阻断阻力肺功能检查在学龄前儿童哮喘诊断中应用的单中心研究

Application of interrupter resistance pulmonary function testing in the diagnosis of asthma in preschool children: a single-center study

摘要:

目的 探讨阻断阻力（interrupter resistance, Rint）肺功能检查对学龄前儿童哮喘的诊断价值，同时对比Rint肺功能检查和脉冲振荡（impulse oscillometry, IOS）对哮喘的诊断意义。方法 前瞻性收集2022年7月—2023年11月收治的4~<6岁反复喘息儿童108例为研究对象，根据结局分为哮喘组（n=61）和非哮喘组（n=47）。对2组患儿的Rint、IOS肺功能参数等进行分析，并比较两者的可行性及价值。结果 哮喘组中Rint实测值/预计值百分比、Rint实测值改善率、Rint预计值改善率高于非哮喘组（P<0.05）。受试者操作特征曲线结果显示，Rint预计值改善率诊断学龄前儿童哮喘的最佳截断值为32.0%，曲线下面积为0.705，灵敏度为41.0%，特异度为91.5%（P<0.05）。在完成度方面，有18例（16.7%）患儿未能完成IOS检查，但是可以顺利完成Rint肺功能检查，且质控良好。Rint肺功能检查及IOS各参数对学龄前儿童哮喘诊断的曲线下面积比较差异均无统计学意义（P>0.05）。结论 Rint肺功能检查可用于辅助诊断学龄前儿童哮喘，其诊断价值与IOS相当，且具有较高的可行性。支气管舒张试验提示Rint预计值改善率≥32%可作为哮喘诊断的截断值。

Abstract:

Objective To investigate the value of interrupter resistance (Rint) pulmonary function testing in the diagnosis of asthma in preschool children, and to compare the significance of Rint pulmonary function testing versus impulse oscillometry (IOS) in the diagnosis of asthma.Methods A prospective study was conducted among 108 children with recurrent wheezing, aged 4 to <6 years, who were admitted from July 2022 to November 2023. According to the treatment outcome, they were divided into an asthmatic group (61 children) and a non-asthmatic group (47 children). Rint pulmonary function parameters and IOS parameters were analyzed for both groups, and the two tests were compared in terms of feasibility and diagnostic value.Results Compared with the non-asthmatic group, the asthmatic group had significantly higher percentage of actual measured value to predicted value for Rint and percent changes in the measured value and predicted value of Rint (P<0.05). The receiver operating characteristic curve analysis showed that the percent change in the predicted value of Rint had an optimal cut-off value of 32.0% in the diagnosis of asthma in preschool children, with an area under the curve (AUC) of 0.705, a sensitivity of 41.0%, and a specificity of 91.5% (P<0.05). In terms of the degree of completion, 18 children (16.7%) failed to complete the IOS test, but they could successfully complete Rint pulmonary function testing with good quality control. Rint pulmonary function testing and IOS had a similar area under the curve in the diagnosis of asthma in preschool children (P>0.05).Conclusions Rint pulmonary function testing can be used to assist in the diagnosis of asthma in preschool children, with a similar diagnostic value to IOS and a relatively high level of feasibility. A percent change of ≥32% in the predicted value of Rint in the bronchial dilation test can be used as a cut-off value for the diagnosis of asthma in preschool children.