脉冲振荡肺功能与黏附分子在儿童哮喘中的临床意义

Values of impulse oscillometry for pulmonary function and adhesion molecules in childhood asthma

摘要:

目的：脉冲振荡肺功能是近年来开展的一项肺功能测定新技术, 特别适用于学龄前儿童，但目前有关报道不多，且尚无统一正常值。可溶性细胞间黏附分子-1（sICAM-1）、内皮细胞黏附分子-1（sVCAM-1）是已明确的反映哮喘严重程度的指标,该文旨在探讨上述指标在儿童哮喘中的临床意义。方法：应用Master Screen系列肺功能测定系统，对25例健康儿童、40例哮喘发作期儿童用脉冲振荡法（IOS)进行肺功能检测，其中23 例患儿激素治疗达缓解期后再次检测；同时对部分上述儿童（发作期23例，缓解期20例, 对照组16例）进行sICAM-1、sVCAM-1水平检测。 结果：IOS肺功能测试发作期R5，R20，R5-R20，X5，Fres，Zrs均高于对照组和缓解组，差异均有显著性(q= 2.91 ~15.61，P<0.01或P<0.05)，缓解期与对照组比较，R5，R5-R20，Fres，Zrs差异有显著性(q=3.08~9.19，P<0.01或 P<0.05)。发作期血清sICAM-1，sVCAM-1明显高于缓解期及对照组(q= 6.23~26.15，P＜0.01）,而缓解期仍高于对照组(q=16.86,12.46, P<0.01)。发作期sICAM-1，sVCAM-1与R5-R20呈正相关（r=0.45,0.57 P<0.05） 结论：IOS肺功能和sICAM-1、sVCAM-1都可以作为儿童哮喘病情严重程度和治疗效果的评价指标，两者之间有一定的相关性，IOS肺功能测定简便、无创,适合于学龄前儿童。［中国当代儿科杂志，2007，9（5）：415-418］

Abstract:

OBJECTIVE: Impulse oscillometry (IOS) is a novel technique for the evaluation of pulmonary function. Soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) are definitive indicators for the severity of asthma. This study aimed to explore the relationship of IOS pulmonary function with sICAM-1 and sVCAM-1, and their values in childhood asthma. METHODS: IOS via Master Screen System for pulmonary function was performed in 40 children with acute asthma and 25 healthy children. Twenty-three of 40 children with acute asthma were re-tested for IOS pulmonary function at remission. sICAM-1 and sVCAM-1 levels were measured in 23 children with acute asthma, 20 asthmatic children at remission and 16 healthy children. RESULTS: The parameters of IOS pulmonary function, R5, R20, R5-R20, X5, Fres and Zrs in children with acute asthma were significantly higher than in asthmatic children at remission and in normal controls (q= 2.91-15.61, P< 0.01 or 0.05). There were significant differences in R5, R5-R20, Fres and Zrs between the asthmatic children at remission and normal controls (q= 3.08- 9.19, P< 0.01 or 0.05). sICAM-1 and sVCAM-1 levels in children with acute asthma were significantly higher than in asthmatic children at remission and in normal controls (q= 6.23-26.15, P< 0.01). The asthmatic children at remission had higher levels of sICAM-1 and sVCAM-1 than the normal controls (q=16.86, 12.46, P< 0.01). R5-R20 positively correlated with sICAM-1 and sVCAM-1 in children with acute asthma (r=0.45, 0.57, P<0.05). CONCLUSIONS: IOS for pulmonary function and sICAM-1 and sVCAM-1 may be used to evaluate the severity and therapeutic effects of childhood asthma. A correlation exists between IOS pulmonary function and sICAM-1 and sVCAM-1.