ABSTRACT
Objective:To explore the application value of tidal lung function combined with fractional exhaled nitric oxide (FeNO) in children with respiratory syncytial virus (RSV) pneumonia.Methods:The clinical data of 65 children with RSV pneumonia in Shanghai Pudong New Area Gongli Hospital from April 2019 to October 2020 were retrospectively collected. According to the pneumonia severity index (PSI), they were divided into severe group (PSI score>130 points, 19 cases), mild to moderate group (PSI score ≤130 points, 46 cases), and 72 healthy children in the same period were selected as the normal control group. The levels of interleukin (IL)-8, IL-6, tumor necrosis factor-α(TNF-α), high-sensitivity C-reactive protein (hs-CRP) and tidal lung function parameters and FeNO were compared among the three groups and analyzed their correlation and evaluated the value in disease severity.Results:The level of FeNO in the severe group was higher than that in the mild to moderate group and the normal control group: (23.04 ± 5.49) ppb vs. (15.75 ± 8.24), (9.28 ± 3.51) ppb; the levels of tidal volume per kilogram of body mass (VT/kg), peak time ratio (TPEF/TE), peak volume ratio (VPEF/VE) in the severe group were lower than those in the mild to moderate group and the normal control group: (6.21 ± 1.89) ml/kg vs. (8.40 ± 1.27), ( 9.39 ± 3.04) ml/kg; (16.39 ± 6.61)% vs. (21.72 ± 5.39)%, (38.65 ± 7.20)%; (22.81 ± 6.39)% vs. (25.62 ± 5.30)%, (39.67 ± 4.04)% , there were statistical differences ( P<0.05). The correlation analysis results showed that the VT/kg, TPEF/TE, VPEF/VE were negatively correlated with IL-6 ( r = - 0.584, - 0.519, - 0.528; P<0.01), IL-8 ( r = - 0.521, - 0.542, - 0.567; P<0.01), TNF-α ( r = - 0.559, - 0.534, - 0.572; P<0.01) and hs-CRP ( r = - 0.528, - 0.567, - 0.533; P<0.01); the level of FeNO was positively correlated with IL-6, IL-8, TNF-α, hs-CRP ( r = 0.672, 0.639, 0.641, 0.672; P<0.01); the levels of VT/kg, TPEF/TE, VPEF/VE were negatively correlated with PSI scores in children with RSV pneumonia ( r = - 0.842, - 0.713, - 0.741; P<0.05); the level of FeNO was positively correlated with PSI scores in children with RSV pneumonia ( r = 0.809, P<0.05). The area under the curve of VT/kg, TPEF/TE, VPEF/VE combined with FeNO to assess the severity of RSV pneumonia in children with RSV pneumonia was 0.888, and the sensitivity and specificity were 73.68% and 91.30%, respectively. Conclusions:Tidal lung function parameters and FeNO are closely related to the severity of RSV pneumonia. The combined detection can be used as an objective basis for assessing the severity of RSV pneumonia.
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Objective:To explore the value of tidal lung function in distinguishing central and small intrathoracic airway obstructive lesions.Methods:A total of 124 infants with intrathoracic obstructive diseases, including bronchiolitis obliterans (BO), bronchiolitis, airway foreign body, and airway stenosis, were confirmed in Children′s Hospital of Chongqing Medical University from April 2014 to June 2019 and selected as subjects, and 111 normal infants were enrolled as healthy control group.According to the location of lesions, these subjects suffering from intrathoracic obstructive diseases were divided into small airway lesion group(BO, bronchiolitis) and central airway lesion group(airway foreign body, airway stenosis). Lung function was assessed by plethysmography.Results:As for the ratio of time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE) and the ratio of volume to reach peak tidal expiratory flow to total expiratory volume (VPTEF/VE), all disease groups were lower than that in healthy control group TEF/TE: BO 13.2(10.3, 16.3)%, bronchiolitis 15.9 (13.2, 19.7)%, airway foreign body 24.5 (16.7, 30.7)%, airway stenosis 20.7 (16.1, 29.3)%, healthy control group 30.2(25.6, 36.5)%; VPTEF/VE: BO 18.2(17.8, 22.3)%, bronchiolitis 20.3(17.0, 21.6)%, airway foreign body 26.0(20.5, 30.7)%, airway stenosis 22.9(20.2, 29.1)%, healthy control group 31.5(28.1, 37.0)%]( P<0.05) and the lesion in the small airway lesion group was significantly lower than that in central airway lesion group.Compared with the healthy control group, the functional residual capacity (FRC)was higher in each disease group[BO (501.6±166.5) mL, bronchiolitis (334.6±149.6) mL, airway foreign body (392.2±130.1) mL, airway stenosis (350.1±127.9) mL, healthy control group (191.6±73.8) mL]( P<0.05). The ratio of peak expiratory flow to tidal expiratory flow at 25% remaining expiration(PF/TEF 25) was obviously higher in small airway lesion group than that in central airway lesion and healthy control group [BO 232.7(183.2, 261.2)%, bronchiolitis 186.4 (153.3, 247.7)%, airway foreign body 143.1(126.8, 168.9)%, airway stenosis 140.3(122.9, 186.0)%, healthy control group 132.3 (123.1, 147.8)%] ( P<0.05), while no significant differences were found between central airway lesion group and healthy control group ( P>0.05). There were no significant differences in effective airway resistance among all groups ( P>0.05). The tidal breathing flow volume (TBFV) curve shape of small airway lesion group showed the depression of expiratory phase to the transverse axis, while the slope of descending branch of expiratory phase had no significant increase in central airway lesion group. Conclusions:Combined with the increase in PF/TEF 25, the decrease in TPTEF/TE and VPTEF/VE is the characteristic of small airway obstruction.PF/TEF 25 is a sensitive index reflecting small airway obstruction.Combined with the value of lung function parameters, the shape of TBFV is helpful to distinguish central and small airway obstructive lesions.
ABSTRACT
OBJECTIVE: To investigate the factors influencing the improvement of tidal lung function bronchodilation test,and to provide evidence for the diagnosis of infant asthma. METHODS: Totally 71 infant patients diagnosed with asthma were included from clinic of Children's Hospital of Capital Institute of Pediatrics and alternativley assigned into two groups,who respectively received bronchodilator via pM DI(pMDI group)or nebulization(nebulization group),and bronchodilation test was performed. The effects of drug delivering methods on the bronchodilation test was compared,and the main observation indexes were respiratory rate(RR),VT/kg,inspiratory time(Ti),expiratory time(Te),Ti/Te,time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)and peak tidal expiratory flow(PTEF). Further analysis was carried within each group. RESULTS: Twenty patients received bronchodilator via pM DI,and fifty-one patients received bronchodilator via nebulization. After drug delivery,the RR of the children in the pMDI group decreased significantly(P=0.003),and the Ti increased significantly(P=0.011). The VT/kg,Ti,Ti/Te,TPTEF/TE and VPEF/VE increased significantly in nebulization group(all P<0.05). In the nebulization group,the improvement rate of TPTEF/TE and VPEF/VE were significantly higher than that of pMDI group(all P<0.05). In the pMDI group,the Te,Ti/Te,TPTEF/TE and VPEF/VE significantly improved in patients with severe airway obstruction(all P<0.05). The above parameters also improved after bronchodilation test in nebulization group. Compared in difference age groups,TPTEF/TE and VPEF/VE in children over 2 years improved more significantly than those in children under 1 year(all P<0.05). CONCLUSION: The effects of nebulization are better than pMDI in tidal lung function bronchodilation test. The improvement rate of tidal lung function is related to the degree of airway obstruction and the age of patients.