体外过敏原与脉冲振荡肺功能测定在儿童咳嗽变异性哮喘中的作用

Roles of allergen testing in vitro and impulse oscillometry for lung function measurements in children with cough variant asthma

摘要:

目的：研究体外过敏原与脉冲振荡肺功能测定在学龄前儿童咳嗽变异性哮喘中的作用。方法：哮喘急性发作组（哮喘急性组）44例，哮喘非急性发作组（哮喘非急性组）41例，咳嗽变异性哮喘组（变异性组）46例，正常对照组35例儿童纳入本次研究。对各组进行血吸入过敏原、食入过敏原筛查和尘螨特异性IgE检测，同时检测血总IgE和血嗜酸性粒细胞阳离子蛋白（ECP），并进行脉冲振荡肺功能测定。结果：哮喘急性组、哮喘非急性组、变异性组吸入过敏原、食入过敏原阳性率、总IgE水平明显高于对照组，3个病例组之间差异无统计学意义；变异性组血ECP水平低于哮喘急性组(P<0.01)，与哮喘非急性组差异无统计学意义。脉冲振荡肺功能检测显示变异性组、哮喘急性组，哮喘非急性组的呼吸总组抗（Zrs）、总呼吸黏性阻力（R5）、中心气道黏性阻力（R20）、周边气道黏性阻力（R5-R20）、共振频率（Fres）均明显高于对照组(P<0.01)；变异性组、哮喘非急性组的Zrs、R5、R20、R5-R20、Fres均明显低于哮喘急性组(P<0.01)。变异性组、哮喘非急性组Zrs、R5、R5-R20、Fres与血ECP呈正相关(P<0.05)。结论：检测血过敏原、ECP、脉冲振荡肺功能有助于了解学龄前儿童咳嗽变异性哮喘气道炎症变化及气道阻塞情况。

Abstract:

OBJECTIVE: To study the roles of allergen testing in vitro and impulse oscillometry for lung function measurements in preschool children with cough variant asthma (CVA). METHODS: ethodsForty-four preschool children with acute asthma, 41 with chronic asthma, 46 with CVA, and 35 healthy preschool children as control were recruited in the study. Inhaled allergen, food allergen, and mite-specific IgE were determined by Pharmacia UniCAP System. Serum eosinophil cationic protein (ECP) and total IgE levels were measured. Lung function was assessed by impulse oscillometry. RESULTS: The positive rates of inhaled allergen and food allergen, and total IgE levels in the CVA, acute asthma and chronic asthma groups were higher than those in the control group (P<0.01). However, no significant differences were found among the three case groups. The serum ECP levels in the CVA group were lower than those in the acute asthma group (P<0.01), but did not show differences when compared with the chronic asthma group. The impulse oscillometry demonstrated that the respiratory total impedance (Zrs), airway resistance at 5 Hz (R5), airway resistance at 20 Hz (R20), subtracting R5 from R20 (R5-R20) and resonant frequency (Fres) in the CVA, acute asthma and chronic asthma groups were higher than those in the control group (P<0.01). Zrs, R5, R20, R5-R20, and Fres in the CVA and chronic asthma groups were lower than those in the acute asthma group (P<0.01). Serum ECP levels were positively correlated with Zrs, R5, R5-R20 and Fres (P<0.05) in the CVA and chronic asthma groups. CONCLUSIONS: The measurements of allergens, serum ECP and impulse oscillometry for lung function are helpful for the evaluation of airway inflammation and airway obstruction in preschool children with CVA.