Longitudinal Assessment of Lung Function From Infancy to Childhood in Patients With Cystic Fibrosis
Longitudinal Assessment of Lung Function From Infancy to Childhood in Patients With Cystic Fibrosis
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DOI：
10.1002/ppul.20994
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发表时间：
2009-04-01
影响因子：
3.1
通讯作者：
Milla, Carlos E.
中科院分区：
文献类型：
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作者：
Harrison, Amy N.;Regelmann, Warren E.;Milla, Carlos E.
基本原理：婴儿肺功能测试（IPFT）已成为评估囊性纤维化（CF）婴儿肺功能的重要临床工具;然而，婴儿期肺功能是否可预测日后的肺功能仍不清楚。我们假设，在儿童期后期，通过IPFT测量气流阻塞与通过常规肺功能测定法测量肺功能密切相关。研究设计和方法：对1994年9月至2003年3月在明尼苏达大学儿童医院接受IPFT研究的所有CIF婴儿进行回顾性分析。共有41名患者接受了IPFT，并在6岁或更大时获得了有效的肺功能测定结果。根据潮气呼吸环计算IPFT值，如I：E比值、呼吸频率、潮气量和T（ptef）/T（e）。被动呼吸系统力学，包括C（rs），R（rs），和tau（rs），通过单次呼吸吸气末闭塞技术进行测量。用力呼气流量，包括V（max）FRC、FVC、FEF（50）和FEF（75），通过快速胸部按压获得，包括通过多次充气法进行的完全肺活量动作。FRC测量值根据通过氮洗脱获得的患者亚组数据计算。此外，还记录了诊断时的年龄以及诊断时和后续访视时的口咽（OP）培养结果。所有患者从5岁开始进行标准肺量测定。选择6岁后的第一个有效流量-容量环进行分析。结果如下：IPFT法测得的R（rs）与FEF（50）、标准肺量计测得的FEV（1）与FEF（25-75）之间存在显著相关性（r > 0.4，P < 0.03）。这些相关性对于在诊断后1个月内获得的IPFT测量结果以及当Rrs表示为sG（rs）时最强。所观察到的相关性与诊断时年龄、性别和诊断时口咽培养中假单胞菌的存在无关。平均Rrs从0.050下降到0.027 cm H（2）O/ml/sec（P
Rationale: Infant pulmonary function testing (IPFT) has become an important clinical tool for the evaluation of lung function in infants with Cystic Fibrosis (CF); however, it is still unclear whether lung function in infancy is predictive of lung function later in life. We hypothesized that measures of airflow obstruction by IPFT would correlate strongly with lung function by conventional spirometry later in childhood. Study Design and Methodology: A retrospective analysis was performed of all CIF infants studied with IPFT at the University of Minnesota Children's Hospital between September 1994 and March 2003. A total of 41 patients underwent IPFT and had valid spirometry results available at age 6 or later. IPFT values, such as I:E ratio, respiratory rate, tidal volume, and T(ptef)/T(e), were calculated from tidal breathing loops. Passive respiratory system mechanics, which included C(rs), R(rs), and tau(rs), were measured by the single breath end-inspiratory occlusion technique. Forced expiratory flows, including V(max)FRC, FVC, FEF(50), and FEF(75), were obtained by rapid thoracic compression and included a full vital capacity maneuver by the multiple inflation method. FRC measurements were calculated from data obtained via nitrogen washout in a subset of patients. In addition, information on age at diagnosis and results of oropharyngeal (OP) cultures at diagnosis and on subsequent visits was recorded. Standard spirometry was performed in all patients starting at age 5. The first valid flow-volume loop after age six was selected for analysis. Results: Significant correlations were observed for the R(rs) and the FEF(50) by IPFT and the FEV(1) and the FEF(25-75) by standard spirometry (r > 0.4 and P < 0.03 for all correlations). These correlations were the strongest for those IPFT measurements obtained within 1 month of diagnosis and when Rrs was expressed as sG(rs). The correlations observed were independent of the effects of age at diagnosis, gender and presence of Pseudomonas in oropharyngeal cultures at the time of diagnosis. Mean Rrs declined from 0.050 to 0.027 cm H(2)O/ml/sec with treatment (P