Lung Function of Adults Born at Very Low Birth Weight
Lung Function of Adults Born at Very Low Birth Weight
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DOI：
10.1542/peds.2019-2359
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发表时间：
2020-02-01
期刊：
影响因子：
8
通讯作者：
Darlow, Brian A.
中科院分区：
文献类型：
--
作者：
Yang, Jun;Kingsford, Rachel A.;Darlow, Brian A.
背景：关于极低出生体重儿（VLBW）和支气管肺发育不良（BPD）对成人肺的影响仍有很多未知之处。我们假设，与对照组相比，VLBW成人肺功能受损，有BPD病史的人肺功能比无BPD病史的人更差。方法：采用正交设计法在26 - 30岁时，新西兰VLBW队列的226名VLBW幸存者和1986年出生的100名足月对照者进行了肺功能检查，包括肺功能测定、体积描记肺容量、肺一氧化碳弥散量和单次呼吸氮洗脱（SBN 2）。结果：35%的VLBW受试者与14%的对照组中确定了阻塞性肺功能测定模式，大多数显示轻度阻塞。与对照组相比，VLBW存活者表现出显著较低的第一秒用力呼气量（FEV 1）、FEV 1/用力肺活量（FVC）比值（FEV 1/FVC）、25%至75% FVC时的用力呼气流量和较高的残气量（RV）、RV/总肺容量（TLC）比值（RV/TLC）、肺一氧化碳弥散量降低和SBN 2 III相斜率增加。在调整性别和吸烟状况后，这种差异仍然存在。在VLBW组中，与无BPD的受试者相比，BPD受试者的FEV 1、FEV 1/FVC和25%-75% FVC时的用力呼气流量显著降低，RV、RV/TLC和SBN 2的III相斜率增加。调整混杂因素后，差异仍然存在。结论：与对照组相比，成年VLBW幸存者表现出更高的气流阻塞、气体滞留、气体交换减少和呼吸不均匀性增加的发生率。研究结果表明，由于VLBW的肺部影响持续到成年期，BPD是对小气道功能的进一步损害。
BACKGROUND: Much remains unknown about the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult lungs. We hypothesized that VLBW adults would have impaired lung function compared with controls, and those with a history of BPD would have worse lung function than those without. METHODS: At age 26 to 30 years, 226 VLBW survivors of the New Zealand VLBW cohort and 100 term controls born in 1986 underwent lung function tests including spirometry, plethysmographic lung volumes, diffusing capacity of the lung for carbon monoxide, and single-breath nitrogen washout (SBN2). RESULTS: An obstructive spirometry pattern was identified in 35% VLBW subjects versus 14% controls, with the majority showing mild obstruction. Compared with controls, VLBW survivors demonstrated significantly lower forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC) ratio (FEV1/FVC), forced expiratory flow at 25% to 75% of FVC and higher residual volume (RV), RV/total lung capacity (TLC) ratio (RV/TLC), decreased diffusing capacity of the lung for carbon monoxide, and increased phase III slope for SBN2. The differences persisted after adjustment for sex and smoking status. Within the VLBW group, subjects with BPD showed significant reduction in FEV1, FEV1/FVC, and forced expiratory flow at 25% to 75% of FVC, and increase in RV, RV/TLC, and phase III slope for SBN2, versus subjects without. The differences remained after adjustment for confounders. CONCLUSIONS: Adult VLBW survivors showed a higher incidence of airflow obstruction, gas trapping, reduced gas exchange, and increased ventilatory inhomogeneity versus controls. The findings suggest pulmonary effects due to VLBW persist into adulthood, and BPD is a further insult on small airway function.