asthmatic children with persistent small airway airflow limitation

  1. Department of Pulmonary Function Laboratory，Children′s Hospital of Chongqing Medical University；National Clinical Research Center for Child Health and Disorders；Ministry of Education Key Laboratory of Child Development and Disorders；Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases，Chongqing  400014，China
  • Online:2025-02-06 Published:2025-04-17

摘要： 目的    探讨存在持续小气道气流受限哮喘患儿的临床特征及不同肺功能评估方法的敏感性。方法    收集2023年2月至2024年4月在重庆医科大学附属儿童医院门诊复诊的9～18岁、近1年内常规通气法肺功能检查连续2次以上提示小气道气流受限的临床缓解期哮喘患儿，总结其临床特征。通过胸部高分辨率CT（HRCT）检查比较小气道管壁面积比值和厚度比值，同时完善常规通气法、脉冲振荡（IOS）、体积描记法肺功能检查及呼出气一氧化氮（FeNO）检测，分析结果及相关性。结果    共纳入53例患儿，男30例、女23例，年龄10（10，11）岁。8例（15.09%）有哮喘家族史，27例（50.94%）有明确的过敏性疾病史。51例（96.23%）患儿遵医嘱规范治疗，6例（11.32%）近1年内有明确的哮喘急性发作。近1年内哮喘控制药物减量者18例（33.96%），减量后症状反复者3例（16.67%）；停药者9例（16.98%），停药后咳喘发作者4例（44.44%）。36例患儿同时完善了胸部HRCT、肺功能检查和FeNO检测，HRCT结果显示该组患儿气道管壁面积比值（WA%）和厚度比值（T/D）明显升高；常规通气法肺功能检查结果显示36（100%）例患儿用力呼气流速（FEF）75和25%~75%平均用力呼气流速（MMEF）数值均低于正常值下限；体积描记法肺功能检查结果显示仅有2例患儿残气容积、残总比的z-评分均大于1.64；IOS结果显示仅有1例提示外周气道阻塞；FeNO检测结果显示仅4例患儿FeNO200和CaNO测值升高。结论    规范治疗且处于临床缓解期但存在持续小气道气流受限的哮喘患儿，可能已经发生小气道重塑，停药后有较高的症状反复比率。常规通气法肺功能提示小气道功能障碍的敏感性优于IOS、体积描记法肺功能检查和FeNO检测。

关键词: 儿童, 支气管哮喘, 小气道功能障碍, 肺功能

Abstract: Objective    To explore the clinical characteristics of children with persistent small airway airflow limitation and the sensitivity of different small airway assessment methods. Methods    Asthmatic children aged 9 to 18 years who were in clinical remission with small airway airflow limitation suggested by routine pulmonary function tests for more than 2 times in the past year，who visited the outpatient clinic of our hospital from February 2023 to April 2024，were enrolled to summarize the clinical characteristics. Chest high-resolution CT （HRCT） was used to compare the ratio of small airway wall area and thickness. Meanwhile，routine pulmonary function tests，pulse oscillation （IOS），plethysmography and exhaled nitric oxide （FeNO） were perfected，and the examination results and their correlation were analyzed. Results    A total of 53 children were included，including 30 males and 23 females，aged 10 （10，11） years. 8 patients （15. 09%） had a family history of asthma，and 27 patients （50. 94%） had a clear history of allergy. 51 cases （96. 23%） were treated according to the doctor's advice，and 6 cases （11. 32%） had definite acute attack of asthma in the past 1 year. In the past year，asthma control drug were reducted in 18 cases （33. 96%），including 3 cases of recurrent symptoms （16. 67%），cough and wheezing occurred in 4 from 9 cases who underwent drug withdrawal （44. 44%）. Pulmonary function，FeNO and HRCT were also tested in 36 children. The FEF75 and MMEF values of 36（100%） children were lower than the lower limit of normal value，and the HRCT results showed that the ratio of airway wall area （WA%） and thickness ratio （T/D） were significantly increased in this group. The results of plethysmography showed that only 2 cases had RV and RV/TLC Z-scores greater than 1. 64. The IOS results showed only 1 case indicated peripheral airway obstruction. FeNO detection showed only 4 cases with elevated FeNO200 and CaNO. Conclusion    Asthmatic children with standard treatment and clinical remission but with persistent small airway airflow limitation may have developed small airway remodeling and have a higher rate of recurrent symptoms after drug withdrawal. The sensitivity of small airway dysfunction indicated by routine ventilation was superior to IOS，plethysmography and FeNO. 

Key words: child, bronchial asthma, small airway dysfunction, lung function