临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (5): 321-327.doi: 10.12372/jcp.2023.23e0206
• 述评 • 下一篇
张皓1, 池艳霞2
收稿日期:
2023-03-20
出版日期:
2023-05-15
发布日期:
2023-05-10
基金资助:
ZHANG Hao1, CHI Yanxia2
Received:
2023-03-20
Published:
2023-05-15
Online:
2023-05-10
摘要:
支气管舒张试验是检查气道可逆性的方法,是用于喘息性疾病诊断、鉴别诊断、治疗和随访的重要手段。随着人们对支气管舒张试验重要性认知的日渐提升,其临床应用迅速增多。目前国内外大量研究聚焦于如何对其结果进行临床解读及阳性阈值的界定。文章旨在探讨新的标准和意见,厘清思路,提出适合我国儿童的建议。
张皓, 池艳霞. 儿童支气管舒张试验检查及临床应用[J]. 临床儿科杂志, 2023, 41(5): 321-327.
ZHANG Hao, CHI Yanxia. Bronchodilation test and its clinical application in children[J]. Journal of Clinical Pediatrics, 2023, 41(5): 321-327.
[1] | 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第四部分)——支气管舒张试验[J]. 中华结核和呼吸杂志, 2014, 37(9): 655-658. |
[2] | 中华医学会儿科学分会呼吸学组肺功能协作组, 中华实用儿科临床杂志编辑委员会. 儿童肺功能系列指南(五): 支气管舒张试验[J]. 中华实用儿科临床杂志, 2017, 32(1): 17-21. |
[3] | 中华医学会儿科分会呼吸学组, 中华儿科杂志编辑委员会. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2016, 54(3): 167-181. |
[4] | 中华医学会儿科学分会呼吸学组肺功能协作组, 中华实用儿科临床杂志编辑委员会. 儿童肺功能系列指南(三): 脉冲振荡[J]. 中华实用儿科临床杂志, 2016, 31(11): 821-825. |
[5] |
King GG, Bates J, Berger KI, et al. Technical standards for respiratory oscillometry[J]. Eur Respir J, 2020, 55(2): 1900753.
doi: 10.1183/13993003.00753-2019 |
[6] |
Kelly VJ, Brown NJ, Sands SA, et al. Effect of airway smooth muscle tone on airway distensibility measured by the forced oscillation technique in adults with asthma[J]. J Appl Physiol (1985), 2012, 112(9): 1494-1503.
doi: 10.1152/japplphysiol.01259.2011 |
[7] |
Barnas GM, Sprung J, Craft TM, et al. Effect of lung volume on lung resistance and elastance in awake subjects measured during sinusoidal forcing[J]. Anesthesiology, 1993, 78(6): 1082-1090.
pmid: 8512101 |
[8] |
Thamrin C, Gangell C, Kusel M, et al. Expression of bronchodilator response using forced oscillation technique measurements: absolute versus relative[J]. Eur Respir J, 2010, 36(1): 212-213.
doi: 10.1183/09031936.00025310 pmid: 20595169 |
[9] |
Thamrin C, Gangell CL, Udomittipong K, et al. Assessment of bronchodilator responsiveness in preschool children using forced oscillations[J]. Thorax, 2007, 62(9): 814-819.
pmid: 17412777 |
[10] |
Oostveen E, Dom S, Desager K, et al. Lung function and bronchodilator response in 4-year-old children with different wheezing phenotypes[J]. Eur Respir J, 2010, 35(4): 865-872.
doi: 10.1183/09031936.00023409 pmid: 19926751 |
[11] |
Calogero C, Parri N, Baccini A, et al. Respiratory impedance and bronchodilator response in healthy Italian preschool children[J]. Pediatr Pulmonol, 2010, 45(11): 1086-1094.
doi: 10.1002/ppul.21292 |
[12] |
Harrison J, Gibson AM, Johnson K, et al. Lung function in preschool children with a history of wheezing measured by forced oscillation and plethysmographic specific airway resistance[J]. Pediatr Pulmonol, 2010, 45(11): 1049-1056.
doi: 10.1002/ppul.v45:11 |
[13] |
Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests[J]. Eur Respir J, 2005, 26(5): 948-968.
doi: 10.1183/09031936.05.00035205 pmid: 16264058 |
[14] |
Kroegel C. Global Initiative for asthma management and prevention--GINA 2006[J]. Pneumologie, 2007, 61(5): 295-304.
pmid: 17523070 |
[15] | 中华医学会儿科学会呼吸学组, 中华儿科杂志编辑委员会. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2008, 46(10): 745-753. |
[16] |
Galant SP, Morphew T, Amaro S, et al. Value of the bronchodilator response in assessing controller naïve asthmatic children[J]. J Pediatr, 2007, 151(5): 457-662.
doi: 10.1016/j.jpeds.2007.05.004 |
[17] |
Tse SM, Gold DR, Sordillo JE, et al. Diagnostic accuracy of the bronchodilator response in children[J]. J Allergy Clin Immunol, 2013, 132(3): 554-559.
doi: S0091-6749(13)00520-4 pmid: 23683464 |
[18] |
Kang XH, Wang W, Cao L. A clinical study to determine the threshold of bronchodilator response for diagnosing asthma in Chinese children[J]. World J Pediatr, 2019, 15(6): 559-564.
doi: 10.1007/s12519-019-00293-9 |
[19] |
Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests[J]. Eur Respir J, 2022, 60(1): 2101499.
doi: 10.1183/13993003.01499-2021 |
[20] |
Brand PL, Quanjer PH, Postma DS, et al. Interpretation of bronchodilator response in patients with obstructive airways disease. The Dutch Chronic Non-Specific Lung Disease (CNSLD) Study Group[J]. Thorax, 1992, 47(6): 429-436.
doi: 10.1136/thx.47.6.429 pmid: 1496502 |
[21] |
Quanjer PH, Ruppel GL, Langhammer A, et al. Bronchodilator response in FVC is larger and more relevant than in FEV1 in severe airflow obstruction[J]. Chest, 2017, 151(5): 1088-1098.
doi: S0012-3692(16)62696-X pmid: 28040521 |
[22] |
Tan WC, Vollmer WM, Lamprecht B, et al. Group BCR. Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study[J]. Thorax, 2012, 67(8): 718-726.
doi: 10.1136/thoraxjnl-2011-201445 pmid: 22544896 |
[23] |
Ward H, Cooper BG, Miller MR. Improved criterion for assessing lung function reversibility[J]. Chest, 2015, 148(4): 877-886.
doi: S0012-3692(15)50275-4 pmid: 25879725 |
[24] |
Koga T, Kamimura T, Oshita Y, et al. Determinants of bronchodilator responsiveness in patients with controlled asthma[J]. J Asthma, 2006, 43(1): 71-74.
pmid: 16448969 |
[25] |
Burity EF, Pereira CA, Jones MH, et al. Bronchodilator response cut-off points and FEV0.75 reference values for spirometry in preschoolers[J]. J Bras Pneumol, 2016, 42(5): 326-332.
doi: 10.1590/S1806-37562015000000216 |
[26] |
Chen C, Jian W, Gao Y, et al. Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness[J]. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2519-2526.
doi: 10.2147/COPD |
[27] |
Lee JS, Huh JW, Chae EJ, et al. Response patterns to bronchodilator and quantitative computed tomography in chronic obstructive pulmonary disease[J]. Clin Physiol Funct Imaging, 2012, 32(1): 12-18.
doi: 10.1111/cpf.2011.32.issue-1 |
[28] |
Song TW, Kim KW, Kim ES, et al. Utility of impulse oscillometry in young children with asthma[J]. Pediatr Allergy Immunol, 2008, 19(8): 763-768.
doi: 10.1111/pai.2008.19.issue-8 |
[29] |
Sheen YH, Jee HM, Ha EK, et al. Impulse oscillometry and spirometry exhibit different features of lung function in bronchodilation[J]. J Asthma, 2018, 55(12): 1343-1351.
doi: 10.1080/02770903.2017.1418884 pmid: 29300537 |
[30] |
Batmaz SB, Kuyucu S, Arıkoglu T, et al. Impulse oscillometry in acute and stable asthmatic children: a comparison with spirometry[J]. J Asthma, 2016, 53(2): 179-186.
doi: 10.3109/02770903.2015.1081699 pmid: 26367097 |
[31] |
Shin YH, Jang SJ, Yoon JW, et al. Oscillometric and spirometric bronchodilator response in preschool children with and without asthma[J]. Can Respir J, 2012, 19(4): 273-277.
doi: 10.1155/2012/560323 pmid: 22891189 |
[32] |
Rao DR, Gaffin JM, Baxi SN, et al. The utility of forced expiratory flow between 25% and 75% of vital capacity in predicting childhood asthma morbidity and severity[J]. J Asthma, 2012, 49(6): 586-592.
doi: 10.3109/02770903.2012.690481 pmid: 22742446 |
[33] |
Galant SP, Morphew T, Guijon O, et al. The bronchodilator response as a predictor of inhaled corticosteroid responsiveness in asthmatic children with normal baseline spirometry[J]. Pediatr Pulmonol, 2014, 49(12): 1162-1169.
doi: 10.1002/ppul.v49.12 |
[34] |
Fernandes AL, Amorim MM, Caetano LB, et al. Bronchodilator response as a hallmark of uncontrolled asthma: a randomised clinical trial[J]. J Asthma, 2014, 51(4): 405-410.
doi: 10.3109/02770903.2013.878845 pmid: 24404797 |
[35] | 中国医药教育协会儿科专业委员会, 中华医学会儿科学分会呼吸学组, 中华医学会儿科学分会新生儿学组, 等. 支气管肺发育不良的儿童期管理专家共识[J]. 中华实用儿科临床杂志, 2022, 37(20): 1527-1538. |
[36] |
Simpson SJ, Turkovic L, Wilson AC, et al. Lung function trajectories throughout childhood in survivors of very preterm birth: a longitudinal cohort study[J]. Lancet Child Adolesc Health, 2018, 2(5): 350-359.
doi: S2352-4642(18)30064-6 pmid: 30169268 |
[37] |
Islam JY, Keller RL, Aschner JL, et al. Understanding the short- and long-term respiratory outcomes of prematurity and bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2015, 192(2): 134-156.
doi: 10.1164/rccm.201412-2142PP |
[38] |
Duijts L, van Meel ER, Moschino L, et al. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia[J]. Eur Respir J, 2020, 55(1): 1900788.
doi: 10.1183/13993003.00788-2019 |
[39] |
Doyle LW, Andersson S, Bush A, et al. Expiratory airflow in late adolescence and early adulthood in individuals born very preterm or with very low birthweight compared with controls born at term or with normal birthweight: a meta-analysis of individual participant data[J]. Lancet Respir Med, 2019, 7(8): 677-686.
doi: 10.1016/S2213-2600(18)30530-7 pmid: 31078498 |
[40] |
Barker AF, Bergeron A, Rom WN, et al. Obliterative bronchiolitis[J]. N Engl J Med, 2014, 370(19): 1820-1828.
doi: 10.1056/NEJMra1204664 |
[41] | Jerkic S P, Brinkmann F, Calder A, et al. Postinfectious bronchiolitis obliterans in children: diagnostic workup and therapeutic options: a workshop report[J]. Can Respir J, 2020, 2020: 5852827. |
[42] | 仲玉强. 肥胖对支气管哮喘患儿肺功能和炎性因子的影响[J]. 中华实用儿科临床杂志, 2016, 31(21): 1668-1670. |
[43] |
Barjaktarevic I, Kaner R, Buhr RG, et al. Bronchodilator responsiveness or reversibility in asthma and COPD - a need for clarity[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13: 3511-3513.
doi: 10.2147/COPD |
[44] |
Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests[J]. Eur Respir J, 2005, 26(5): 948-968.
doi: 10.1183/09031936.05.00035205 pmid: 16264058 |
[1] | 罗明静, 余嘉明, 王晓东, 张小玲, 余阅, 张瑜, 文飞球, 刘四喜. 424例地中海贫血患儿异基因造血干细胞移植后继发侵袭性真菌病临床分析[J]. 临床儿科杂志, 2025, 43(1): 21-28. |
[2] | 刘冬霞, 金蓉, 林荣军. 儿童重症难治性肺炎支原体肺炎并发闭塞性支气管炎危险因素分析[J]. 临床儿科杂志, 2025, 43(1): 29-34. |
[3] | 钟瑾虹, 王灿, 陈芳. 婴幼儿纤维支气管镜诊疗中镇静技术的研究进展[J]. 临床儿科杂志, 2025, 43(1): 50-55. |
[4] | 蒋卫芹, 王静, 程安娜, 陈婷婷, 黄玉娟. 儿童热性惊厥急性期惊厥复发的危险因素分析[J]. 临床儿科杂志, 2025, 43(1): 8-13. |
[5] | 邱琇, 韦冬梅, 林珊珊, 夏慧敏, 周文浩. 广州出生队列研究的理念与实践[J]. 临床儿科杂志, 2024, 42(9): 747-752. |
[6] | 陈倩, 田英, 孙锟, 张军. 关注环境、立足疾病的大型出生队列研究平台[J]. 临床儿科杂志, 2024, 42(9): 753-757. |
[7] | 范建霞. 健康生命轨迹计划缘起与发展:社区-家庭-母婴多层面儿童超重与肥胖干预研究队列[J]. 临床儿科杂志, 2024, 42(9): 768-773. |
[8] | 姜涛, 李双杰, 唐莲, 欧阳文献. 慢性乙型肝炎患儿外周血MAIT细胞的免疫生物学特性[J]. 临床儿科杂志, 2024, 42(9): 787-790. |
[9] | 周洁, 刘克强, 王金玲, 王莹. MYH11延长突变导致巨膀胱-小结肠-肠蠕动不良综合征1例报告及文献复习[J]. 临床儿科杂志, 2024, 42(9): 798-804. |
[10] | 褚思嘉, 汤继宏. 儿童急性淋巴细胞白血病及其治疗所伴发的中枢神经系统损伤研究进展[J]. 临床儿科杂志, 2024, 42(9): 811-816. |
[11] | 丁亚平, 夏姗姗, 张晨美. 《2023年国际儿童肾脏营养工作组临床实践建议:儿童急性肾损伤的营养管理》解读[J]. 临床儿科杂志, 2024, 42(8): 667-672. |
[12] | 李怡蓉, 李惠萍, 高靖瑜, 肖玉华, 陈小敏, 卢艳玲, 赵娜娜, 冯晓勤. FLAG-IDA诱导化疗方案中不同剂量阿糖胞苷治疗儿童急性髓系白血病疗效比较[J]. 临床儿科杂志, 2024, 42(8): 673-677. |
[13] | 黄博, 董艳迎, 宋琳岚. 儿童传染性单核细胞增多症348例临床特征分析[J]. 临床儿科杂志, 2024, 42(8): 678-683. |
[14] | 王丹, 邵静波, 李红, 张娜, 朱嘉莳, 付盼, 王真. 儿童血液系统恶性肿瘤并发肿瘤溶解综合征38例临床特点分析[J]. 临床儿科杂志, 2024, 42(8): 684-690. |
[15] | 马岩, 韦性娇, 白华, 张艳, 田新敏, Aqsa Ahmad, 梁丽俊. 西部地区某三甲医院儿童慢性肾脏病5期病因构成及临床特征分析[J]. 临床儿科杂志, 2024, 42(8): 697-703. |
|