儿童阻塞性通气功能障碍判断参数的临床分析

doi:10.12372/jcp.2023.23e0183

摘要/Abstract

摘要：

目的对儿童阻塞性通气功能障碍的相关肺功能参数进行临床合理性分析。方法选取2021年1月至12月在呼吸科就诊并完成肺功能检查的6~18岁患儿，以1岁为年龄间隔分组。检测用力肺活量（FVC）、最大肺活量（VC_max）、第1秒用力呼气容积（FEV₁）、FEV₁/FVC、FEV₁/VC_max等肺功能参数，分析FEV₁/FVC实测值和实测值/预计值、FEV₁/VC_max实测值和实测值/预计值分别在临床判读阻塞性通气功能障碍时的一致情况。结果纳入儿童7 025例，男4 543例、女2 482例，平均年龄（8.6±2.5）岁，以6~10岁儿童为最多，共4 769例（67.9%）。除10~11岁、11~12岁组不同性别间的FEV₁差异无统计学意义（P>0.05）以外，其他年龄组不同性别间FEV₁、FVC、VC_max差异均有统计学意义（P<0.05），FEV₁、FVC、VC_max均为男性大于女性。除15~16岁、16~17岁组以外，其他各年龄组不同性别之间FEV₁/FVC实测值和实测值/预计值差异均有统计学意义（P<0.05）；除13~14岁、16~17岁组以外，其他各年龄组不同性别之间FEV₁/VC_max实测值和实测值/预计值差异均有统计学意义（P<0.05），女性FEV₁/FVC、FEV₁/VC_max的实测值和实测值/预计值均高于男性。FEV₁/FVC实测值<80%和FEV₁/FVC实测值/预计值<92%的判读不一致率为6.8%，FEV₁/FVC实测值和FEV₁/VC_max实测值判读不一致率为5.0%，最终得出理想的FEV₁/VC_max实测值/预计值为93.9%。结论建议FEV₁/VC_max的实测值/预计值<93.9%可作为判读儿童阻塞性通气功能障碍的临床参考标准。

关键词: 哮喘, 阻塞性通气功能障碍, 肺活量, 儿童

Abstract:

Objective To analyze the clinical rationality of pulmonary function parameters associated with obstructive ventilation dysfunction in children. Methods Children aged 6-18 years who attended the respiratory department and completed pulmonary function tests from January to December 2021 were selected and grouped at an age interval of one year. The relevant lung function parameters such as forced vital capacity (FVC), maximum vital capacity (VC_max), forced expiratory volume in the first second (FEV₁), FEV₁/FVC, FEV₁/VC_max were detected. The clinical consistency between measured and measured/predicted value of FEV₁/FVC, measured and measured/predicted value of FEV₁/VC_max, respectively, in the interpretation of obstructive lesions was compared. Results A total of 7025 children were enrolled, including 4543 males and 2482 females with median age of (8.6±2.5) years old, with the largest number of children aged 6-10 years old. Except for 10-11 and 11-12 age group, the volume correlation parameters FVC, VC_max and FEV₁ were greater in males than in females, and their absolute values increased with the increase of age. There was a slight difference between VC_max and FVC in all age groups, and VC_max was slightly higher than FVC. The measured and predicted values of FEV₁/FVC in females were higher than those in males except 15-16 and 16-17 age group. The measured and predicted values of FEV₁/VC_max for females were higher than those for males except for 13-14 and 16-17 age group. When the measured value of FEV₁/FVC < 80% and the measured/predicted value of FEV₁/FVC < 92%, the interpretation inconsistency rate is 6.8%, and the interpretation inconsistency rate between the measured value of FEV₁/FVC and the measured value of FEV₁/VC_max is 5.0%. Finally, the ideal FEV₁/VC_max measured/predicted value is 93.9%. Conclusions The measured/predicted value of FEV₁/VC_max<93.9% can be used as a clinical reference standard for the interpretation of obstructive ventilation dysfunction in children.

Key words: asthma, obstructive ventilation dysfunction, vital capacity, child

邬宇芬, 董文芳, 潘春红, 张皓. 儿童阻塞性通气功能障碍判断参数的临床分析[J]. 临床儿科杂志, 2023, 41(5): 339-345.

WU Yufen, DONG Wenfang, PAN Chunhong, ZHANG Hao. Clinical analysis of the criteria of obstructive ventilation dysfunction in children in Shanghai[J]. Journal of Clinical Pediatrics, 2023, 41(5): 339-345.

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组别	性别/例				t值	P	身高/cm		t值	P
组别	男	女	男	女	t值	P	男	女	t值	P
6~7岁	1 094	662	23.9±5.6	22.4±4.1	6.30	<0.001	120.5±5.7	119.3±6.2	4.36	<0.001
7~8岁	769	396	25.6±6.4	25.3±4.9	6.25	<0.001	127.3±6.6	125.7±6.3	4.28	<0.001
8~9岁	642	362	31.5±6.7	28.6±5.7	6.81	<0.001	133.5±6.3	132.1±4.0	3.15	0.002
9~10岁	547	297	34.8±7.4	31.9±6.8	5.54	<0.001	138.8±6.8	136.8±6.7	4.09	0.000
10~11岁	524	236	40.2±9.8	37.3±8.6	4.04	<0.001	144.7±7.0	145.3±7.7	0.96	0.339
11~12岁	317	170	45.1±11.2	42.6±9.4	2.54	0.012	150.5±7.6	150.3±8.2	0.21	0.837
12~13岁	270	131	50.5±12.5	47.2±10.4	2.66	0.005	157.6±7.8	155.4±7.4	2.71	0.007
13~14岁	149	100	54.9±12.9	49.8±9.9	3.53	<0.001	165.2±8.2	158.2±5.7	7.98	<0.001
14~15岁	116	80	60.7±13.6	50.5±9.4	6.22	<0.001	168.6±7.7	160.0±9.4	7.88	<0.001
15~16岁	60	23	60.2±16.8	54.3±9.4	2.01	0.048	171.5±9.8	159.3±10.0	4.85	<0.001
16~17岁	39	17	63.4±20.6	51.2±10.9	2.31	0.025	171.5±11.7	160.4±12.9	3.15	<0.001
17~18岁	16	8	64.3±18.9	55.8±7.4	1.21	0.240	170.3±13.9	156.3±4.5	2.75	0.012

组别	FEV₁/L		t值	P	FVC/L		t值	P
组别	男	女	t值	P	男	女	t值	P
6~7岁	1.3±0.2	1.3±0.3	4.42	<0.001	1.6±0.3	1.5±0.3	7.36	<0.001
7~8岁	1.5±0.3	1.5±0.3	5.04	<0.001	1.8±0.3	1.7±0.3	6.94	<0.001
8~9岁	1.7±0.3	1.6±0.3	6.98	<0.001	2.1±0.3	1.9±0.3	9.10	<0.001
9~10岁	1.9±0.4	1.7±0.3	6.00	<0.001	2.3±0.4	2.0±0.4	9.33	<0.001
10~11岁	2.0±0.4	2.0±0.4	1.83	0.068	2.5±0.4	2.3±0.5	4.17	<0.001
11~12岁	2.3±0.5	2.2±0.5	1.30	0.193	2.8±0.5	2.6±0.6	3.34	0.001
12~13岁	2.6±0.6	2.5±0.5	2.19	0.029	3.2±0.7	2.9±0.5	4.82	<0.001
13~14岁	3.0±0.6	2.5±0.6	6.01	<0.001	3.6±0.8	2.9±0.6	7.93	<0.001
14~15岁	3.3±0.7	2.6±0.6	6.65	<0.001	4.0±0.8	3.0±0.6	9.54	<0.001
15~16岁	3.3±0.9	2.7±0.4	4.03	<0.001	4.0±1.0	3.1±0.4	5.63	<0.001
16~17岁	3.7±0.9	2.7±0.8	4.02	<0.001	4.2±1.1	3.1±0.8	3.77	<0.001
17~18岁	3.3±1.0	2.6±0.4	2.46	0.022	4.3±1.3	3.0±0.3	2.66	0.014

组别	VC_max (x±s)/L		t值	P	VC_max-FVC[M(P₂₅~P₇₅)]/L		Z值	P
组别	男	女	t值	P	男	女	Z值	P
6~7岁	1.6±0.3	1.5±0.3	7.26	<0.001	0.03(0~0.04)	0.02(0~0.03)	0.50	0.619
7~8岁	1.9±0.3	1.7±0.3	7.22	<0.001	0.03(0~0.04)	0.02(0~0.03)	1.08	0.280
8~9岁	2.1±0.3	1.9±0.3	9.69	<0.001	0.04(0~0.05)	0.02(0~0.03)	2.70	0.007
9~10岁	2.3±0.4	2.1±0.4	9.20	<0.001	0.03(0~0.04)	0.03(0~0.04)	0.47	0.642
10~11岁	2.5±0.4	2.4±0.5	4.43	<0.001	0.04(0~0.05)	0.03(0~0.04)	2.04	0.042
11~12岁	2.8±0.5	2.6±0.6	3.46	0.001	0.04(0~0.06)	0.03(0~0.04)	1.54	0.124
12~13岁	3.3±0.5	5.0±0.5	4.96	<0.001	0.05(0~0.07)	0.04(0~0.05)	2.20	0.028
13~14岁	3.7±0.8	2.9±0.6	7.99	<0.001	0.05(0~0.07)	0.04(0~0.04)	1.17	0.240
14~15岁	4.0±0.8	3.0±0.6	9.53	<0.001	0.06(0~0.10)	0.04(0~0.04)	2.04	0.041
15~16岁	4.1±1.0	3.1±0.4	4.36	<0.001	0.08(0~0.13)	0.02(0~0.01)	3.55	<0.001
16~17岁	4.3±1.1	3.1±0.8	3.86	<0.001	0.08(0~0.13)	0.04(0~0.06)	1.76	0.079
17~18岁	4.3±1.3	3.0±0.3	3.69	0.002	0.03(0~0.06)	0.02(0~0.01)	0.46	0.647

组别	FEV₁/FVC实测值		t值	P	FEV₁/FVC实测值/预计值		t值	P
组别	男	女	t值	P	男	女	t值	P
6~7岁	84.2±7.7	86.4±7.1	6.08	<0.001	98.3±9.0	100.9±8.3	5.97	<0.001
7~8岁	83.7±7.4	85.1±7.3	2.91	0.004	98.1±8.7	99.6±8.5	2.77	0.006
8~9岁	83.0±7.0	84.2±7.6	2.53	0.012	97.5±8.2	99.9±8.9	2.43	0.015
9~10岁	81.4±8.1	84.1±7.9	4.65	<0.001	95.9±9.6	99.0±9.3	4.52	<0.001
10~11岁	81.4±7.8	84.3±8.4	4.57	<0.001	96.2±9.2	99.7±9.9	4.62	<0.001
11~12岁	81.3±8.3	84.7±7.5	4.44	<0.001	96.3±9.8	100.3±8.9	4.42	<0.001
12~13岁	81.5±7.3	85.0±9.2	3.81	<0.001	97.0±8.7	101.0±10.9	3.72	<0.001
13~14岁	84.5±7.6	87.1±11.7	2.11	<0.001	100.9±9.1	103.7±13.9	1.74	0.084
14~15岁	82.6±7.8	88.8±9.2	5.07	<0.001	98.7±9.3	105.7±11.0	4.76	<0.001
15~16岁	83.2±12.5	87.1±7.7	1.39	0.168	99.6±14.9	103.7±9.1	1.23	0.222
16~17岁	88.9±9.7	87.6±4.8	0.52	0.604	106.5±11.5	104.4±5.8	0.91	0.369
17~18岁	78.0±8.2	85.3±6.3	2.21	0.038	93.3±9.9	101.4±7.4	2.24	0.038

组别	FEV₁/VC_max实测值		t值	P	FEV₁/VC_max实测值/预计值		t值	P
组别	男	女	t值	P	男	女	t值	P
6~7岁	82.8±7.7	85.0±7.1	6.09	<0.001	96.7±8.9	99.3±8.3	6.10	<0.001
7~8岁	82.4±7.4	83.9±7.4	3.08	0.002	96.5±8.5	98.0±8.5	7.10	0.004
8~9岁	81.5±6.8	83.1±7.5	3.26	0.001	95.8±8.0	97.6±8.8	3.26	0.001
9~10岁	80.3±8.0	83.0±7.9	4.76	<0.001	94.6±9.5	97.7±9.2	4.63	<0.001
10~11岁	80.1±7.9	83.3±8.2	5.05	<0.001	94.6±9.3	98.1±9.6	5.10	<0.001
11~12岁	80.2±8.3	83.7±7.6	4.61	<0.001	95.0±9.8	99.2±8.9	4.59	<0.001
12~13岁	80.3±7.3	84.0±9.0	4.13	<0.001	95.4±8.7	99.8±10.6	4.04	<0.001
13~14岁	83.3±7.8	85.9±11.6	2.08	0.038	99.4±9.2	102.2±13.8	1.87	0.062
14~15岁	81.3±7.8	87.5±9.0	5.11	<0.001	97.2±9.3	104.1±10.7	4.80	<0.001
15~16岁	81.3±12.1	86.6±7.4	2.44	0.018	97.3±14.4	103.1±8.7	2.24	<0.001
16~17岁	87.2±9.50	86.7±4.2	0.26	0.795	104.4±11.3	103.2±5.0	0.52	0.605
17~18岁	77.3±8.5	84.8±6.4	2.20	0.036	92.5±10.3	100.8±7.7	2.21	0.040