肺通气功能检测小气道功能参数在哮喘诊断及评估中的应用
The Application of Pulmonary Ventilation Function Testing of Small Airway Function Parameters in the Diagnosis and Evaluation of Asthma
DOI: 10.12677/acm.2024.1441229, PDF,   
作者: 杨靖溢, 罗征秀*：重庆医科大学附属儿童医院呼吸科，重庆
关键词: 肺通气功能；小气道；支气管哮喘；Pulmonary Ventilatory Function； Small Airways； Bronchial Asthma
摘要: 支气管哮喘是常见慢性气道炎症性疾病，小气道是哮喘气道炎症及阻塞关键部位，与哮喘发生发展密切相关。肺通气功能检测作为运用最广泛的肺功能检测手段，对小气道功能评估具有较高灵敏性及特异性，本文就肺通气功能检测小气道功能参数在哮喘诊断、评估中的作用进行综述，以期提高临床工作者对小气道功能的认识及重视，推动哮喘精准化管理及治疗。
Abstract: Bronchial asthma is a common chronic inflammatory disease of the airways, and the small airways are the key site of airway inflammation and obstruction in asthma, which is closely related to the occurrence and development of asthma. As the most widely used pulmonary function test, pulmonary ventilation function test has high sensitivity and specificity in the assessment of small airway function. This article reviews the role of pulmonary ventilation function test in the diagnosis and assessment of asthma in order to improve the understanding and attention of clinical workers to small airway function, and to promote the accurate management and treatment of asthma.
文章引用：杨靖溢, 罗征秀. 肺通气功能检测小气道功能参数在哮喘诊断及评估中的应用[J]. 临床医学进展, 2024, 14(4): 1813-1818. https://doi.org/10.12677/acm.2024.1441229

参考文献

[1] Global Initiative for Asthma (2022) 2022 GINA Report, Global Strategy for Asthma Management and Prevention.
[2] 杨哲, 宋欣, 李硕, 等. 支气管哮喘控制患儿小气道功能状况及影响因素分析[J]. 中华实用儿科临床杂志, 2017, 32(16): 1244-1247.
[3] 中华医学会儿科学分会呼吸学组, 编辑委员会中华儿科杂志. 儿童支气管哮喘诊断与防治指南(2016年版) [J]. 中华儿科杂志, 2016, 54(3): 167-181.
[4] Hopp, R.J., Wilson, M.C. and Pasha, M.A. (2022) Small Airway Disease in Pediatric Asthma: The Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clinical Reviews in Allergy & Immunology, 62, 145-159. [Google Scholar] [CrossRef] [PubMed]
[5] 刘秀蜀, 黄轶喆, 邓灵东. 肺功能检测在儿童哮喘的临床应用[J]. 中国现代药物应用, 2015, 9(11): 86-87.
[6] 洪建国. 开展支气管哮喘的无创监测[J]. 中国实用儿科杂志, 2009, 24(4): 241-243.
[7] 中华医学会儿科学分会呼吸学组肺功能协作组, 编辑委员会中华实用儿科临床杂志. 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.
[8] Sposato, B., Scalese, M., Migliorini, M.G., et al. (2014) Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset. Allergy, Asthma & Immunology Research, 6, 242-251. [Google Scholar] [CrossRef] [PubMed]
[9] Ciprandi, G., Capasso, M., Tosca, M., et al. (2012) A Forced Expiratory Flow at 25-75% Value <65% of Predicted Should be Considered Abnormal: A Real-World, Cross-Sectional Study. Allergy & Asthma Proceedings, 33, e5-e8. [Google Scholar] [CrossRef] [PubMed]
[10] Simon, M.R., Chinchilli, V.M., Phillips, B.R., et al. (2010) Forced Expiratory Flow between 25% and 75% of Vital Capacity and FEV1/Forced Vital Capacity Ratio in Relation to Clinical and Physiological Parameters in Asthmatic Children with Normal FEV1 Values. The Journal of Allergy and Clinical Immunology, 126, 527-534. [Google Scholar] [CrossRef] [PubMed]
[11] 上海市医学会儿科学分会呼吸学组, 浦东上海儿童医学中心儿科医疗联合体, 上海智慧儿科临床诊治技术工程技术研究中心. 儿童哮喘小气道功能障碍评估及治疗专家共识[J]. 中华实用儿科临床杂志, 2021, 36(23): 1761-1768.
[12] Yi, L., Zhao, Y., Guo, Z., et al. (2023) The Role of Small Airway Function Parameters in Preschool Asthmatic Children. BMC Pulmonary Medicine, 23, Article No. 219. [Google Scholar] [CrossRef] [PubMed]
[13] Polverino, F. and Soriano, J.B. (2020) Small Airways and Early Origins of COPD: Pathobiological and Epidemiological Considerations. European Respiratory Journal, 55, Article 1902457 [Google Scholar] [CrossRef] [PubMed]
[14] Lutfi, M.F. (2016) Patterns of Changes and Diagnostic Values of FEF50%, FEF25%-75% and FEF50%/FEF25%-75% Ratio in Patients with Varying Control of Bronchial Asthma. International Journal of Health Sciences, 10, 3-11. [Google Scholar] [CrossRef] [PubMed]
[15] Alberts, W.M., Ferris, M.C., Brooks, S.M., et al. (1994) The FEF25-75% and the Clinical Diagnosis of Asthma. Annals of Allergy, Asthma & Immunology, 73, 221-225.
[16] Rao, D.R., Gaffin, J.M., Baxi, S.N., et al. (2012) The Utility of Forced Expiratory Flow between 25% and 75% of Vital Capacity in Predicting Childhood Asthma Morbidity and Severity. Journal of Asthma, 49, 586-592. [Google Scholar] [CrossRef] [PubMed]
[17] Yi, F., Jiang, Z., Li, H., et al. (2021) Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features. Frontiers in Physiology, 12, Article 761622. [Google Scholar] [CrossRef] [PubMed]
[18] Yuan, H., Liu, X., Li, L., et al. (2019) Clinical and Pulmonary Function Changes in Cough Variant Asthma with Small Airway Disease. Allergy, Asthma & Clinical Immunology, 15, Article No. 41. [Google Scholar] [CrossRef] [PubMed]
[19] 邬宇芬, 张皓, 郭艳芳, 等. 支气管激发试验及小气道功能检测在咳嗽变异性哮喘诊断中的应用[J]. 临床儿科杂志, 2015(4): 330-333.
[20] Minshall, E.M., Hogg, J.C. and Hamid, Q.A. (1998) Cytokine mRNA Expression in Asthma Is not Restricted to the Large Airways. The Journal of Allergy and Clinical Immunology, 101, 386-390. [Google Scholar] [CrossRef] 
[21] Hamid, Q., Song, Y., Kotsimbos, T.C., et al. (1997) Inflammation of Small Airways in Asthma. The Journal of Allergy and Clinical Immunology, 100, 44-51. [Google Scholar] [CrossRef] 
[22] Taha, R.A., Minshall, E.M., Miotto, D., et al. (1999) Eotaxin and Monocyte Chemotactic Protein-4 mRNA Expression in Small Airways of Asthmatic and Nonasthmatic Individuals. The Journal of Allergy and Clinical Immunology, 103, 476-483. [Google Scholar] [CrossRef] 
[23] Telenga, E.D., van den Berge, M., Ten, H.N., et al. (2013) Small Airways in Asthma: Their Independent Contribution to the Severity of Hyperresponsiveness. European Respiratory Journal, 41, 752-754. [Google Scholar] [CrossRef] [PubMed]
[24] 乔廉洁, 薄建萍. 哮喘患者小气道功能与气道高反应性的关系探讨[J]. 临床肺科杂志, 2019, 24(9): 1622-1626.
[25] Fonseca-Guedes, C.H., Cabral, A.L. and Martins, M.A. (2003) Exercise-Induced Bronchospasm in Children: Comparison of FEV1 and FEF25-75% Responses. Pediatric Pulmonology, 36, 49-54. [Google Scholar] [CrossRef] [PubMed]
[26] Drewek, R., Garber, E., Stanclik, S., et al. (2009) The FEF25-75 and Its Decline as a Predictor of Methacholine Responsiveness in Children. Journal of Asthma, 46, 375-381. [Google Scholar] [CrossRef] [PubMed]
[27] 廉建丽, 李继玲, 陈俊松. 小气道功能指标在儿童哮喘病情严重程度评估及临床诊断中的应用[J]. 安徽医药, 2019, 23(6): 1101-1105.
[28] 李金英, 安淑华, 赵清娟, 等. 常规肺通气功能检测在儿童哮喘评估中的应用[J]. 临床儿科杂志, 2011, 29(10): 977-979.
[29] 曹菊英, 杨希晨, 刘桂华, 等. 支气管哮喘儿童肺功能检测与评价[J]. 临床肺科杂志, 2011, 16(11): 1703-1704.
[30] Anderson, W.J., Zajda, E. and Lipworth, B.J. (2012) Are We Overlooking Persistent Small Airways Dysfunction in Community-Managed Asthma. Annals of Allergy, Asthma & Immunology, 109, 185-189. [Google Scholar] [CrossRef] [PubMed]
[31] Kraft, M., Richardson, M., Hallmark, B., et al. (2022) The Role of Small Airway Dysfunction in Asthma Control and Exacerbations: A Longitudinal, Observational Analysis Using Data from the ATLANTIS Study. The Lancet Respiratory Medicine, 10, 661-668. [Google Scholar] [CrossRef] 
[32] 姜荷云, 戚凯文, 步美玲, 等. 脉冲振荡肺功能与常规肺通气功能评估儿童支气管哮喘控制水平的比较[J]. 中华实用儿科临床杂志, 2023, 38(4): 291-295.
[33] Siroux, V., Boudier, A., Dolgopoloff, M., et al. (2016) Forced Midexpiratory Flow between 25% and 75% of Forced Vital Capacity Is Associated with Long-Term Persistence of Asthma and Poor Asthma Outcomes. The Journal of Allergy and Clinical Immunology, 137, 1709-1716. [Google Scholar] [CrossRef] [PubMed]
[34] 范良勤, 张鸿, 田鹏, 等. 儿童咳嗽变异性哮喘转为典型哮喘风险调查及列线图预测模型的构建和验证[J]. 临床肺科杂志, 2023, 28(12): 1861-1867.
[35] 柴小艺. 小气道功能评估在儿童哮喘缓解期中的临床价值[D]: [硕士学位论文]. 沈阳: 中国医科大学, 2022.
[36] 陈俊松, 李敏, 汤昱. 小气道功能指标在儿童哮喘缓解期病情评估中的意义[J]. 浙江医学, 2018, 40(7): 722-724, 738.
[37] Lipworth, B., Manoharan, A. and Anderson, W. (2014) Unlocking the Quiet Zone: The Small Airway Asthma Phenotype. The Lancet Respiratory Medicine, 2, 497-506. [Google Scholar] [CrossRef] 
[38] Postma, D.S., Bush, A. and van den Berge, M. (2015) Risk Factors and Early Origins of Chronic Obstructive Pulmonary Disease. The Lancet, 385, 899-909. [Google Scholar] [CrossRef] 
[39] Burgel, P.R. (2011) The Role of Small Airways in Obstructive Airway Diseases. European Respiratory Review, 20, 23-33. [Google Scholar] [CrossRef] [PubMed]
[40] Hogg, J.C., McDonough, J.E. and Suzuki, M. (2013) Small Airway Obstruction in COPD: New Insights Based on Micro-CT Imaging and MRI Imaging. Chest, 143, 1436-1443. [Google Scholar] [CrossRef] [PubMed]
[41] McGeachie, M.J. (2017) Childhood Asthma Is a Risk Factor for the Development of Chronic Obstructive Pulmonary Disease. Current Opinion in Allergy and Clinical Immunology, 17, 104-109. [Google Scholar] [CrossRef] 
[42] Chiu, H.Y., Hsiao, Y.H., Su, K.C., et al. (2020) Small Airway Dysfunction by Impulse Oscillometry in Symptomatic Patients with Preserved Pulmonary Function. The Journal of Allergy and Clinical Immunology: In Practice, 8, 229-235. [Google Scholar] [CrossRef] [PubMed]
[43] Sorkness, R.L., Bleecker, E.R., Busse, W.W., et al. (2008) Lung Function in Adults with Stable but Severe Asthma: Air Trapping and Incomplete Reversal of Obstruction with Bronchodilation. Journal of Applied Physiology, 104, 394-403. [Google Scholar] [CrossRef] [PubMed]
[44] Shi, Y., Aledia, A.S., Galant, S.P., et al. (2013) Peripheral Airway Impairment Measured by Oscillometry Predicts Loss of Asthma Control in Children. The Journal of Allergy and Clinical Immunology, 131, 718-723. [Google Scholar] [CrossRef] [PubMed]

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