Bending the Twig Does the Tree Incline: Lung Function after Lower Respiratory Tract Illness in Infancy.
Bending the Twig Does the Tree Incline: Lung Function after Lower Respiratory Tract Illness in Infancy.
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弯曲树枝会使树倾斜：婴儿期下呼吸道疾病后的肺功能。
DOI：
10.1164/rccm.201611-2325ed
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发表时间：
2017
影响因子：
24.7
通讯作者：
Martinez,FernandoD
中科院分区：
文献类型：
--
作者：
Martinez,FernandoD
40年前，利德及其同事（1）进行了一项开创性的观察：他们对伦敦西部近500名出生时的受试者进行了跟踪调查，报告称，那些“仅患有支气管炎或肺炎，无哮喘”的受试者在5岁时的呼气峰流速明显低于那些没有此类发作的受试者。最低的峰值流速在儿童的发作发生在生命的第一年。在同一队列中，这些作者在出生后不久和1岁时测量了哭泣的功能，但在出生后第一年或5岁时，这些测量结果与支气管炎或肺炎之间没有任何联系（2）。鉴于哭泣试验的局限性，一个主要问题没有得到解决：5岁时观察到的呼气峰流量不足是急性呼吸道事件造成的损害的结果，还是这些不足发生在事件本身之前？弯曲的树枝会使树倾斜吗？在随后的四十年中进行的几项纵向研究令人信服地表明，在生命的最初几年患有下呼吸道疾病（LRTI）的儿童在生命的最初几周内评估的肺功能指标存在缺陷（4-6）。这些结果表明，利德及其同事（1）的观察结果至少部分可以用子宫内肺或气道生长的改变来解释，这将使那些受影响的人易于发生LRTI和持续性肺功能损害。尽管如此，不能排除严重LRTI可能导致气道损伤的可能性，而不依赖于先前存在的肺功能缺陷。Castro-Rodrıguez及其同事（7）报告称，在生命的前3年内经放射学证实患有肺炎的儿童在11岁时的FEV 1和FEF 25 -75低于无LRTI病史的儿童。有肺炎史的儿童在出生后不久测量的功能残气量下的最大流量也有减少的趋势，但在一小群参与者中进行了婴儿肺功能测试。因此，无法阐明在上学期间观察到的FEV 1和FEF 25 -75的缺陷是否可以完全解释为预先存在的肺功能损害。212-220）贡献了令人信服的新信息，有助于阐明这一难题（8）。在这项全面的研究中，研究人员测量了呼出的一氧化氮，并评估了在南非开普敦以外的贫困社区长大的儿童在6周和1岁时从潮式呼吸和多次呼吸冲洗中获得的参数。对每个LRTI进行详细的确定和临床评价。正如预期的那样，他们发现从6周龄到1岁的呼吸频率，潮气量和肺清除指数的显着跟踪，但当在6周龄测量时，这些参数都不能预测LRTI的后续发展。相反，与没有LRTI的儿童相比，复发性LRTI的儿童在1岁时的所有三项指标都发生了变化。因此，数据
Forty years ago, Leeder and coworkers (1) made a seminal observation: having followed almost 500 subjects from birth in western London, they reported that those with episodes of “bronchitis or pneumonia alone, without asthma” had significantly lower peak expiratory flow rates at age 5 years than those without such episodes. The lowest peak flow rates were observed in children whose episodes occurred in the first year of life. In the same cohort, these authors measured crying ventilatory function shortly after birth and at age 1 year, but were unable to find any association between either of these measurements and bronchitis or pneumonia during the first year of life or up to age 5 years (2). Given the limitations of the crying test used, a major issue was left unresolved: were the deficits in peak expiratory flows observed at age 5 years the result of damage caused by the acute respiratory episodes, or did these deficits precede the episodes themselves? Does the bending twig incline the tree (3)? Several longitudinal studies performed during the subsequent four decades have convincingly shown that children who have lower respiratory tract illnesses (LRTIs) during the first years of life have deficits in measures of lung function assessed during the first weeks of life (4–6). These results suggested that the observations by Leeder and coworkers (1) could, at least in part, be explained by alterations in lung or airway growth in utero, which would predispose those affected to both LRTI and persistent lung function impairment. Still, the possibility could not be excluded that severe LRTI could cause airway damage independent of preexisting lung function deficits. Castro-Rodrıguez and coworkers (7) reported that children who had radiologically ascertained pneumonia during the first 3 years of life had lower FEV1 and FEF25–75 at age 11 years than children with no history of LRTI. There was also a trend for the children with a history of pneumonia to have diminished maximal flows at functional residual capacity measured shortly after birth, but infant lung function testing was performed in a small group of participants. Thus, it could not be elucidated whether the deficits in FEV1 and FEF25–75 observed during the school years could be fully explained by preexisting lung function impairment.The results of the Drakenstein Child Health Study published in this issue of the Journal (pp. 212–220) contribute cogent new information that helps to elucidate this conundrum (8). In this thorough study, investigators measured exhaled nitric oxide and assessed parameters obtained from tidal breathing and from multiple breath washouts at 6 weeks and 1 year of age in children raised in a poor community outside Cape Town, South Africa. Detailed ascertainment and clinical evaluation of each LRTI was performed. As expected, they found significant tracking of respiratory rate, tidal volume, and lung clearance index from 6 weeks to 1 year of age, but none of these parameters, when measured at 6 weeks of age, predicted the subsequent development of LRTI. All three, on the contrary, were altered at age 1 year in children who had recurrent LRTI as compared with those who had no LRTI. The data thus
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DOI：
10.1164/arrd.1980.122.5.709
发表时间：
2015-05
期刊：
The American review of respiratory disease
影响因子：
--
作者：
B. Burrows;F. Hasan;R. Barbee;M. Halonen;M. Lebowitz
通讯作者：
B. Burrows;F. Hasan;R. Barbee;M. Halonen;M. Lebowitz
“当树枝弯曲时，树就会倾斜”（也许）
DOI：
10.1164/arrd.1980.122.6.813
发表时间：
2015
期刊：
The American review of respiratory disease
影响因子：
--
作者：
B. Burrows;L. Taussig
通讯作者：
L. Taussig
婴儿的呼吸功能与随后的呼吸道疾病的关系：一项流行病学研究。
DOI：
--
发表时间：
1976
期刊：
Bulletin europeen de physiopathologie respiratoire
影响因子：
--
作者：
Colley;Holland Ww;Leeder;Corkhill Rt
通讯作者：
Corkhill Rt
DOI：
10.1056/nejmoa1500245
发表时间：
2015-07-30
期刊：
The New England journal of medicine
影响因子：
--
作者：
Jain S;Self WH;Wunderink RG;Fakhran S;Balk R;Bramley AM;Reed C;Grijalva CG;Anderson EJ;Courtney DM;Chappell JD;Qi C;Hart EM;Carroll F;Trabue C;Donnelly HK;Williams DJ;Zhu Y;Arnold SR;Ampofo K;Waterer GW;Levine M;Lindstrom S;Winchell JM;Katz JM;Erdman D;Schneider E;Hicks LA;McCullers JA;Pavia AT;Edwards KM;Finelli L;CDC EPIC Study Team
通讯作者：
CDC EPIC Study Team
DOI：
10.1136/jech.30.4.219
发表时间：
1976
期刊：
British Journal of Preventive & Social Medicine
影响因子：
--
作者：
S. Leeder;R. Corkhill;M. Wysocki;W. Holland
通讯作者：
W. Holland