Backman Katri, Piippo-Savolainen Eija, Ollikainen Hertta, Koskela Heikki, Korppi Matti
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland; Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Respir Med. 2014 Jan;108(1):218-23. doi: 10.1016/j.rmed.2013.11.014. Epub 2013 Dec 2.
Lower respiratory infections in infancy may be associated with lung function deficits in adulthood. Our aim was to evaluate lung function, with a special focus on irreversible airway obstruction, thirty years after bronchiolitis or pneumonia in infancy.
In 1981-1982, 83 children under two years of age were hospitalized for bronchiolitis and 44 for pneumonia at Kuopio University Hospital, Finland. In 2010, 47 bronchiolitis patients, 22 pneumonia patients and 138 controls attended the study, including spirometry before (pre-BD) and after bronchodilatation (post-BD). The measured indices were forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), that were presented as % of predicted value (FVC% and FEV1%). FEV1/FVC was presented as both absolute FVC/FEV1-ratio and % of predicted (FEV1/FVC%). Irreversible airway obstruction was defined as post-BD FEV1/FVC% below 88% of predicted (FEV1/FVC% <88%) according to Finnish reference values or FEV1/FVC-ratio below fifth percentile (FEV1/FVC <5th percentile), according to Global Lung Function Initiative reference values.
All lung function indices were lower in former bronchiolitis patients and pre- and post-BD FEV1% in pneumonia patients, compared to controls. 21% of bronchiolitis (OR, 95%CI; 5.59, 1.72-18.21) and 9% of pneumonia patients (2.24, 0.34-13.56) had FEV1/FVC% <88% compared to controls (4%). Likewise 7 (15%) of bronchiolitis (7.07, 1.33-37.22) and 1 (5%) of pneumonia patients (1.73, 0.12-24.77) had FEV1/FVC <5th percentile compared to controls 2 (1%).
Evidence of reduced lung function was present 30 years after hospitalization for bronchiolitis or pneumonia in infancy. Irreversible airway obstruction after severe bronchiolitis in infancy suggests permanent, structural alterations in airways.
婴儿期下呼吸道感染可能与成年期肺功能缺陷有关。我们的目的是评估婴儿期患细支气管炎或肺炎30年后的肺功能，特别关注不可逆性气道阻塞。
1981 - 1982年，芬兰库奥皮奥大学医院收治了83名两岁以下因细支气管炎住院的儿童和44名因肺炎住院的儿童。2010年，47名细支气管炎患者、22名肺炎患者和138名对照者参与了该研究，包括支气管扩张前（预支气管扩张，pre - BD）和支气管扩张后（post - BD）的肺活量测定。测量指标为用力肺活量（FVC）和一秒用力呼气容积（FEV1），以预测值的百分比表示（FVC%和FEV1%）。FEV1/FVC以绝对FVC/FEV1比值和预测值的百分比（FEV1/FVC%）两种形式呈现。根据芬兰参考值，不可逆性气道阻塞定义为支气管扩张后FEV1/FVC%低于预测值的88%（FEV1/FVC% <88%）；根据全球肺功能倡议参考值，定义为FEV1/FVC比值低于第五百分位数（FEV1/FVC <5th percentile）。
与对照组相比， former细支气管炎患者的所有肺功能指标均较低，肺炎患者支气管扩张前和后的FEV1%也较低。与对照组（4%）相比，21%的细支气管炎患者（比值比，95%置信区间；5.59，1.72 - 18.21）和9%的肺炎患者（2.24，0.34 - 13.56）的FEV1/FVC% <88%。同样，与对照组2名（1%）相比，7名（15%）细支气管炎患者（7.07，1.33 - 37.22）和1名（5%）肺炎患者（1.73，0.12 - 24.77）的FEV1/FVC <5th percentile。
婴儿期患细支气管炎或肺炎住院30年后存在肺功能下降的证据。婴儿期严重细支气管炎后的不可逆性气道阻塞提示气道存在永久性结构改变。
