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体重指数对健康及哮喘青少年对乙酰甲胆碱支气管激发试验反应的影响。

Effect of body mass index on response to methacholine bronchial provocation in healthy and asthmatic adolescents.

作者信息

Mansell Anthony L, Walders Natalie, Wamboldt Marianne Z, Carter Rick, Steele Dale W, Devin Jerilyn A, Monica Taylor H, Miller Alison L, Wamboldt Frederick S

机构信息

Department of Pediatrics, Rhode Island Hospital, Brown University, Providence, 02903, USA.

出版信息

Pediatr Pulmonol. 2006 May;41(5):434-40. doi: 10.1002/ppul.20368.

Abstract

A linkage between airway hyperreactivity and obesity could partly explain the prevalence of obesity in asthmatics. To test for such a linkage, we analyzed body mass index (BMI), pulmonary function, methacholine bronchial provocation, and asthma severity scores in 216 adolescents (aged 12-18 years), of whom 82 were healthy and 134 were asthmatic. Methacholine provocations in a subgroup of 36 subjects (healthy and asthmatic) enabled us to examine the effects of BMI on dynamic hyperinflation and ventilatory indices during induced bronchospasm. Age- and gender-specific BMI was higher in asthmatics (74 +/- 24%) compared to healthy subjects (61 +/- 28%, P < 0.002). General linear model analysis, in which baseline spirometric results were adjusted for gender, age, race, and height, showed opposing effects of BMI on expiratory flow in controls and asthmatics (P < 0.05), i.e., forced expired volume in 1 sec increased with BMI in controls (P < 0.02), but forced expiratory flow (FEF)(25-75%) decreased with BMI in asthmatics (P < 0.05). However, linear regression analysis showed no effect of BMI on the provocation dose for methacholine (PD(20)) in either controls or asthmatics, and there was no effect of BMI on asthma severity scores. Overweight (BMI >85th percentile) and nonoverweight subjects had similar degrees of dynamic hyperinflation during positive provocations, but overweight subjects had greater decreases in mean inspiratory flow (mean, 28% vs. 9%, P < 0.05). We conclude that our measurements support a relationship between overweight and baseline flow limitation, rather than a relationship between overweight and airways hyperreactivity, in the linkage between overweight and asthma during adolescence.

摘要

气道高反应性与肥胖之间的联系可能部分解释了哮喘患者中肥胖的普遍存在。为了检验这种联系,我们分析了216名青少年(年龄在12至18岁之间)的体重指数(BMI)、肺功能、乙酰甲胆碱支气管激发试验以及哮喘严重程度评分,其中82名健康青少年,134名哮喘患者。对36名受试者(包括健康和哮喘患者)的亚组进行乙酰甲胆碱激发试验,使我们能够研究BMI对诱发支气管痉挛期间动态肺过度充气和通气指标的影响。与健康受试者(61±28%)相比,哮喘患者的年龄和性别特异性BMI更高(74±24%,P<0.002)。通过一般线性模型分析,对基线肺量计结果进行性别、年龄、种族和身高校正后,发现BMI对对照组和哮喘患者的呼气流量有相反的影响(P<0.05),即对照组中1秒用力呼气容积随BMI增加(P<0.02),而哮喘患者中用力呼气流量(FEF)(25-75%)随BMI降低(P<0.05)。然而,线性回归分析显示,BMI对对照组或哮喘患者的乙酰甲胆碱激发剂量(PD20)均无影响,且BMI对哮喘严重程度评分也无影响。超重(BMI>第85百分位数)和非超重受试者在阳性激发试验期间的动态肺过度充气程度相似,但超重受试者的平均吸气流量下降幅度更大(平均分别为28%和9%,P<0.05)。我们得出结论,我们的测量结果支持在青少年超重与哮喘的联系中,超重与基线气流受限之间存在关系,而非超重与气道高反应性之间存在关系。

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