小气道指标在儿童气道高反应性检测中的应用

发布时间：2018-04-28 21:33

本文选题：儿童 + 气道高反应性　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的探讨小气道各项指标在支气管激发试验评估儿童气道高反应性(AHR)中的应用。方法回顾性分析178例以乙酰甲胆碱作为激发剂进行支气管激发试验的患儿。以乙酰甲胆碱(Mch)浓度≤16mg/m1时导致第一秒最大呼气量(FEV1)下降≥20%为阳性诊断标准,比较乙酰甲胆碱激发试验MCC)阳性组和MCC阴性组的用力肺活量(FVC),FEV1,呼气流速峰值(PEF)及小气道各项指标基础值与下降百分率,分析FEV1与小气道各项指标的相关性。结果患儿年龄为4至13岁,共178例,其中男性患儿102例,女性患儿76例；其中MCC阳性组为96例,阴性组为82例；MCC阳性患儿与阴性患儿年龄差异无显著性统计学意义(p=0.1)；基础肺功能FVC, MCC阳性组与MCC阴性组无显著统计学差异(p0.05),FEV1、PEF大气道指标,MCC阳性组均低于MCC阴性组(p0.001)；小气道指标MEF75占预计值、MEF50占预计值、MEF25占预计值和MMEF占预计值,MCC阳性组分别为89.89±18.69、86.31±24.29、92.81±34.17、90.04±26.12,MCC阴性组分别为104.97±20.06、109.5±24.12、118.93±34.29、113.41±25.43,两组差异有显著性统计学意义(p0.001)；MCC阳性组比阴性组各项小气道指标下降的程度大且速度快(p0.001)；FEV1下降百分率与MEF25下降百分率无明显相关(r=0.483,p0.001),其余小气道指标与FEV1相关系数均约为0.7(p0.001)；当定义MMEF下降百分率10%(Mch浓度为0.5mg/ml)为诊断指标时,灵敏度为58.33%、特异度为68.29%、阳性预测值为68.29%、阴性预测值为58.33%,当MMEF占预计值90%和MMEF下降10%(Mch浓度为0.5mg/ml)联合应用诊断气道高反应性时,灵敏度上升为80.9%、特异度上升为93.81%、阳性预测值上升为92.53%、阴性预测值上升为83.33%；MMEF占预计值、MMEF下降百分率(Mch浓度为0.5mg/ml)的曲线下面积分别为0.75和0.85。结论MCC阳性组的各项小气道指标显著低于MCC阴性组；激发试验FEV1下降百分率除了与MEF25下降百分率无明显相关外,其余小气道指标与FEV1呈明显正相关；预测气道高反应性MMEF下降百分率优于MMEF占预计值；小气道各项指标的基础值及激发试验中下降百分率在辅助诊断儿童气道高反应性有重要的参考价值。
[Abstract]:Objective to explore the application of small airway parameters in evaluating bronchial hyperresponsiveness (AHR) in children with bronchial provocation test.
Methods a retrospective analysis of 178 cases of bronchial provocation test with methacholine as a activator. With the concentration of acetylmethacholine (Mch) less than 16mg/m1, the first second maximum expiratory volume (FEV1) decreased more than 20% as the positive diagnostic standard, and compared the active lung activity (FVC), FEV1 in the positive and MCC negative groups of the methacholine test MCC test group and the MCC negative group. The peak expiratory flow rate (PEF) and the basic and descending percentages of various indicators of small airway were analyzed, and the correlation between FEV1 and various indexes of small airway was analyzed.
Results the age of the children was 4 to 13 years old, of which there were 178 cases, including 102 male children and 76 female children, of which 96 cases were MCC positive group and 82 cases in negative group, and there was no significant statistical significance between MCC positive children and negative children (p=0.1). There was no significant difference in basic pulmonary function FVC, MCC positive group and MCC negative group (P0.05), FEV1, PEF. The MCC positive group was lower than the MCC negative group (p0.001), the small airway index MEF75 accounted for the expected value, the MEF50 accounted for the estimated value, the MEF25 accounted for the estimated value and the MMEF accounted for the estimated value, MCC positive groups were 89.89 + 18.69,86.31 + 24.29,92.81 + 26.12, respectively, and MCC negative groups were 104.97 + + + + 25.43, respectively. There was significant statistical significance in the two groups (p0.001), and the decrease of small airway index in MCC positive group was larger and faster than that in negative group (p0.001). The percentage of FEV1 decline was not significantly correlated with the percentage of MEF25 decline (r=0.483, p0.001), and the other small airway index and FEV1 correlation coefficient were all about 0.7 (p0.001); when MMEF decreased, the percentage of FEV1 was reduced by 100 percent. The sensitivity of 10% (Mch concentration 0.5mg/ml) was 58.33%, the specificity was 68.29%, the positive predictive value was 68.29%, the negative predictive value was 58.33%. When the MMEF accounted for 90% and MMEF decreased 10% (Mch concentration was 0.5mg/ml), the sensitivity increased by 80.9%, the specificity increased to 93.81%, and the positive predictive value was 93.81%. The increase was 92.53%, the negative predictive value increased to 83.33%, the MMEF accounted for the estimated value, and the area under the curve of MMEF decline (Mch concentration 0.5mg/ml) was 0.75 and 0.85. respectively.
Conclusion the small airway index of MCC positive group was significantly lower than that of MCC negative group; the percentage of FEV1 decline in the test of excitation test was not significantly correlated with the percentage of MEF25 decrease, and the other small airway indexes were positively correlated with FEV1, and the prediction of the percentage of airway hyperresponsiveness MMEF was better than the predicted value of MMEF, and the basic value of the small airway indexes was the basic value. And the percentage of decrease in the provocation test has important reference value in assisting diagnosis of airway hyperresponsiveness in children.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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