运动激发试验在儿童咳嗽变异性哮喘中诊断价值的研究

doi:10.7499/j.issn.1008-8830.2408044

摘要
图/表
参考文献(22)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (616 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探究运动激发试验（exercise challenge testing, ECT）对儿童咳嗽变异性哮喘（cough variant asthma, CVA）的诊断价值。方法前瞻性纳入2023年1月—2024年1月收治的78例慢性咳嗽患儿，进行ECT，收集临床资料。根据支气管舒张剂治疗效果分为CVA组（n=44）和非CVA组（n=34），分析比较两组治疗前临床特征、肺功能和ECT差异。结果与非CVA组相比，CVA组男童更多，运动诱发的比例更高，呼出气一氧化氮水平更高，ECT后第1秒用力呼气容积（forced expiratory volume in one second, FEV₁）下降更显著（P<0.05）。二元logistic回归分析显示运动诱发因素和FEV₁下降百分比高为慢性咳嗽患儿发生CVA的危险因素（P<0.05）。ECT诊断CVA的最佳切点值为FEV₁下降超过8.44%，曲线下面积为0.751（P<0.05），灵敏度为65.9%，特异度为79.4%。在运动诱发性慢性咳嗽患儿中ECT诊断CVA的最佳切点值为FEV₁下降超过8.44%，曲线下面积为0.810（P<0.05），灵敏度为77.1%，特异度77.8%。结论 ECT在儿童慢性咳嗽病因诊断中具有临床应用价值，以FEV₁下降8.44%为诊断CVA的最佳切点值，尤其适用于运动诱发者，可提高灵敏度。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	庄东林
	冯雍
	尚云晓

关键词 ：咳嗽变异性哮喘, 运动激发试验, 儿童

Abstract：Objective To investigate the value of exercise challenge testing (ECT) in the diagnosis of cough variant asthma (CVA) in children. Methods A prospective study was conducted on 78 children with chronic cough who were admitted between January 2023 and January 2024. ECT was performed, and clinical data were collected. According to the effect of bronchodilator treatment, the children were divided into a CVA group (44 children) and a non-CVA group (34 children), and the two groups were compared in terms of clinical characteristics, pulmonary function, and ECT results before treatment. Results Compared with the non-CVA group, the CVA group had a significantly higher proportion of boys, a significantly higher proportion of children with exercise-induced chronic cough, a significantly higher level of fractional exhaled nitric oxide, and a significantly greater reduction in forced expiratory volume in 1 second (FEV₁) after ECT (P<0.05). The regression analysis showed that exercise-induced chronic cough and the reduction in FEV₁ were risk factors for CVA (P<0.05). A reduction in FEV₁ of 8.44% was the optimal cut-off value for ECT in the diagnosis of CVA, with an area under the curve of 0.751 (P<0.05), a sensitivity of 65.9%, and a specificity of 79.4%. For the children with exercise-induced chronic cough, a reduction in FEV₁ of 8.44% was the optimal cut-off value for ECT in the diagnosis of CVA, with an area under the curve of 0.810 (P<0.05), a sensitivity of 77.1%, and a specificity of 77.8%. Conclusions ECT has clinical application value in the etiological diagnosis of pediatric chronic cough, with a reduction in FEV1 of 8.44% serving as the optimal cut-off value for diagnosing CVA. It is particularly suitable for children with exercise-induced chronic cough, increasing the sensitivity for CVA diagnosis.

Key words： Cough variant asthma Exercise challenge testing Child

收稿日期: 2024-08-08

通讯作者: 尚云晓，男，主任医师。Email：shangyunx@sina.com。 E-mail: shangyunx@sina.com

作者简介: 庄东林，女，硕士研究生；

引用本文:

庄东林,冯雍,尚云晓. 运动激发试验在儿童咳嗽变异性哮喘中诊断价值的研究[J]. 中国当代儿科杂志, 2024, 26(12): 1288-1293.

ZHUANG Dong-Lin,FENG Yong,SHANG Yun-Xiao. Value of exercise challenge testing in the diagnosis of cough variant asthma in children[J]. CJCP, 2024, 26(12): 1288-1293.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2408044 或 http://www.zgddek.com/CN/Y2024/V26/I12/1288

	Marchant JM, Newcombe PA, Juniper EF, et al. What is the burden of chronic cough for families?[J]. Chest, 2008, 134(2): 303-309. PMID: 18641100. DOI: 10.1378/chest.07-2236.
	中华医学会儿科学分会呼吸学组慢性咳嗽协作组, 《中华儿科杂志》编辑委员会. 中国儿童慢性咳嗽诊断与治疗指南（2013年修订）[J]. 中华儿科杂志, 2014, 52(3): 184-188. PMID: 24824387. DOI: 10.3760/cma.j.issn.0578-1310.2014.03.005.
	中国儿童慢性咳嗽病因构成比研究协作组. 中国儿童慢性咳嗽病因构成比多中心研究[J]. 中华儿科杂志, 2012, 50(2): 83-92. PMID: 22455629. DOI: 10.3760/cma.j.issn.0578-1310.2012.02.002.
	4 陈俊红, 余静. 儿童咳嗽变异性哮喘的研究进展[J]. 临床医学研究与实践, 2023, 8(1): 190-194. DOI: 10.19347/j.cnki.2096-1413.202301054.
	5 王宁. 儿童运动激发试验的临床应用[J]. 中国实用儿科杂志, 2021, 36(6): 426-429. DOI: 10.19538/j.ek2021060606.
	6 于兴梅, 朱海艳, 杨晓蕴, 等. 儿童咳嗽变异性哮喘患者气道高反应的动态观察[J]. 中华医学杂志, 2014, 94(16): 1215-1218. DOI: 10.3760/cma.j.issn.0376-2491.2014.16.005.
	Gao YH, Guan WJ, Xu G, et al. Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in bronchiectasis[J]. Int J Tuberc Lung Dis, 2014, 18(12): 1431-1437. PMID: 25517807. DOI: 10.5588/ijtld.14.0195.
	8 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. 儿童肺功能及气道非创伤性炎症指标系列指南（七）: 呼出气体一氧化氮监测[J]. 中华实用儿科临床杂志, 2017, 32(21): 1622-1627. DOI: 10.3760/cma.j.issn.2095-428X.2017.21.006.
	9 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. DOI: 10.3760/cma.j.issn.2095-428X.2016.10.006.
	Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations[J]. Eur Respir J, 2012, 40(6): 1324-1343. PMID: 22743675. PMCID: PMC3786581. DOI: 10.1183/09031936.00080312.
	11 张美杰, 武怡, 李程程, 等. 简易运动激发试验联合小气道功能检查在咳嗽变异性哮喘早期诊断的应用价值[J]. 中国综合临床, 2019, 35(5): 465-469. DOI: 10.3760/cma.j.issn.1008-6315.2019.05.018.
	Yuan H, Liu X, Li L, et al. Clinical and pulmonary function changes in cough variant asthma with small airway disease[J]. Allergy Asthma Clin Immunol, 2019, 15: 41. PMID: 31303871. PMCID: PMC6604225. DOI: 10.1186/s13223-019-0354-1.
	Manoharan A, Anderson WJ, Lipworth J, et al. Assessment of spirometry and impulse oscillometry in relation to asthma control[J]. Lung, 2015, 193(1): 47-51. PMID: 25516285. DOI: 10.1007/s00408-014-9674-6.
	Tian C, Xiong S, Li S, et al. Spirometry in the diagnosis of cough variant asthma in children[J]. Pediatr Pulmonol, 2024, 59(2): 291-299. PMID: 37921541. DOI: 10.1002/ppul.26745.
	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. PMID: 34949706. DOI: 10.1183/13993003.01499-2021.
	Song WJ, Kim HJ, Shim JS, et al. Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: a systematic review and meta-analysis[J]. J Allergy Clin Immunol, 2017, 140(3): 701-709. PMID: 28088474. DOI: 10.1016/j.jaci.2016.11.037.
	Chen LC, Zeng GS, Wu LL, et al. Diagnostic value of FeNO and MMEF for predicting cough variant asthma in chronic cough patients with or without allergic rhinitis[J]. J Asthma, 2021, 58(3): 326-333. PMID: 31820665. DOI: 10.1080/02770903.2019.1694035.
	Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction[J]. Am J Respir Crit Care Med, 2013, 187(9): 1016-1027. PMID: 23634861. DOI: 10.1164/rccm.201303-0437ST.
	19 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（六）: 支气管激发试验[J]. 中华实用儿科临床杂志, 2017, 32(4): 263-269. DOI: 10.3760/cma.j.issn.2095-428X.2017.04.007.
	Godfrey S, Springer C, Bar-Yishay E, et al. Cut-off points defining normal and asthmatic bronchial reactivity to exercise and inhalation challenges in children and young adults[J]. Eur Respir J, 1999, 14(3): 659-668. PMID: 10543290. DOI: 10.1034/j.1399-3003.1999.14c28.x.
	Lammers N, van Hoesel MHT, Brusse-Keizer MGJ, et al. Can pediatricians assess exercise-induced bronchoconstriction from post-exercise videos?[J]. Front Pediatr, 2020, 7: 561. PMID: 32039118. PMCID: PMC6989467. DOI: 10.3389/fped.2019.00561.
	Pedersen ESL, Ardura-Garcia C, de Jong CCM, et al. Diagnosis in children with exercise-induced respiratory symptoms: a multi-center study[J]. Pediatr Pulmonol, 2021, 56(1): 217-225. PMID: 33079473. DOI: 10.1002/ppul.25126.