超重和肥胖与哮喘患儿肺功能的相关性研究

doi:10.12372/jcp.2024.23e0554

摘要/Abstract

摘要：

目的研究超重和肥胖与哮喘患儿肺功能的相关性。方法选取2022年7月—2022年9月在呼吸科门诊就诊的368例哮喘患儿，根据体重指数（BMI）分为非超重肥胖组235例（63.8%）、超重组57例（15.5%）、肥胖组76例（20.7%），检测3组患儿肺功能的指标。包括用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、1秒率（FEV₁/FVC），用力呼出25%肺活量时的瞬间流量（FEF₂₅）、用力呼出50%肺活量时的瞬间流量（FEF₅₀）、用力呼出75%肺活量时的瞬间流量（FEF₇₅），用力呼气中期流量（FEF_25~75），呼气峰值流量（PEF）。结果在超重和肥胖患儿中，哮喘控制不良的比例更高，与非超重肥胖组比较，差异有统计学意义（P<0.05）。在368例哮喘患儿中，BMI数值和FEV₁/FVC呈负相关（r=-0.22，P<0.05），与FVC、FEV₁、FEF₂₅、FEF₅₀、FEF₇₅、FEF_25~75各指标呈正相关（P<0.05）。在急性发作期及缓解期患儿中，BMI数值和肺功能各指标的相关性表现结果同前。结论超重和肥胖患儿中，哮喘控制不良的比例更高。随着BMI数值的升高，哮喘患儿的FEV₁/FVC呈下降趋势，超重和肥胖对哮喘患儿的负面影响主要表现在中央气道。

关键词: 肥胖, 超重, 哮喘, 肺功能, 儿童

Abstract:

Objective To study the correlation between overweight and obesity and lung function in children with asthma. Methods A total of 368 children with asthma attending the respiratory outpatient clinic from July 2022 to September 2022 were selected and categorized into 235 cases (63.8%) in the non-overweight and obese group, 57 cases (15.5%) in the overweight group, and 76 cases (20.7%) in the obese group according to the body mass index (BMI), and the indexes of lung function were tested in the three groups of children. These included forced vital capacity (FVC), forced expiratory volume at the end of the first second (FEV₁), one-second rate (FEV₁/FVC), forced expiratory flow rate (FEF) accounted for 25%, 50%, 75% of forced vital capacity (FEF₂₅, FEF₅₀, FEF₇₅), forced expiratory flow rate in the middle period (FEF_25-75), peak expiratory flow (PEF). Results Among overweight and obese children, the proportion of poorly controlled asthma was higher, and the difference was statistically significant when compared with the non-overweight and obese group (P<0.05). Among 368 children with asthma, BMI values were negatively correlated with FEV₁/FVC (r=-0.22, P<0.05) and positively correlated with each of the FVC, FEV₁, FEF₂₅, FEF₅₀, FEF₇₅, and FEF_25-75 (P<0.05). In children with acute exacerbation and remission, the results of correlation between BMI values and lung function indicators were the same as before. Conclusions The proportion of poorly controlled asthma was higher in overweight and obese children. With the increase of BMI, the FEV₁/FVC of children with asthma showed a decreasing trend. Therefore, the negative effects of overweight and obesity on children with asthma were mainly manifested in the central airway.

Key words: obesity, overweight, asthma, lung function, children

李丹, 张睿, 刘峰, 赵德育. 超重和肥胖与哮喘患儿肺功能的相关性研究[J]. 临床儿科杂志, 2024, 42(5): 429-433.

LI Dan, ZHANG Rui, LIU Feng, ZHAO Deyu. Correlation between overweight and obesity and lung function in children with asthma[J]. Journal of Clinical Pediatrics, 2024, 42(5): 429-433.

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项目	非超重肥胖（n=235）	超重（n=57）	肥胖（n=76）	P
年龄/岁	8（6~9）	8（6~10）	8（6~10）	0.601
BMI	15.3(14.1~16.4)	18.3(17.5~20.7)	21.6(19.8~23.7)	<0.001
FVC	1.5（1.2~1.8）	1.7（1.3~2.2）	1.8（1.5~2.4）	<0.001
FVC%	75.9（69.3~83.3）	77.4（70.3~85.5）	83.0（76.8~88.9）	<0.001
FEV₁	1.5（1.2~1.8）	1.6（1.3~2.1）	1.7（1.5~2.2）	<0.001
FEV₁%	87.7（80.5~95.3）	89.0（77.2~97.5）	93.7（86.8~102.9）	<0.001
FEV₁/FVC	100.0（95.3~100.0）	99.7（92.6~100.0）	98.1（93.2~100.0）	0.335
PEF	3.3（2.8~4.1）	3.7（2.8~4.2）	3.8（3.1~4.5）	0.012
PEF%	84.4（76.3~94.2）	82.2（71.0~93.8）	86.2（76.7~94.8）	0.603
FEF₂₅	3.0（2.6~3.8）	3.4（2.6~3.8）	3.4（2.8~4.2）	0.012
FEF₅₀	2.1（1.7~2.6）	2.3（1.9~2.9）	2.5（2.0~2.9）	0.004
FEF₇₅	1.2（1.0~1.6）	1.4（1.0~1.7）	1.4（1.1~1.8）	0.003
FEF_25~75	2.0（1.6~2.5）	2.2（1.7~2.7）	2.3（1.9~2.9）	0.002
FEF_25~75%	90.1（75.7~104.4）	92.9（73.4~113.3）	96.1（78.2~116.0）	0.097

BMI	FVC	FVC%	FEV₁	FEV₁%	FEV₁/FVC	PEF	PEF%	FEF₂₅	FEF₅₀	FEF₇₅	FEF_25~75	FEF_25~75%
r^1）	0.512	0.204	0.503	0.152	-0.220	0.408	-0.013	0.387	0.365	0.324	0.381	0.054
P	<0.001	<0.001	<0.001	0.003	<0.001	<0.001	0.802	<0.001	<0.001	<0.001	<0.001	0.302

BMI	FVC	FVC%	FEV₁	FEV₁%	FEV₁/FVC	PEF	PEF%	FEF₂₅	FEF₅₀	FEF₇₅	FEF_25~75	FEF_25~75%
急性发作期
r	0.511	0.320	0.512	0.288	-0.238	0.461	0.180	0.441	0.383	0.311	0.391	0.167
P	<0.001	0.003	<0.001	0.007	0.027	<0.001	0.096	<0.001	<0.001	0.004	<0.001	0.125
缓解期
r	0.568	0.204	0.570	0.157	-0.194	0.452	-0.044	0.438	0.463	0.435	0.479	0.083
P	<0.001	0.002	<0.001	0.016	0.003	<0.001	0.499	<0.001	<0.001	<0.001	<0.001	0.204
慢性持续期
r	0.499	0.448	0.491	0.401	-0.188	0.388	0.244	0.407	0.301	0.277	0.335	0.110
P	<0.001	0.001	<0.001	0.005	0.200	0.006	0.094	0.004	0.037	0.056	0.020	0.455