超重和肥胖与哮喘患儿肺功能的相关性研究
Correlation between overweight and obesity and lung function in children with asthma
Received date: 2023-06-20
Online published: 2024-05-10
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(FEF25~75),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、FEF25~75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。
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 . DOI: 10.12372/jcp.2024.23e0554
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 (FEF25-75), 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 FEF25-75 (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
[1] | 全国儿科哮喘防治协作组. 全国90万0-14儿童中支气管哮喘患病情况调查[J]. 中华结核和呼吸杂志, 1993, 16(哮喘增刊): 64-68. |
[2] | 全国儿科哮喘防治协作组. 中国城区儿童哮喘患病率调查[J]. 中华儿科杂志, 2003, 41(20): 123-127. |
[3] | 全国儿科哮喘防治协作组. 第三次中国城市儿童哮喘流行病学调查[J]. 中华儿科杂志, 2013, 51(10): 729-735. |
[4] | Lang JE, Bunnel HT, Hossain MJ, et al. Being overweight or obese and the development of asthma[J]. Pediatrics, 2018, 142(6): e20182119. |
[5] | Deng XL, Ma J, Yuan Y, et al. Association between overweight or obesity and the risk for childhood asthma and wheeze: An update meta-analysison 18 articles and 73 252 children[J]. Pediatr Obes, 2019, 14(9): e12532. |
[6] | 中华医学会儿科学分会呼吸学组, 《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(2016年版)[J]. 中华儿科杂志, 2016, 54(3): 167-181. |
[7] | 李辉, 季成叶, 宗心南, 等. 中国0-18岁儿童/青少年体重指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7): 493-498. |
[8] | Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update[J]. Curr Allergy Asthma Rep, 2021, 21(12): 46. |
[9] | Reyes-Angel J, Kaviany P, Rastogi D, et al. Obesity-related asthma in children and adolescents[J]. Lancet Child Adolesc Health, 2022, 6(10): 713-724. |
[10] | Forno E, Lescher R, Stmnk R, et al. Decreased response to inhaled steroids in overweight and obese asthmatic children[J]. Allergy Clin Immunol, 2011, 127(3): 741-749. |
[11] | Peters U, Dixon AE, Forno E. Obesity and asthma[J]. Allergy Clin Immunol, 2018, 141(4): 1169-1179. |
[12] | Fitzpatrick AM, Mutic AD, Mohammad AF, et al. Obesity is associated with sustained symptomatology and unique inflammatory features in children with asthma[J]. Allergy Clin Immunol Pract, 2022, 10(3): 815-826. |
[13] | Mcgarry ME, Castellanos E, Thakur N, et al. Obesity and bronchodilator response in black and hispanic children and adolescents with asthma[J]. Chest, 2015, 147 (6): 1591-1598. |
[14] | 吕晓江, 刘增荣, 康迁, 等. 肥胖伴哮喘患儿自身体质指数变化与脂肪因子、肺功能的相关性研究[J]. 四川医学, 2019, 40(11): 1090-1092. |
[15] | Chih AH, Chen YC, Tu YK, et al. Mediating pathways from central obesity to childhood asthma: a population-based longitudinal study[J]. Eur Respir J, 2016, 48(3): 748-757. |
[16] | King GG, Brown NJ, Diba C, et al. The effects of body weight on airway calibre[J]. Eur Respir J, 2005, 25(5): 896-901. |
[17] | Papoutsakis C, Priftis KN, Drakouli M, et al. Childhood overweight/obesity and asthma: is there a link? A systematic review of recent epidemiologic evidence[J]. J Acad Nutr Diet, 2013, 113(1): 77-105. |
[18] | Mahut B, Beydon N, Delclaux C. Overweight is not a comorbidity factor during childhood asthma: the GrowthOb study[J]. Eur Respir J, 2012, 39(5): 1120-1126. |
[19] | 徐晓雯, 黄英, 王健, 等. 肥胖对不同年龄段哮喘患儿肺功能的影响[J]. 中国当代儿科杂志, 2017, 19(5): 519-523. |
[20] | 许志飞, 申昆玲. 儿童肥胖与阻塞性睡眠呼吸暂停/低通气综合征关系的新进展[J]. 中国实用儿科杂志, 2013, 28(1): 9-12. |
[21] | Arismendi E, Bantulá M, Perpi?a M, et al. Effects of obesity and asthma on lung function and airway dysanapsis in adults and children[J]. J Clin Med, 2020, 9(11): 3762. |
[22] | Forno E, Weiner DJ, Mullen J, et al. Obesity and airway dysanapsis in children with and without asthma[J]. Am J Respir Crit Care Med, 2017, 195(3): 314-323. |
[23] | 刘传合, 郑劲平. 正确理解和应用儿童肺功能检测[J]. 中国实用儿科杂志, 2021, 36(6): 408-411. |
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