不同体重指数的哮喘患儿规范化激素治疗后肺功能变化

叶泽慧; 黄英; 王莹; 王冬娟

doi:10.7499/j.issn.1008-8830.2013.11.014

PDF(1315 KB)

中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (11) : 983-986. DOI: 10.7499/j.issn.1008-8830.2013.11.014

论著·临床研究

不同体重指数的哮喘患儿规范化激素治疗后肺功能变化

叶泽慧，黄英，王莹，王冬娟

作者信息 +

Association between body mass index and lung function in children with asthma after corticosteroids inhalation

YE Ze-Hui, HUANG Ying, WANG Ying, WANG Dong-Juan

Author information +

文章历史 +

摘要

目的：研究不同体重指数（BMI）的哮喘患儿经吸入糖皮质激素（ICS）治疗后肺功能的改善情况。方法：157例哮喘患儿根据BMI分为肥胖组（46例）、超重组（50例）和体重正常组（61例），检测所有患儿治疗前及规范化ICS治疗1年后，大气道通气功能指标1秒用力呼气容积（FEV1）、用力肺活量（FVC）及小气道通气功能指标用力呼气25%流量（MEF25）、用力呼气50%流量（MEF50）。结果：治疗前各组患儿行肺功能激发试验，雾化吸入乙酰甲胆碱后肥胖组FVC%、FEV1%、MEF25%及MEF50%下降率均明显高于体重正常组（均P<0.01）；雾化吸入沙丁胺醇后肥胖组FEV1%、MEF25%和MEF50%以及超重组MEF25%和MEF50%改善率均明显低于体重正常组（均P<0.05）。ICS治疗1年后，与治疗前相比，体重正常组FVC%、FEV1%均明显升高，而肥胖组和超重组仅FVC%升高。结论：肥胖能够增加哮喘患儿对乙酰甲胆碱敏感性，而抑制对沙丁胺醇反应性；规律ICS治疗能改善正常体重哮喘患儿大气道通气功能，对小气道通气功能影响较小；肥胖能够抑制ICS对哮喘患儿肺功能的改善作用。

Abstract

OBJECTIVE: To study the association between body mass index (BMI) and lung function of asthmatic children after inhaling corticosteroids (ICS). METHODS: One hundred and fifty-seven children with asthma were classified into obese (46 cases), over-weight (50 cases) and normal-weight groups (61 cases) based on BMI. All of the children received ICS for one year. Pulmonary functions were evaluated before and after treatment. Large airway function includes forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%). Small airway function includes maximal expiratory flow 25 (MEF25%) and maximal expiratory flow 50 (MEF50%). RESULTS: The bronchial provocation test before treatment showed that the decline rate of pulmonary function (FVC%, FEV1%, MEF25% and MEF50%) in the obese group was higher than the normal-weight group after methacholine inhalation. After salbutamol inhalation, the improvement rate of the large airway (FVC%) and small airway (MEF25% and MEF50%) functions in the obese group was lower than the normal-weight group, and the improvement rate of small airway (MEF25% and MEF50%) function in the over-weight group was lower than in the normal-weight group. After treatment with ICS for one year, large airway function (FVC% and FEV1%) in the normal-weight group was higher than pre-treatment, however only FVC% in the normal-weight and obese groups was higher than pre-treatment. There was no significant difference in small airway function before and after treatment in all three groups. CONCLUSIONS: Obesity can increase the sensitivity to methacholine and restrain the sensitivity to tosalbutamol in children with asthma. ICS can improve the large airway function in asthmatic children with normal body weight, but has no effect on small airway function. Obesity can restrain the effect of ICS on asthmatic children.

导出引用

叶泽慧，黄英，王莹，王冬娟. 不同体重指数的哮喘患儿规范化激素治疗后肺功能变化[J]. 中国当代儿科杂志. 2013, 15(11): 983-986 https://doi.org/10.7499/j.issn.1008-8830.2013.11.014

YE Ze-Hui, HUANG Ying, WANG Ying, WANG Dong-Juan. Association between body mass index and lung function in children with asthma after corticosteroids inhalation[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(11): 983-986 https://doi.org/10.7499/j.issn.1008-8830.2013.11.014

参考文献

[1] Ford ES. The epidemiology of obesity and asthma[J]. J Allergy Clin Immunol, 2005, 115(5): 897-909.

[2] Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies[J]. Am J Respir Crit Care Med, 2007, 175(7): 661-666.

[3] Boulet LP, Franssen E. Influence of obesity on response to fluticasone with or without salmeterol in moderate asthma[J]. Respir Med, 2007, 101(11): 2240-2247.

[4] 中华医学会儿科分会呼吸学组. 儿童支气管哮喘诊断与防治指南（2008年修订）[J]. 中华儿科杂志, 2008, 46(10): 745-753.

[5] 李辉, 季成叶, 宗心南, 张亚钦. 中国0-18岁儿童、青少年体块指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7): 493-498.

[6] 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.

[7] 任世友, 任世琼, 李娜, 孙建. 哮喘对吸入糖皮质激素治疗反应性与肥胖的关系[J]. 四川医学, 2010, 31(5): 622-624.

[8] Sutherland ER, Lehman EB, Teodorescu M, Wechsler ME. Body mass index and phenotype in subjects with mild-to-moderate persistent asthma[J]. J Allergy Clin Immunol, 2009, 123(6): 1328-1334.

[9] Santamaria F, Montella S, Greco L, Valerio G, Franzese A, Maniscalco M, et al. Obesity duration is associated to pulmonary function impairment in obese subjects[J]. Obesity, 2011, 19(8): 1623-1628.

[10] Ye Z, Huang Y, Liu D, Chen X, Wang D, Huang D, et al. Obesity induced by neonatal overfeeding worsens airway hyperresponsiveness and inflammation[J]. PLoS One, 2012, 7(10): e47013.

[11] Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary[J]. Eur Respir J, 2008, 31(1): 143-178.

[12] Forno E, Lescher R, Strunk R, Weiss S, Fuhlbrigge A, Celedon JC. Decreased response to inhaled steroids in overweight and obese asthmatic children[J]. J Allergy Clin Immunol, 2011, 127(3): 741-749.

[13] Yang E, Kim W, Kwon BC, Choi SY, Sohn MH, Kim KE. Relationship among pulmonary function, bronchial hyperresponsiveness, and atopy in children with clinically stable asthma[J]. Lung, 2006, 184(2): 73-79.

[14] Tantisira KG, Fuhlbrigge AL, Tonascia J, Van Natta M, Zeiger RS, Strunk RC, et al. Bronchodilation and bronchoconstriction: predictors of future lung function in children asthma[J]. J Allergy Clin Immunol, 2006, 117(6): 1264-1271.