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

Abstract

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

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.

Figures/Tables 6

References 21

[1]	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(二): 肺容积和通气功能[J]. 中华实用儿科临床杂志, 2016, 31(10): 744-750.
[2]	朱蕾, 陈荣昌. 成人肺功能诊断规范中国专家共识[J]. 临床肺科杂志, 2022, 27(7): 973-981.
[3]	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.
[4]	张皓, 邬宇芬, 黄剑峰, 等. 儿童肺功能检测及评估专家共识[J]. 临床儿科杂志, 2014, 32(2): 104-114.
[5]	Swanney MP, Ruppel G, Enright PL, et al. Using the lower limit of normal for the FEV₁/FVC reduces the misclassifification of airway obstruction[J]. Thorax, 2008, 63(12): 1046-1051. doi: 10.1136/thx.2008.098483 pmid: 18786983
[6]	Kainu A, Timonen KL, Toikka J, et al. Reference values of spirometry for Finnish adults[J]. Clin Physiol Funct Imaging, 2016, 36(5): 346-358. doi: 10.1111/cpf.2016.36.issue-5
[7]	Stanojevic S. Standardisation of lung function test interpretation: Global Lung Function Initiative[J]. Lancet Respir Med, 2018, 6(1): 10-12. doi: 10.1016/S2213-2600(17)30472-1 pmid: 29226810
[8]	Langhammer A, Johannessen A, Holmen TL, et al. Global Lung Function Initiative 2012 reference equations for spirometry in the Norwegian population[J]. Eur Respir J, 2016, 48(6): 1602-1611. doi: 10.1183/13993003.00443-2016 pmid: 27824594
[9]	Beydon N, Davis SD, Lombardi E, et al. An official American Thoracic Society /European Respiratory Society statement: pulmonary function testing in preschool children[J]. Am J Respir Crit Care Med, 2007, 175(12): 1304-1345. doi: 10.1164/rccm.200605-642ST
[10]	李辉, 张亚钦, 朱宗涵. 1975—2005年中国7岁以下儿童体格发育变化趋势[J]. 中华预防医学杂志, 2009, 43(3): 182-186.
[11]	首都儿科研究所, 九市儿童体格发育调查协作组. 2015年中国九市七岁以下儿童体格发育调查[J]. 中华儿科杂志, 2018, 56(3): 192-199.
[12]	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
[13]	Qvarfordt M, Anderson M, Svartengren M. Quality and learning aspects of the first 9000 spirometries of the LifeGene study[J]. NPJ Prim Care Respir Med, 2018, 28(1): 6. doi: 10.1038/s41533-018-0073-y
[14]	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
[15]	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第二部分)——肺量计检查[J]. 中华结核和呼吸杂志, 2014, 37(7): 481-486.
[16]	江梅, 陈维清, 郑劲平. 肺通气功能正常参考值的研究进展[J]. 中华结核和呼吸杂志, 2013, 36(12): 973-976.
[17]	朱蕾. 肺功能诊断的争议与对策[J]. 中华结核和呼吸杂志, 2015, 38(6): 405-407.
[18]	Perez T, Chanez P, Dusser D, et al. Small airway impairment in moderate to severe asthmatics without significant proximal airway obstruction[J]. Respir Med, 2013, 107(11): 1667-1674. doi: 10.1016/j.rmed.2013.08.009 pmid: 24025779
[19]	Huprikar NA, Skabelund AJ, Bedsole VG, et al. Comparison of forced and slow vital capacity maneuvers in defining airway obstruction[J]. Respir Care, 2019, 64(7): 786-792. doi: 10.4187/respcare.06419 pmid: 30890630
[20]	Schwartz A, Arnold N, Skinner B, et al. Preserved ratio impaired spirometry in a spirometry database[J]. Respir Care, 2021, 66(1): 58-65. doi: 10.4187/respcare.07712 pmid: 32873751
[21]	李硕, 宋欣, 刘传合, 等. 北京市5-14岁儿童肺通气功能正常值的测定[J]. 中华实用儿科临床杂志, 2013, 28(17): 1343-1346.

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

Clinical analysis of the criteria of obstructive ventilation dysfunction in children in Shanghai

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 21

Related Articles 15

Metrics

Comments

Recommended 0

一秒率参数	FEV₁/FVC实测值		总计
一秒率参数	≥80%	<80%	总计
FEV₁/FVC实测值/预计值
≥92%	4 934(70.2)	476(6.8)	5 410(77.0)
<92%	2(0.03)	1 613(23.0)	1 615(23.0)
FEV₁/VC_max实测值
≥80%	4 935(70.3)	0(0)	4 935(70.3)
<80%	354(5.0)	1 736(24.7)	2 090(29.8)

[1]	ZOU Liping. Childhood encephalopathy: a group of diseases associated with various diseases [J]. Journal of Clinical Pediatrics, 2023, 41(9): 641-643.
[2]	ZHANG Weihua, ZOU Liping, REN Haitao, GUAN Hongzhi. Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 644-649.
[3]	HOU Chi, CHEN Wenxiong, LIAO Yinting, WU Wenxiao, TIAN Yang, ZHU Haixia, PENG Bingwei, ZENG Yiru, WU Wenlin, CHEN Zongzong, LI Xiaojing. Clinical analysis of autoimmune glial fibrillary acidic protein astrocytopathy in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 656-660.
[4]	YANG Yating, CAI Yuehao, FANG Qiong, CHEN Lang, CHEN Qiaobin, LIN Zhi, WU Feifei, LIN Meng. Clinical analysis of idiopathic and symptomatic occipital lobe epilepsy in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 668-673.
[5]	HOU Ruolin, WU Jing, LI Ling. Pediatric autoimmune encephalitis with brain MRI showing meningeal thickening and enhancement [J]. Journal of Clinical Pediatrics, 2023, 41(9): 674-679.
[6]	WU Yuefang, SUN Yanling, WU Wanshui, DU Shuxu, LI Miao, SUN Liming. Analysis of prognostic factors and survival status of group 4 medulloblastoma in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 686-691.
[7]	SUN Juan, LI Haiying, JIA Peisheng, WANG Huaili. Clinical analysis of fulminant myocarditis in 12 children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 692-696.
[8]	Reviewer: WANG Chenhui, Reviser: YANG Hui. Research progress on early screening and diagnosis of Crohn's disease in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 708-714.
[9]	SHEN Nan, DU Bailu. Strategies for the diagnosis, treatment, and management of invasive fungal infections in children with hematologic neoplasms [J]. Journal of Clinical Pediatrics, 2023, 41(8): 571-577.
[10]	XU Beixue, LIU Quanbo. Clinical analysis of 195 children with invasive pulmonary fungal infection [J]. Journal of Clinical Pediatrics, 2023, 41(8): 584-588.
[11]	CHEN Hongyu, LIU Zihao, WANG Heping, LIAO Cuijuan, LI Li, WANG Wenjian, LAI Jianwei. Role of nontypeable Haemophilus influenzae biofilms in chronic pulmonary infection in children [J]. Journal of Clinical Pediatrics, 2023, 41(8): 589-593.
[12]	KANG Lei, GUO Fang, LI Lifang, BAI Xinfeng, CHENG Caiyun, XU Meixian. Value of metagenomic next-generation sequencing in children with visceral leishmaniasis associated with hemolytic histiocytosis [J]. Journal of Clinical Pediatrics, 2023, 41(8): 594-598.
[13]	SUN Zhicai, LIU Yuling, LI Xiaolin, PAN Xiaofen. Clinical analysis of 15 children with primary nephrotic syndrome complicated with adrenal crisis [J]. Journal of Clinical Pediatrics, 2023, 41(8): 610-612.
[14]	WANG Hongxia, PAN Xiang, LU Jun. Report a case of α-ketoadipic aciduria caused by compound heterozygous variant of DHTKD1 gene [J]. Journal of Clinical Pediatrics, 2023, 41(8): 624-628.
[15]	XI Bixin, HU Qun, LIU Aiguo. Research advances of the bronchiolitis obliterans syndrome following allogeneic hematopoietic stem cell transplant in children [J]. Journal of Clinical Pediatrics, 2023, 41(8): 629-633.