發(fā)布時(shí)間：2018-04-28 21:33

  本文選題：兒童 + 氣道高反應(yīng)性　； 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的探討小氣道各項(xiàng)指標(biāo)在支氣管激發(fā)試驗(yàn)評估兒童氣道高反應(yīng)性(AHR)中的應(yīng)用。 方法回顧性分析178例以乙酰甲膽堿作為激發(fā)劑進(jìn)行支氣管激發(fā)試驗(yàn)的患兒。以乙酰甲膽堿(Mch)濃度≤16mg/m1時(shí)導(dǎo)致第一秒最大呼氣量(FEV1)下降≥20%為陽性診斷標(biāo)準(zhǔn),比較乙酰甲膽堿激發(fā)試驗(yàn)MCC)陽性組和MCC陰性組的用力肺活量(FVC),FEV1,呼氣流速峰值(PEF)及小氣道各項(xiàng)指標(biāo)基礎(chǔ)值與下降百分率,分析FEV1與小氣道各項(xiàng)指標(biāo)的相關(guān)性。 結(jié)果患兒年齡為4至13歲,共178例,其中男性患兒102例,女性患兒76例；其中MCC陽性組為96例,陰性組為82例；MCC陽性患兒與陰性患兒年齡差異無顯著性統(tǒng)計(jì)學(xué)意義(p=0.1)；基礎(chǔ)肺功能FVC, MCC陽性組與MCC陰性組無顯著統(tǒng)計(jì)學(xué)差異(p0.05),FEV1、PEF大氣道指標(biāo),MCC陽性組均低于MCC陰性組(p0.001)；小氣道指標(biāo)MEF75占預(yù)計(jì)值、MEF50占預(yù)計(jì)值、MEF25占預(yù)計(jì)值和MMEF占預(yù)計(jì)值,MCC陽性組分別為89.89±18.69、86.31±24.29、92.81±34.17、90.04±26.12,MCC陰性組分別為104.97±20.06、109.5±24.12、118.93±34.29、113.41±25.43,兩組差異有顯著性統(tǒng)計(jì)學(xué)意義(p0.001)；MCC陽性組比陰性組各項(xiàng)小氣道指標(biāo)下降的程度大且速度快(p0.001)；FEV1下降百分率與MEF25下降百分率無明顯相關(guān)(r=0.483,p0.001),其余小氣道指標(biāo)與FEV1相關(guān)系數(shù)均約為0.7(p0.001)；當(dāng)定義MMEF下降百分率10%(Mch濃度為0.5mg/ml)為診斷指標(biāo)時(shí),靈敏度為58.33%、特異度為68.29%、陽性預(yù)測值為68.29%、陰性預(yù)測值為58.33%,當(dāng)MMEF占預(yù)計(jì)值90%和MMEF下降10%(Mch濃度為0.5mg/ml)聯(lián)合應(yīng)用診斷氣道高反應(yīng)性時(shí),靈敏度上升為80.9%、特異度上升為93.81%、陽性預(yù)測值上升為92.53%、陰性預(yù)測值上升為83.33%；MMEF占預(yù)計(jì)值、MMEF下降百分率(Mch濃度為0.5mg/ml)的曲線下面積分別為0.75和0.85。 結(jié)論MCC陽性組的各項(xiàng)小氣道指標(biāo)顯著低于MCC陰性組；激發(fā)試驗(yàn)FEV1下降百分率除了與MEF25下降百分率無明顯相關(guān)外,其余小氣道指標(biāo)與FEV1呈明顯正相關(guān)；預(yù)測氣道高反應(yīng)性MMEF下降百分率優(yōu)于MMEF占預(yù)計(jì)值；小氣道各項(xiàng)指標(biāo)的基礎(chǔ)值及激發(fā)試驗(yàn)中下降百分率在輔助診斷兒童氣道高反應(yīng)性有重要的參考價(jià)值。
[Abstract]:Objective to explore the application of small airway parameters in evaluating bronchial hyperresponsiveness (AHR) in children with bronchial provocation test.
Methods a retrospective analysis of 178 cases of bronchial provocation test with methacholine as a activator. With the concentration of acetylmethacholine (Mch) less than 16mg/m1, the first second maximum expiratory volume (FEV1) decreased more than 20% as the positive diagnostic standard, and compared the active lung activity (FVC), FEV1 in the positive and MCC negative groups of the methacholine test MCC test group and the MCC negative group. The peak expiratory flow rate (PEF) and the basic and descending percentages of various indicators of small airway were analyzed, and the correlation between FEV1 and various indexes of small airway was analyzed.
Results the age of the children was 4 to 13 years old, of which there were 178 cases, including 102 male children and 76 female children, of which 96 cases were MCC positive group and 82 cases in negative group, and there was no significant statistical significance between MCC positive children and negative children (p=0.1). There was no significant difference in basic pulmonary function FVC, MCC positive group and MCC negative group (P0.05), FEV1, PEF. The MCC positive group was lower than the MCC negative group (p0.001), the small airway index MEF75 accounted for the expected value, the MEF50 accounted for the estimated value, the MEF25 accounted for the estimated value and the MMEF accounted for the estimated value, MCC positive groups were 89.89 + 18.69,86.31 + 24.29,92.81 + 26.12, respectively, and MCC negative groups were 104.97 + + + + 25.43, respectively. There was significant statistical significance in the two groups (p0.001), and the decrease of small airway index in MCC positive group was larger and faster than that in negative group (p0.001). The percentage of FEV1 decline was not significantly correlated with the percentage of MEF25 decline (r=0.483, p0.001), and the other small airway index and FEV1 correlation coefficient were all about 0.7 (p0.001); when MMEF decreased, the percentage of FEV1 was reduced by 100 percent. The sensitivity of 10% (Mch concentration 0.5mg/ml) was 58.33%, the specificity was 68.29%, the positive predictive value was 68.29%, the negative predictive value was 58.33%. When the MMEF accounted for 90% and MMEF decreased 10% (Mch concentration was 0.5mg/ml), the sensitivity increased by 80.9%, the specificity increased to 93.81%, and the positive predictive value was 93.81%. The increase was 92.53%, the negative predictive value increased to 83.33%, the MMEF accounted for the estimated value, and the area under the curve of MMEF decline (Mch concentration 0.5mg/ml) was 0.75 and 0.85. respectively.
Conclusion the small airway index of MCC positive group was significantly lower than that of MCC negative group; the percentage of FEV1 decline in the test of excitation test was not significantly correlated with the percentage of MEF25 decrease, and the other small airway indexes were positively correlated with FEV1, and the prediction of the percentage of airway hyperresponsiveness MMEF was better than the predicted value of MMEF, and the basic value of the small airway indexes was the basic value. And the percentage of decrease in the provocation test has important reference value in assisting diagnosis of airway hyperresponsiveness in children.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 吳雪郡;黃英;王瑩;龔財(cái)惠;;619例兒童哮喘肺功能FEV1和PEF與小氣道的關(guān)系[J];南方醫(yī)科大學(xué)學(xué)報(bào);2011年11期

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本文編號：1816994