Longitudinal Lung Function Growth of Mexican Children Compared with International Studies

Introduction

Our aim was to compare the longitudinal lung function growth of Mexican children and adolescents with the collated spirometric reference proposed for international use and with that of Mexican-Americans from the National Health State Examination Survey III (NHANES) III study.

Materials and Methods

A cohort of Mexican children in third year of primary school was followed with spirometry twice a year through secondary school. Multilevel mixed-effects lineal models separated by gender were fit for the spirometric variables of 2,641 respiratory-healthy Mexican children expressed as Z-scores of tested reference equations. Impact of adjustment by sitting height on differences with Mexican-American children was observed in a subsample of 1,987 children.

Results

At same gender, age, and height, Mexican children had increasingly higher forced expiratory volume in 1 s (FEV₁) and Forced vital capacity (FVC) than the children from the collated reference study (mean Z-score, 0.68 for FEV₁ and 0.51 for FVC) and than Mexican-American children (Z-score, 0.23 for FEV₁ and 0.21 for FVC) respectively. Differences with Mexican-Americans were not reduced by adjusting by sitting height.

Conclusions

For reasons that remain unclear, the gender-, age-, and height-adjusted lung function of children from Mexico City is higher than that reported by several international studies.     

The Effect of Air Pollution on Exhaled Nitric Oxide of Atopic and Nonatopic Subjects

Levels of exhaled nitric oxide (NO) were determined in well-characterized atopic and nonatopic subjects on 4 days with a different level of outdoor air pollution. The two groups matched well regarding spirometric values, i.e., no difference with regard to FEV(1), FVC, and peak flow. On the 4 test days asymptomatic atopic subjects exhaled 1.5- to 2.4-fold higher levels of NO compared with nonatopic subjects. In both groups the increase in exhaled NO in response to air pollution was similar (2.5 times maximal increase, P < 0.01). In conclusion, atopic subjects exhale higher levels of NO compared with nonatopic subjects, but respond to a similar degree to increased levels of air pollution.     

Effects of PM2.5 and NO2 on the 8-isoprostane and lung function indices of FVC and FEV1 in students of Ahvaz city,Iran

The aim of this study was to determine the correlation between PM_2.5 and NO₂ pollutants and oxidative stress marker (8-isoprostane) and lung function tests (FVC and FEV₁) in healthy children who were living and studying in three different areas of Ahvaz city including A₁: Naderi site with high traffic, A₂: Alavi Alley site with average traffic, and A₃: Ein 2 site with low traffic (a rural area on the suburb of Ahvaz). 30 students in the 12–13 year-old range were selected from each studied zone (1, 2 and 3 sites) during three months of year. Of each student, one sample was taken every two weeks to measure 8-isoprostane of exhaled breath condensate (EBC). Air pollution data were collected from three air quality monitoring stations. Also, the relationship between air pollution and 8-isoprostane as well as lung function tests were determined using generalized estimating equations (GEE). The mean concentration of PM_2.5 and NO₂ in A₁, A₂ and A₃ areas were 116, 92 and 45 (μg/m³) also 77, 53 and 14 (ppb) respectively. Among all studied students, there was a significant correlation between the increase of mean concentration of PM_2.5 and NO₂ in 1–4 before sampling day, increased 8-isoprostane concentration and decreased FEV₁, while there was no significant correlation between them and decreased FVC. In A₁ site, an increase in IQR (13 μg/m³) PM_2.5 and IQR (6.5 ppb) NO₂ on 1–4 days before sampling was associated with 0.38 unit (95% CI: 0.11, 0.65) and 1.1 unit (95% CI: 0.85, 1.35) increase in 8-isoprostane concentration, also decreased 121 ml and 190 ml FEV₁, respectively. Results showed that the short-term exposure to traffic-related air pollution can decrease the values of lung function indices and increase the oxidative stress. It may adversely affect children’s lungs.     

Long-term exposure to outdoor VOCs and lung function in urban adults: a cross-sectional study in Tabriz an industrialized city in the northwest of Iran

Abstract

This study aimed to evaluate the effects of outdoor benzene, toluene, xylenes, and styrene (BTXS) on respiratory system performance in adults living in an industrialized city. The concentration of BTXS was measured in the three selected areas (low traffic, high traffic and industrial). Pulmonary function of totally 219 participants who have lived in the selected areas for at least five years, were evaluated through the spiromertry. Based on the results, significant differences were observed between the mean concentrations of BTXS (industrial area?>?high traffic area?>?low traffic area). Considerable decline of 0.46?L, 0.41?L, 2.99%, 0.9?L/min, and 0.59?L/s for Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), FEV₁/FVC, Peak Expiratory Flow (PEF) and Forced Expiratory Flow between 25% and 75% of vital capacity (FEF_25–75%), respectively, were detected in industrial area residents compared to the low traffic region. In addition, some spirometric parameters were different between the other sampling sites. In conclusion, the results showed that the long term exposure to higher concentrations of BTXS increases respiratory dysfunction risks in industrial and high traffic areas respectively, as compared with living in the low traffic region.     

Long-Term Exposure to Primary Traffic Pollutants and Lung Function in Children: Cross-Sectional Study and Meta-Analysis

Background

There is widespread concern about the possible health effects of traffic-related air pollution. Nitrogen dioxide (NO₂) is a convenient marker of primary pollution. We investigated the associations between lung function and current residential exposure to a range of air pollutants (particularly NO₂, NO, NOx and particulate matter) in London children. Moreover, we placed the results for NO₂ in context with a meta-analysis of published estimates of the association.

Methods and Findings

Associations between primary traffic pollutants and lung function were investigated in 4884 children aged 9–10 years who participated in the Child Heart and Health Study in England (CHASE). A systematic literature search identified 13 studies eligible for inclusion in a meta-analysis. We combined results from the meta-analysis with the distribution of the values of FEV₁ in CHASE to estimate the prevalence of children with abnormal lung function (FEV₁<80% of predicted value) expected under different scenarios of NO₂ exposure. In CHASE, there were non-significant inverse associations between all pollutants except ozone and both FEV1 and FVC. In the meta-analysis, a 10 μg/m³ increase in NO₂ was associated with an 8 ml lower FEV₁ (95% CI: -14 to -1 ml; p: 0.016). The observed effect was not modified by a reported asthma diagnosis. On the basis of these results, a 10 μg/m³ increase in NO₂ level would translate into a 7% (95% CI: 4% to 12%) increase of the prevalence of children with abnormal lung function.

Conclusions

Exposure to traffic pollution may cause a small overall reduction in lung function and increase the prevalence of children with clinically relevant declines in lung function.     

An Elevated Body Mass Index Increases Lung Volume but Reduces Airflow in Italian Schoolchildren

BackgroundAsthma and obesity are important and growing health issues worldwide. Obesity is considered a risk factor for asthma, due to the induction of changes in airway mechanics and altered airway inflammation.MethodsWe cross-sectionally investigated the effect of increased weight on pulmonary function in a large population sample of healthy children, aged 10–17 yrs living in Palermo, Italy. Explanatory effect of weight on lung function variables were evaluated by multiple linear regression models, taking into account height, gender, and age-class.ResultsAmong the 2,393 subjects, FVC and FEV₁ were positively correlated to weight. Multiple regression models showed that the weight beta coefficient for FEV₁ was significantly lower with respect to that for FVC (0.005 and 0.009 l/kg, respectively), indicating a different magnitude in explanatory effect of weight on FVC and FEV₁. Both FEV₁/FVC and FEF_25–75%/FVC ratios were negatively correlated to weight, while FEF_25–75% was not significantly correlated. Similar results were obtained also when 807 symptomatic subjects were introduced in the model through a sensitivity analysis.ConclusionIn healthy children, the disproportionate increase of FEV₁ and FVC with weight produces airflow decrease and consequently apparent poorer lung function independently from respiratory disease status.     

结缔组织病相关间质性肺炎患者血清NLR、PLR以及LDH水平的表达及临床意义

摘要 目的：研究结缔组织病相关间质性肺炎（CTD-ILD）患者血清中性粒细胞与淋巴细胞计数的比值（NLR）、血小板与淋巴细胞计数的比值（PLR）以及乳酸脱氢酶（LDH）水平的表达及临床意义。方法：选择从2018年1月到2021年1月在中国人民解放军联勤保障部队第九六Ο医院接受治疗的CTD患者155例作为研究对象，根据有无合并间质性肺炎（ILD）分为ILD组、无ILD组。ILD组患者根据不同影像分型分为寻常型ILD（UILD）组、非特异型ILD（NSILD）组、未定型组，根据病变范围分级情况分为Ⅰ级组、Ⅱ级组、Ⅲ级组；根据病情状况分为活动组、非活动组；根据预后分为存活组、死亡组。另选同期在医院接受健康体检的志愿者80例作为对照组，比较各组血清NLR、PLR、LDH、纤维蛋白原（Fib）、第1秒用力呼气容积（FEV₁）占预计值的百分比（FEV₁%）、用力肺活量（FVC）、以及FEV1/FVC比值。结果：ILD组的血清NLR、PLR、LDH及Fib水平较无ILD组及对照组明显更高，而FVC、FEV₁%及FEV1/FVC水平较无ILD组及对照组明显更低（P＜0.05）。无ILD组的血清NLR、PLR、LDH及Fib水平较对照组明显更高，而FVC、FEV₁%及FEV1/FVC水平较对照组明显更低（P＜0.05）。不同影像分型患者血清NLR、PLR、LDH、Fib、FVC、FEV₁%及FEV₁/FVC水平比较，差异不显著（P＞0.05）。Ⅱ级组及Ⅲ级组患者血清NLR、PLR以及LDH水平较Ⅰ级组更高，且Ⅲ级组较Ⅱ级组更高（P＜0.05），而三组Fib、FVC、FEV₁%及FEV1/FVC水平比较，差异不显著（P＞0.05）。活动组患者血清NLR、PLR以及LDH水平较非活动组更高（P＜0.05），而Fib、FVC、FEV₁%及FEV₁/FVC水平比较，差异不显著（P＞0.05）。死亡组患者血清NLR、PLR以及LDH水平较存活组更高（P＜0.05），而Fib、FVC、FEV₁%及FEV₁/FVC水平比较，差异不显著（P＞0.05）。结论：NLR、PLR以及LDH水平在CTD-ILD患者血清中呈现高表达，且这三项指标有助于较好地评价患者的病情及预后。     

Instability in the COPD Diagnosis upon Repeat Testing Vary with the Definition of COPD

Background

A low FEV₁/FVC from post-bronchodilator spirometry is required to diagnose COPD. Both the FEV₁ and the FVC can vary over time; therefore, individuals can be given a diagnosis of mild COPD at one visit, but have normal spirometry during the next appointment, even without an intervention.

Methods

We analyzed two population-based surveys of adults with spirometry carried out for the same individuals 5-9 years after their baseline examination. We determined the factors associated with a change in the spirometry interpretation from one exam to the next utilizing different criteria commonly used to diagnose COPD.

Results

The rate of an inconsistent diagnosis of mild COPD was 11.7% using FEV₁/FVC <0.70, 5.9% using FEV₁/FEV₆ <the lower limit of the normal range, LLN and 4.1% using the GOLD stage 2-4 criterion. The most important factor associated with diagnostic inconsistency was the closeness of the ratio to the LLN during the first examination. Inconsistency decreased with a lower FEV₁.

Conclusions

Using FEV₁/FEV₆ <LLN or GOLD stage 2-4 as the criterion for airflow obstruction reduces inconsistencies in the diagnosis of mild COPD. Further improvement could be obtained by defining a borderline zone around the LLN (e.g. plus or minus 0.6 SD), or repeating the test in patients with borderline results.     

Intravenously Given Methylprednisolone in Refractory Asthma

A study was designed to compare the time course response of two high-dose methylprednisolone regimens in adult refractory corticosteroid-dependent asthmatics: Group A received 125 mg intravenously every six hours for three days; group B received 125 mg every six hours for ten days. Sixteen patients during 22 hospital stays were randomly assigned to one of the two groups. Forced vital capacity (FVC), forced expired volume in one second (FEV₁) and forced expiratory flow between 25 percent and 75 percent of vital capacity (FEF_25%-75%) improved significantly over the ten days in both groups (P<.005) in all patients. No differences in baseline two-, four-, seven- or ten-day spirometric values were noted between groups (P>.2).In most steroid-dependent asthmatic patients, three days'' therapy with 125 mg every six hours of methylprednisolone given intravenously resulted in obvious and sustained ventilatory improvement. Close observation with spirometric and clinical evaluation is then necessary to detect the occasional patient in whom relapse will occur and longer periods of high-dose steroid therapy will be needed.     

CT Air Trapping Is Independently Associated with Lung Function Reduction over Time

Purpose

We aimed to study the association between lung function decline and quantitative computed tomography (CT) air trapping.

Materials and Methods

Current and former heavy smokers in a lung cancer screening trial underwent volumetric low-dose CT in inspiration and expiration. Spirometry was obtained at baseline and after 3 years. The expiratory to inspiratory ratio of mean lung density (E/I-ratio_MLD) was used to quantify air trapping. CT emphysema was defined as voxels in inspiratory CT below −950 Hounsfield Unit. Linear mixed modeling was used to determine the association between CT air trapping and lung function.

Results

We included 985 subjects with a mean age of 61.3 years. Independent of CT emphysema, CT air trapping was significantly associated with a reduction in forced expiratory volume in one second (FEV₁) and the ratio of FEV₁ over the forced vital capacity (FEV₁/FVC); FEV₁ declines with 33 mL per percent increase in CT air trapping, while FEV₁/FVC declines 0.58% per percent increase (both p<0.001). CT air trapping further elicits accelerated loss of FEV₁/FVC (additional 0.24% reduction per percent increase; p = 0.014).

Conclusion

In a lung cancer screening cohort, quantitatively assessed air trapping on low-dose CT is independently associated with reduced lung function and accelerated decline of FEV₁/FVC.     

Reliability of FEV1/FEV6 to Diagnose Airflow Obstruction Compared with FEV1/FVC: The PLATINO Longitudinal Study

QUESTION

A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV₁/FEV₆) to the ratio of the FEV₁/Forced vital capacity (FEV₁/FVC) for the detection of airway obstruction.

METHODS

The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5–9 years in three Latin-American cities.

RESULTS

Using the FEV₁/FVC<Lower limit of normal (LLN) index, COPD prevalence apparently changed from 9.8 to 13.2% in Montevideo, from 9.7 to 6.0% in São Paulo and from 8.5 to 6.6% in Santiago, despite only slight declines in smoking prevalence (from 30.8% to 24.3%). These changes were associated with differences in Forced expiratory time (FET) between the two surveys. In contrast, by using the FEV₁/FEV₆ to define airway obstruction, the changes in prevalence were smaller: 9.7 to 10.6% in Montevideo, 8.6 to 9.0% in São Paulo, and 7.5 to 7.9% in Santiago. Changes in the prevalence of COPD with criteria based on FEV₁/FVC correlated strongly with changes in the FET of the tests (R² 0.92) unlike the prevalence based on a low FEV₁/FEV₆ (R² = 0.40).

CONCLUSION

The FEV₁/FEV₆ is a more reliable index than FEV₁/FVC because FVC varies with the duration of the forced exhalation. Reporting FET and FEV₁/FEV₆<LLN helps to understand differences in prevalence of COPD obtained from FEV₁/FVC-derived indices.     

经肋间单孔胸腔镜肺叶切除术对非小细胞肺癌患者肺功能及远期生活质量的影响

摘要 目的：探究经肋间单孔胸腔镜肺叶切除术对非小细胞肺癌患者（NSCLC）肺功能及远期生活质量的影响。方法：选取我院2017年1月~2018年1月收治的128例NSCLC患者为研究对象,随机分为对照组和观察组各64例。对照组行传统开胸肺叶切除术,观察组行经肋间单孔胸腔镜肺叶切除术,比较两组患者的围手术期指标（手术时间、切口长度、失血量、引流量、拔管时间、下床活动时间、淋巴结清扫个数）、肺功能（MVV、PEF、FEV₁、FVC、FEV₁/FVC）、生活质量评分（FACT-L、SF-36）、并发症情况及远期生存率、复发率。结果：观察组手术时间、切口长度、失血量、引流量、拔管时间、下床活动时间均明显低于对照组（P＜0.05）,淋巴结清扫个数与对照组比较差异无统计学意义（P＞0.05）。手术前,两组MVV、PEF、FEV₁、FVC、FEV₁/FVC水平差异均无统计学意义（P＞0.05）;手术后,两组MVV、PEF、FEV₁、FVC、FEV₁/FVC水平均有下降（P＜0.05）,且观察组MVV、PEF、FEV₁、FVC、FEV₁/FVC水平均明显高于对照组（P＜0.05）。手术前,两组FACT-L、SF-36评分差异均无统计学意义（P＞0.05）;手术后,两组FACT-L、SF-36评分均有提高（P＜0.05）,且观察组FACT-L、SF-36评分均明显高于对照组（P＜0.05）。观察组并发症发生率为6.25%,明显低于对照组20.31%,差异有统计学意义（P＜0.05）。观察组术后2年生存率为98.41%,明显高于对照组79.36%,差异有统计学意义（P＜0.05）。观察组复发率为4.68%,明显低于对照组17.46%,差异有统计学意义（P＜0.05）。结论：经肋间单孔胸腔镜肺叶切除术用于治疗NSCLC能够降低患者围手术期的风险,提高肺功能水平,降低术后并发症的发生,还可以改善远期生活质量,减少复发、提高生存率,值得临床推广。     

The Association of Normal Range Glycated Hemoglobin with Restrictive Lung Pattern in the General Population

Glycated hemoglobin (HbA1c) is an important diagnostic indicator of diabetes mellitus, and some authors have argued that it is related to impaired lung function in the diabetic population. However, there was rare study for association between lung function and HbA1c in the non-diabetic population. We investigated whether HbA1c below the diagnostic threshold is related to deficits in lung function. We analyzed biochemical and spirometry data from a nation-wide, population-based, case-control study (the KNHANES IV and V). Eligible as cases were all native Koreans aged 40 years or more with no medical illness. A total of 3670 participants were divided into 4 groups according to HbA1c (%) as follows: Group I (n = 842), ≥ 4.0 and ≤ 5.3; Group II (n = 833), > 5.3 and ≤ 5.5; Group III (n = 898), > 5.5 and ≤ 5.7; and Group IV (n = 1097), > 5.7 and ≤ 6.4. Group I had the greatest forced vital capacity (FVC, 96.3 ± 0.5% pred, P < 0.0001), forced expiratory volume per second (FEV₁, 93.8 ± 0.5% pred, P < 0.0001) and FEV₁/FVC (0.792 ± 0.003, P < 0.0001) compared with the other groups. Linear regression showed that HbA1c was closely related to FVC (β = -6.972154, P < 0.0001) and FEV₁ (β = -5.591589, P < 0.0001), but not to FEV₁/FVC. Logistic regression analysis revealed a significant association between HbA1c and a restrictive spirometric pattern (FVC < 80% pred., FEV₁/FVC ≥ 0.70; OR = 3.772, 95% CI = 1.234-11.53), indicating that elevated HbA1c is closely associated with lung impairment in the non-diabetic population. In the healthy population, relatively high HbA1c level is associated with decrements of FVC and FEV₁ and may be a reliable predictor of poor lung function, especially the restrictive pattern.     

Dietary intake,lung function and airway inflammation in Mexico City school children exposed to air pollutants

Introduction

Air pollutant exposure has been associated with an increase in inflammatory markers and a decline in lung function in asthmatic children. Several studies suggest that dietary intake of fruits and vegetables might modify the adverse effect of air pollutants.

Methods

A total of 158 asthmatic children recruited at the Children''s Hospital of Mexico and 50 non-asthmatic children were followed for 22 weeks. Pulmonary function was measured and nasal lavage collected and analyzed every 2 weeks. Dietary intake was evaluated using a 108-item food frequency questionnaire and a fruit and vegetable index (FVI) and a Mediterranean diet index (MDI) were constructed. The impact of these indices on lung function and interleukin-8 (IL-8) and their interaction with air pollutants were determined using mixed regression models with random intercept and random slope.

Results

FVI was inversely related to IL-8 levels in nasal lavage (p < 0.02) with a significant inverse trend (test for trend p < 0.001), MDI was positively related to lung function (p < 0.05), and children in the highest category of MDI had a higher FEV₁ (test for trend p < 0.12) and FVC (test for trend p < 0.06) than children in the lowest category. A significant interaction was observed between FVI and ozone for FEV₁ and FVC as was with MDI and ozone for FVC. No effect of diet was observed among healthy children.

Conclusion

Our results suggest that fruit and vegetable intake and close adherence to the Mediterranean diet have a beneficial effect on inflammatory response and lung function in asthmatic children living in Mexico City.     

慢性阻塞性肺疾病患者中血清亲环素A、趋化因子CX3CL1表达水平及临床意义

摘要 目的：探讨慢性阻塞性肺疾病（COPD）患者中血清亲环素A（CyPA）、趋化因子CX3CL1以及其他炎性指标的表达水平及其临床意义。方法：选取2019年1月-2021年6月本院收治的COPD患者120例作为研究对象,其中68例患者为急性加重期组,52例患者为稳定期组;另选取体检健康者45例作为对照组。收集所有受试者的临床资料,检测其血清中CyPA、CX3CL1、C反应蛋白（CRP）、白细胞介素-6（IL-6）以及基质金属蛋白酶-9（MMP-9）水平,比较3组患者各参数的差异,并与肺功能进行相关性分析,比较急性加重期患者治疗前后各指标的差异。结果：急性加重期组患者的血清 CyPA、CX3CL1、CRP、IL-6、MMP-9水平均明显高于稳定期组和对照组患者,稳定期组患者的血清 CyPA、CX3CL1、CRP、IL-6、MMP-9水平均明显高于对照组患者（均P＜0.05）;而急性加重期组患者的第1s用力呼气量（FEV₁）、用力肺活量（FVC）、第1s用力呼气量（FEV₁）与用力肺活量（FVC）的比值（FEV₁%）、最大呼气峰流速（PEF）以及最大呼气中期流速（MMEF）明显低于稳定期组和对照组患者,稳定期组患者的FEV₁、FVC、FEV₁/FVC、PEF、MMEF明显低于对照组患者（均P＜0.05）。COPD患者的血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平与FEV₁、FVC、FEV₁/FVC、PEF、MMEF呈负相关（P<0.05）。与治疗前相比较,急性加重期组患者在治疗后血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平明显下降,而FEV₁、FVC、FEV₁/FVC、PEF、MMEF明显上升（均P＜0.05）。结论：COPD患者的血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平可在一定程度上预测患者的严重程度,同时也可以作为急性加重期治疗后效果的评价指标。     

Responses of FEV6, FVC,and FET to inhaled bronchodilator in the adult general population

Background

The assessment of bronchodilator-induced change in forced vital capacity (FVC) is dependent on forced expiratory time (FET) in subjects with airflow limitation. Limited information is available on the concurrent responses of FVC, forced expiratory volume in six seconds (FEV₆), and FET in the bronchodilation test among patients with obstructive airways disease or in the general population. The aim of this study was to assess the changes in FEV₆, FVC, and FET, and their relationships in a standardized bronchodilation test in the general population.

Methods

We studied bronchodilation response in a general adult population sample of 628 individuals (260 men, 368 women) with flow-volume spirometry. The largest FVC, the corresponding FET and the largest FEV₆ both at the baseline and after 0.4 mg of inhaled salbutamol were selected for analysis.

Results

After administration of salbutamol FEV₆ decreased on average -13.4 (95% CI -22.3 to -4.5) ml or -0.2% (-0.4% to 0.0%) from the baseline. The 95^th percentile of change in FEV₆ was 169.1 ml and 5.0%. FVC decreased on average -42.8 (-52.4 to -33.3) ml or -1.0% (-1.2% to -0.7%). Concurrently FET changed on average -0.2 (-0.4 to 0.0) seconds or 0.4% (-1.4% to 2.3%). There were four subjects with an increase of FVC over 12% and only one of these was associated with prolonged FET after salbutamol. Changes in FEV₆ and FVC were more frequently positive in subjects with reduced FEV₁/FVC in baseline spirometry.

Conclusion

In general adult population, both FEV₆ and FVC tended to decrease, but FET remained almost unchanged, in the bronchodilation test. However, those subjects with signs of airflow limitation at the baseline showed frequently some increase of FEV₆ and FVC in the bronchodilation test without change in FET. We suggest that FEV₆ could be used in assessment of bronchodilation response in lieu of FVC removing the need for regulation of FET during bronchodilation testing.     

枸橼酸咖啡因联合磷酸肌酸钠治疗新生儿呼吸窘迫综合征的疗效观察

目的:枸橼酸咖啡因联合磷酸肌酸钠治疗新生儿呼吸窘迫综合征的疗效,观察其对肺功能的影响。方法:选取我院新生儿科2016年6月至2019年6月收治的112例新生儿呼吸窘迫综合征的患儿作为研究对象,随机分为对照组和观察组(n=56)。对照组患儿采取枸橼酸咖啡因联合呼吸机辅助呼吸治疗,观察组患儿在对照组基础上再联合磷酸肌酸钠治疗,比较两组患儿临床疗效、血气分析指标、肺功能及心肌酶的变化,同时观察并发症支气管肺发育不良(BPD)的发生情况。结果:治疗后24 h及48 h,两组患儿PaO₂和PaO₂/FiO₂显著上升,PaCO₂明显下降(P<0.05);且观察组患儿PaO₂及PaO₂/FiO₂均高于对照组,差异有统计学意义(P<0.05)。治疗后24 h,两组患儿FEV1和FEV1/FVC较治疗前明显升高,观察组FEV1/FVC显著高于对照组(P<0.05)。治疗后48 h,患儿FEV1和FEV1/FVC进一步改善,观察组改善情况也优于对照组(P<0.05)。治疗后,患儿CK-MB和LDH水平较治疗前逐渐下降,且观察组CK-MB和LDH明显低于对照组(P<0.05)。观察组临床治疗总有效率为91.07%,显著高于对照组82.14%,且不良反应BPD发生率也低于对照组,差异有统计学意义(P<0.05)。结论:枸橼酸咖啡因联合磷酸肌酸钠治疗NRDS临床疗效显著,可有效改善患儿肺功能,减少心肌损伤,从而降低心肺不良反应并发症的发生率,有助于预后,值得临床推广与应用。     

Pulmonary function and incident bronchitis and asthma in children: a community-based prospective cohort study

Background

Previous studies revealed that reduction of airway caliber in infancy might increase the risks for wheezing and asthma. However, the evidence for the predictive effects of pulmonary function on respiratory health in children was still inconsistent.

Methods

We conducted a population-based prospective cohort study among children in 14 Taiwanese communities. There were 3,160 children completed pulmonary function tests in 2007 and follow-up questionnaire in 2009. Poisson regression models were performed to estimate the effect of pulmonary function on the development of bronchitis and asthma.

Results

After adjustment for potential confounders, pulmonary function indices consistently showed protective effects on respiratory diseases in children. The incidence rate ratios of bronchitis and asthma were 0.86 (95% CI 0.79–0.95) and 0.91 (95% CI 0.82–0.99) for forced expiratory volume in 1 second (FEV₁). Similar adverse effects of maximal mid-expiratory flow (MMEF) were also observed on bronchitis (RR = 0.73, 95% CI 0.67–0.81) and asthma (RR = 0.85, 95% CI 0.77–0.93). We found significant decreasing trends in categorized FEV₁ (p for trend = 0.02) and categories of MMEF (p for trend = 0.01) for incident bronchitis. Significant modification effects of traffic-related air pollution were noted for FEV₁ and MMEF on bronchitis and also for MMEF on asthma.

Conclusions

Children with high pulmonary function would have lower risks on the development of bronchitis and asthma. The protective effect of high pulmonary function would be modified by traffic-related air pollution exposure.     

慢性阻塞性肺疾病急性加重期患者血清SAA水平与肺功能、炎性因子的相关性及其诊断价值分析

目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清淀粉样蛋白A(SAA)水平与肺功能及炎性因子的相关性,并分析其诊断价值。方法:选取2013年6月-2018年6月中国人民解放军第970医院收治的204例慢性阻塞性肺疾病(COPD)患者作为研究对象,其中COPD稳定期患者132例作为COPD稳定组,AECOPD患者72例作为AECOPD组。另选取同期于中国人民解放军第970医院进行健康体检的50例健康体检者作为健康组。比较三组受试者血清SAA水平、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平及肺功能,采用Pearson相关性分析AECOPD患者血清SAA水平与肺功能及炎性因子的相关性,并分析SAA对AECOPD的诊断价值。结果:AECOPD组患者血清SAA、PCT、CRP、IL-6、IL-8水平较COPD稳定组及健康组升高(P0.05),COPD稳定组患者血清SAA、IL-6、IL-8、PCT、CRP水平均高于健康组,差异有统计学意义(P0.05);AECOPD组患者第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、第一秒用力呼吸容积占用力肺活量的百分比(FEV1/FVC%)、第一秒用力呼气容积占预计值百分比(FEV1%)低于COPD稳定组及健康组,差异有统计学意义(P0.05),COPD稳定组患者FEV1、FVC、FEV1/FVC%、FEV1%低于健康组,差异有统计学意义(P0.05)。Pearson相关性分析显示,AECOPD患者血清SAA水平与IL-8、IL-6、CRP、PCT呈正相关,与FEV1%、FEV1/FVC%、FEV1、FVC呈负相关(P0.05)。受试者工作特征(ROC)曲线结果显示,SAA对AECOPD诊断的敏感度为80.85%,特异度为80.07%,曲线下面积为0.832。结论:AECOPD患者血清SAA水平明显升高,其与患者肺功能及炎症因子存在相关性,具有较高的诊断价值,可用于AECOPD患者病情的评估。