Paton J Y, Bautista D B, Stabile M W, Waldman A E, Nassar A G, Platzker A C, Keens T G
Division of Neonatology and Pediatric Pulmonology, Childrens Hospital, Los Angeles, California 90027.
Pediatr Pulmonol. 1991;10(1):25-9. doi: 10.1002/ppul.1950100106.
Digital clubbing and pulmonary function tests were measured in children, adolescents, and adults with chronic lung diseases to determine pulmonary function correlates with a quantitative measure of clubbing. The group had a mean age of 13.8 +/- 6.0 (SD) years, mean PaO2 of 81 +/- 21 mm Hg, and mean FEV1 of 60% +/- 26% predicted. Digital clubbing was diagnosed in 43 cases when the distal phalangeal depth to interphalangeal depth (DPD/IPD) ratio, measured on a finger cast, was greater than or equal to 1 (greater than 3 SD above mean from 85 controls; no history of pulmonary disease; mean age, 14.8 +/- 7.6). The PaO2 of patients with digital clubbing was 69.4 +/- 2.1 (SEM) mm Hg compared with 88.3 +/- 1.3 mm Hg in those without digital clubbing (P less than 0.0001). Digital clubbing was present in 39 of the 84 (46%) hypoxic patients (PaO2 less than or equal to 88) but only four of the 78 (5%) normoxic patients (P less than 0.0001). The DPD/IPD ratio was negatively correlated with PaO2 in subjects with cystic fibrosis and interstitial fibrosis. Weak negative correlations were seen for all other subjects except asthmatics. Overall, the DPD/IPD ratio was significantly correlated with PaO2 (r = -0.53; P less than 0.0001). The DPD/IPD ratio was correlated with other lung function abnormalities (increased RV, decreased FEV1, and FEF25%-75%) only for the subjects with cystic fibrosis. We conclude that digital clubbing is associated with hypoxemia and airway obstruction. The relation is seen most clearly in subjects with cystic fibrosis, possibly reflecting the prolonged duration of hypoxemia. Digital clubbing is rarely seen in normoxic subjects.
对患有慢性肺部疾病的儿童、青少年和成人进行了杵状指和肺功能测试，以确定肺功能与杵状指定量测量之间的相关性。该组的平均年龄为13.8±6.0（标准差）岁，平均动脉血氧分压（PaO2）为81±21毫米汞柱，第一秒用力呼气容积（FEV1）平均为预测值的60%±26%。当在手指模型上测量的远端指骨深度与指间深度（DPD/IPD）比值大于或等于1（比85名无肺部疾病病史的对照者的平均值高3个标准差以上；平均年龄为14.8±7.6）时，诊断出43例杵状指。有杵状指的患者的PaO2为69.4±2.1（标准误）毫米汞柱，而无杵状指的患者为88.3±1.3毫米汞柱（P＜0．0001）。84例低氧血症患者（PaO2≤88）中有39例（46%）出现杵状指，而78例正常氧合患者中只有4例（5%）出现杵状指（P＜0．0001）。在患有囊性纤维化和间质性纤维化的受试者中，DPD/IPD比值与PaO2呈负相关。除哮喘患者外，在所有其他受试者中均观察到弱负相关。总体而言，DPD/IPD比值与PaO2显著相关（r = -0.53；P＜0．0001）。仅在患有囊性纤维化的受试者中，DPD/IPD比值与其他肺功能异常（残气量增加、FEV1降低和25%-75%用力呼气流量降低）相关。我们得出结论，杵状指与低氧血症和气道阻塞有关。这种关系在囊性纤维化患者中最为明显，可能反映了低氧血症的持续时间较长。在正常氧合的受试者中很少见到杵状指。
