Longitudinal evaluation of airway function 21 years after preterm birth
Longitudinal evaluation of airway function 21 years after preterm birth
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DOI：
10.1164/rccm.200705-701oc
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发表时间：
2008-07-01
影响因子：
24.7
通讯作者：
Bush, Andrew
中科院分区：
文献类型：
--
作者：
Narang, Indra;Rosenthal, Mark;Bush, Andrew
理论基础：关于早产儿到成年后呼吸道发病率和肺功能的纵向数据有限。目的：确定早产儿从童年到成年期的呼吸道症状、肺活量测定和呼吸道高反应性的演变。方法：早产儿(出生体重中位数1,440g；妊娠中位数31.5wk)，出生时招募(未接受表面活性物质治疗)，在童年中期有过度的呼吸道症状、呼吸道阻塞和气道高反应性增加。在中位年龄21.7岁，60名受试者(指数研究组)和50名健康对照受试者被招募来确定呼吸道发病率和肺活量。测量和主要结果：呼吸系统症状问卷，肺活量测定和乙酰甲胆碱激发试验。指数研究组的呼吸道症状(16/60)明显多于对照组(4/50)(优势比为4.2；95%可信区间为1.3~13.5；P=0.01)，但在肺活量测定方面无显著差异。具体而言，在指数研究组和对照组，FEV1的平均z分数(组间差值的95%可信区间)分别为-0.60和-0.58(-0.44~0.49)(P=0.92)；用力呼气中期流量的平均z分数分别为-1.02和-0.86(-0.33~0.64)(P=0.52)；FVC的平均z分数分别为-0.29和-0.33(-0.46~0.38)(P=0.85)。与对照组相比，早产儿的呼吸道高反应性分别为23%和19%(P=0.89)。结论：早产儿21年后仍存在过度呼吸道症状。令人放心的是，这项纵向研究没有显示早产成人持续呼吸道阻塞或气道高反应性的证据。
Rationale: There are limited longitudinal data about respiratory morbidity and lung function after preterm birth into adulthood.Objectives: To determine the evolution of respiratory symptoms, spirometry, and airway hyperresponsiveness of ex-preterm subjects from childhood into adulthood.Methods: Ex-preterm subjects (median birth weight, 1,440 g; median gestation, 31.5 wk), recruited at birth (not treated with surfactant), had excess respiratory symptoms, airway obstruction, and increased airway hyperresponsiveness in mid-childhood. At a median age of 21.7 years, 60 of these subjects (the index study group) and 50 healthy term control subjects were recruited to determine respiratory morbidity and spirometry.Measurements and Main Results: Respiratory symptom questionnaire, spirometry, and methacholine challenge test. The index study group had significantly more respiratory symptoms (16 of 60) than did control subjects (4 of 50) (odds ratio, 4.2; 95% confidence interval, 1.3 to 13.5; P = 0.01), but no significant difference in measured spirometry. Specifically, in the index study group and control subjects, the mean z scores (95% confidence interval of the group difference) for the FEV1 were -0.60 and -0.58 (-0.44 to 0.49), respectively (P = 0.92); for the forced mid-expiratory flow they were -1.02 and -0.86 (-0.33 to 0.64), respectively (P = 0.52); and for the FVC they were -0.29 and -0.33 (-0.46 to 0.38), respectively (P = 0.85). Ex-preterm adults did not show evidence of increased airway hyperresponsiveness compared with control subjects, 23 and 19%, respectively (P = 0.89).Conclusions: There are still excess respiratory symptoms 21 years after preterm birth. Reassuringly, this longitudinal study did not show evidence of persistent airway obstruction or airway hyperresponsiveness in ex-preterm adults.