Barreto Mario, Villa Maria P, Montesano Marilisa, Rennerova Zuzana, Monti Fabiana, Darder Maria T, Martella Susy, Ronchetti Roberto
Pediatric Clinic, Sant'Andrea Hospital, Second Faculty of Medicine, University "La Sapienza," Rome, Italy.
Pediatr Pulmonol. 2006 Feb;41(2):141-5. doi: 10.1002/ppul.20358.
Spirometry in adult subjects can induce a fall in concentration of exhaled nitric oxide (FE(NO)). Scarce information is available on the FE(NO) decrease after spirometry or after other forced lung-function maneuvers in children. We compared changes in FE(NO) induced by repeated spirometry and testing of maximal expiratory pressures (P(Emax)). Twenty-four sex- and age-matched children aged 9-18 years (mean age +/- SD, 13.3 +/- 2.8 years; 12 healthy, 12 asthmatic) were allocated to 1-week-apart sessions of repeated maneuvers of either forced vital capacity (FVC) or P(Emax). Baseline FE(NO) measurements were followed by FVC or P(Emax) maneuvers every 15 min for 45 min, whereas FE(NO) was measured at each step for 60 min. After repeated P(Emax) but not after FVC maneuvers, FE(NO) values decreased significantly from baseline in both groups. In healthy children, geometric mean FE(NO) (95% confidence intervals) decreased from 9.1 (7.0-11.8) ppb at baseline to 8.2 (6.3-10.6) ppb at 15 min and 7.7 (5.6-10.6) ppb at 30 min (P < 0.05 and P < 0.01, respectively), and remained unchanged at 45 and 60 min. In asthmatic children, FE(NO) levels fell from 21.6 (13.3-34.9) ppb at baseline to 15.1 (9.1-25.1) ppb at 15 min and remained low at 30, 45, and 60 min: 17.8 (10.7-29.5) ppb, 17.5 (10.2-30.1) ppb, and 17.6 (10.6-29.2) ppb, P < 0.01, for all differences from baseline. Repeated P(Emax) and FVC maneuvers increased FE(NO) variability, as compared with repeated FE(NO) measurements alone. Previous forced lung-function maneuvers may affect FE(NO) measurements in children. Although P(Emax) testing has a greater influence than spirometry on FE(NO) levels in children, both procedures should be avoided before measuring FE(NO).
成人受试者的肺功能测定可导致呼出一氧化氮（FE(NO)）浓度下降。关于儿童肺功能测定或其他用力肺功能操作后FE(NO)降低的信息很少。我们比较了重复肺功能测定和最大呼气压（P(Emax)）测试引起的FE(NO)变化。24名年龄和性别匹配的9至18岁儿童（平均年龄±标准差，13.3±2.8岁；12名健康儿童，12名哮喘儿童）被分配到间隔1周的用力肺活量（FVC）或P(Emax)重复操作 sessions。在进行FVC或P(Emax)操作前，先进行基线FE(NO)测量，每15分钟进行一次FVC或P(Emax)操作，共持续45分钟，而在每个步骤中测量FE(NO)持续60分钟。在重复进行P(Emax)操作后而非FVC操作后，两组的FE(NO)值均较基线显著下降。在健康儿童中，几何平均FE(NO)（95%置信区间）从基线时的9.1（7.0 - 11.8）ppb降至15分钟时的8.2（6.3 - 10.6）ppb和30分钟时的7.7（5.6 - 10.6）ppb（分别为P < 0.05和P < 0.01），并在45分钟和60分钟时保持不变。在哮喘儿童中，FE(NO)水平从基线时的21.6（13.3 - 34.9）ppb降至15分钟时的15.1（9.1 - 25.1）ppb，并在30、45和60分钟时保持较低水平：17.8（10.7 - 29.5）ppb、17.5（10.2 - 30.1）ppb和17.6（10.6 - 29.2）ppb，与基线的所有差异均为P < 0.01。与单独重复测量FE(NO)相比，重复进行P(Emax)和FVC操作增加了FE(NO)的变异性。先前的用力肺功能操作可能会影响儿童的FE(NO)测量。尽管P(Emax)测试对儿童FE(NO)水平的影响比肺功能测定更大，但在测量FE(NO)之前，这两种操作均应避免。
