Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Department of Respiratory Medicine, Royal Children's Hospital, Herston, QLD 4029, Australia.
Chest. 2010 Jul;138(1):158-64. doi: 10.1378/chest.09-2932. Epub 2010 Feb 19.
Longitudinal FEV(1) data in children with non-cystic fibrosis (non-CF) bronchiectasis (BE) are contradictory, and there are no multifactor data on the evolution of lung function and growth in this group. We longitudinally reviewed lung function and growth in children with non-CF BE and explored biologically plausible factors associated with changes in these parameters over time.
Fifty-two children with > or = 3 years of lung function data were retrospectively reviewed. Changes in annual anthropometry and spirometry at year 3 and year 5 from baseline were analyzed. The impact of sex, age, cause, baseline FEV(1), exacerbation frequency, radiologic extent, socioeconomic status, environmental tobacco smoke exposure, and period of diagnosis was evaluated.
Over 3 years, the group mean forced expiratory flow midexpiratory phase percent predicted and BMI z-score improved by 3.01 (P = .04; 95% CI, 0.14-5.86) and 0.089 (P = .01; 95% CI, 0.02-0.15) per annum, respectively. FEV(1)% predicted, FVC% predicted, and height z-score all showed nonsignificant improvement. Over 5 years, there was improvement in FVC% predicted (slope 1.74; P = .001) annually, but only minor improvement in other parameters. Children with immunodeficiency and those with low baseline FEV(1) had significantly lower BMI at diagnosis. Frequency of hospitalized exacerbation and low baseline FEV(1) were the only significant predictors of change in FEV(1) over 3 years. Decline in FEV(1)% predicted was large (but nonsignificant) for each additional year in age of diagnosis.
Spirometric and anthropometric parameters in children with non-CF BE remain stable over a 3- to 5-year follow-up period once appropriate therapy is instituted. Severe exacerbations result in accelerated lung function decline. Increased medical cognizance of children with chronic moist cough is needed for early diagnosis, better management, and improving overall outcome in BE.
非囊性纤维化（非 CF）支气管扩张症（BE）患儿的纵向 FEV1 数据存在争议，并且该组人群的肺功能和生长演变尚无多因素数据。我们对非 CF BE 患儿的肺功能和生长进行了纵向研究，并探讨了与这些参数随时间变化相关的生物学上合理的因素。
回顾性分析了 52 例有≥3 年肺功能数据的患儿。分析了从基线开始第 3 年和第 5 年的年度人体测量学和肺活量测定值的变化。评估了性别、年龄、病因、基线 FEV1、发作频率、放射学范围、社会经济状况、环境烟草烟雾暴露和诊断时间的影响。
3 年内，该组的用力呼气流量 mid 呼气阶段预计百分比和 BMI z 评分分别每年改善 3.01（P=0.04；95%CI，0.14-5.86）和 0.089（P=0.01；95%CI，0.02-0.15）。FEV1%预计值、FVC%预计值和身高 z 评分均无明显改善。5 年内，FVC%预计值每年都有改善（斜率 1.74；P=0.001），但其他参数仅略有改善。免疫缺陷和基线 FEV1 较低的患儿在诊断时 BMI 较低。3 年内，FEV1 变化的唯一显著预测因素是住院发作频率和低基线 FEV1。诊断年龄每增加 1 岁，FEV1%预计值的下降幅度较大（但无统计学意义）。
一旦给予适当的治疗，非 CF BE 患儿的肺功能和人体测量参数在 3 至 5 年的随访期间保持稳定。严重发作会导致肺功能加速下降。需要提高对慢性湿咳患儿的医学认识，以便早期诊断、更好地管理，并改善 BE 的整体预后。
