Kim Do Kyun, Choi Sun Hee, Yu Jinho, Yoo Young, Kim Beyong ll, Koh Young Yull
Department of Pediatrics, Seoul National University Hospital, Chongno-gu, Seoul, Korea.
Pediatr Pulmonol. 2006 Jun;41(6):538-43. doi: 10.1002/ppul.20402.
Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma, but it is also frequently present in children and adults with chronic obstructive lung diseases. Bronchopulmonary dysplasia (BPD) is a chronic lung disease, most commonly developing after mechanical ventilation and oxygen therapy in premature infants. BHR is usually measured by bronchial challenges, using direct or indirect stimuli. The aim of this study was to evaluate BHR to direct and indirect stimuli in young children with BPD. Methacholine and adenosine 5'-monophosphate (AMP) bronchial challenges were performed on preschool children with BPD (n = 19), using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. The results obtained were then compared with those of asthmatic (n = 25) and control (n = 23) preschool children. A positive response to methacholine (endpoint concentration, < or = 8 mg/ml) was observed in 89.5% (17/19) of patients with BPD, but a positive response to AMP (endpoint concentration, < or = 200 mg/ml) was observed only in 21.1% (4/19). All patients with asthma responded positively to methacholine, and most (23/25, 92.0%) of them also responded positively to AMP. The majority of controls were unresponsive to both challenges. BHR to methacholine is a frequent finding in preschool-age survivors of BPD, but is usually not accompanied by BHR to AMP. This suggests that most patients with BPD do not have the inflammatory airway response which is characteristic of asthmatic patients.
支气管高反应性（BHR）是哮喘的一个特征性表现，但它也经常出现在患有慢性阻塞性肺疾病的儿童和成人中。支气管肺发育不良（BPD）是一种慢性肺部疾病，最常见于早产儿机械通气和氧疗后。BHR通常通过支气管激发试验来测量，使用直接或间接刺激。本研究的目的是评估患有BPD的幼儿对直接和间接刺激的BHR。采用改良听诊法对19例患有BPD的学龄前儿童进行了乙酰甲胆碱和5'-单磷酸腺苷（AMP）支气管激发试验。终点定义为喘息和/或氧饱和度下降的出现。然后将获得的结果与哮喘（25例）和对照（23例）学龄前儿童的结果进行比较。19例BPD患者中，89.5%（17/19）对乙酰甲胆碱有阳性反应（终点浓度≤8mg/ml），但仅21.1%（4/19）对AMP有阳性反应（终点浓度≤200mg/ml）。所有哮喘患者对乙酰甲胆碱均有阳性反应，其中大多数（23/25，92.0%）对AMP也有阳性反应。大多数对照对两种激发试验均无反应。BPD学龄前幸存者中对乙酰甲胆碱的BHR很常见，但通常不伴有对AMP的BHR。这表明大多数BPD患者没有哮喘患者特有的气道炎症反应。
