Portex Unit, Respiratory Physiology and Medicine, UCL, Institute of Child Health, London, WC1N 1EH, UK.
Eur Respir J. 2011 May;37(5):1199-207. doi: 10.1183/09031936.00071110. Epub 2010 Oct 14.
Advances in neonatal care have resulted in increased survival of children born extremely pre-term (EP). Nevertheless the incidence of bronchopulmonary dysplasia and long-term respiratory morbidity remains high. We investigated the nature of pathophysiological changes at 11 yrs of age to ascertain whether respiratory morbidity in EP children primarily reflects alterations in the lung periphery or more centralised airway function in this population. Spirometry, plethysmography, diffusing capacity, exhaled nitric oxide, multiple-breath washout, skin tests and methacholine challenge were used during laboratory-based assessments in a subgroup of the 1995 EPICure cohort and in controls. Results were obtained in 49 EP and 52 control children. Lung function abnormalities were found in 78% of EP children, with evidence of airway obstruction, ventilation inhomogeneity, gas trapping and airway hyperresponsiveness. Levels of atopy and exhaled nitric oxide were similar between the groups. Prior wheeze was associated with significant reductions in forced flows and volumes. By contrast, abnormalities of the lung periphery appear to be mediated primarily through EP birth per se. The prevalence of lung function abnormalities, which is largely obstructive in nature and likely to have long-term implications, remains high among 11-yr-old children born EP. Spirometry proved an effective means of detecting these persistent abnormalities.
新生儿护理的进步使得极早产儿（EP）的存活率提高。然而，支气管肺发育不良和长期呼吸系统发病率仍然很高。我们研究了 11 岁时病理生理学变化的性质，以确定 EP 儿童的呼吸系统发病率主要反映了该人群肺外周或更集中的气道功能的改变。在基于实验室的评估中，使用了肺量计、体积描记法、扩散能力、呼气一氧化氮、多次呼吸冲洗、皮肤测试和乙酰甲胆碱挑战，在 1995 年 EPICure 队列的一个亚组和对照组中进行了研究。在 49 名 EP 儿童和 52 名对照儿童中获得了结果。78%的 EP 儿童存在肺功能异常，有气道阻塞、通气不均、气体潴留和气道高反应性的证据。两组之间的过敏和呼气一氧化氮水平相似。既往喘息与用力流量和容量的显著降低有关。相比之下，肺外周的异常似乎主要是通过 EP 出生本身介导的。在 11 岁的 EP 出生儿童中，肺功能异常的患病率仍然很高，这些异常主要是阻塞性的，可能有长期影响。肺量计被证明是检测这些持续性异常的有效手段。
