Taytard J, Boizeau P, Alberti C, Beydon N
AP-HP, hôpital Trousseau, service de pneumologie pédiatrique, Paris, France; Université Pierre et Marie-Curie-Paris 6, Inserm U938, Paris, France.
AP-HP, hôpital Robert Debré, Unité d'Épidémiologie Clinique, Paris, France.
Rev Mal Respir. 2019 Oct;36(8):937-945. doi: 10.1016/j.rmr.2019.06.007. Epub 2019 Sep 11.
The reference technique to measure the diffusing capacity of the lung for carbon monoxide (DLco) is the single-breath method (sb). For patients unable to perform this method, the rebreathing method (rb) can be used. However, the clinical relevance of DLCOrb has not been evaluated. The aim of this study was to assess the feasibility of the rb method in children seen in a clinical setting and its relationships with sb method.
We prospectively included children referred for 1) a suspected or confirmed interstitial lung disease (ILD group) (DLCOsb and DLCOrb measurements) ; 2) controlled asthma with normal lung function (DLCOrb measurements to derive DLCOrb/KCOrb expected values). DLCOrb was computed from the decrease in CO and Helium concentrations during tidal breathing in a rebreathing bag.
Data on DLCOrb measurements were available for 53 (91%) children in the ILD group and 48 (91%) control children (mean (range) 11.5 (4.3-18.2) and 9.5 (4-17) years ; respectively). In the ILD group, high or moderate correlations were found between raw DLCOrb and DLCOsb values (rhô=0.82 ; P<0.0001) and between KCOrb and KCOsb (rhô=0.62 ; P<0.0001), respectively. Results expressed as percentage predicted were moderately correlated (rhô=0.55 ; P=0.0003 for DLCO ; rhô=0.51 ; P=0.001 for KCO).
DLCOrb is easy to perform in children and gives values that are highly correlated to DCLOsb. Our preliminary results are in favour of a possible clinical use after further validation.
测量肺一氧化碳弥散量（DLco）的参考技术是单呼吸法（sb）。对于无法进行该方法的患者，可采用重复呼吸法（rb）。然而，DLCOrb的临床相关性尚未得到评估。本研究的目的是评估rb方法在临床环境中儿童患者的可行性及其与sb方法的关系。
我们前瞻性纳入了因以下原因就诊的儿童：1）疑似或确诊的间质性肺疾病（ILD组）（测量DLCOsb和DLCOrb）；2）肺功能正常的控制性哮喘（测量DLCOrb以得出DLCOrb/KCOrb预期值）。DLCOrb通过重复呼吸袋中潮气呼吸期间一氧化碳和氦浓度的下降来计算。
ILD组53名（91%）儿童和48名（91%）对照儿童有DLCOrb测量数据（平均（范围）分别为11.5（4.3 - 18.2）岁和9.5（4 - 17）岁）。在ILD组中，原始DLCOrb与DLCOsb值之间（相关系数=0.82；P<0.0001）以及KCOrb与KCOsb之间（相关系数=0.62；P<0.0001）分别存在高度或中度相关性。以预测百分比表示的结果呈中度相关（DLCO的相关系数=0.55；P = 0.0003；KCO的相关系数=0.51；P = 0.001）。
DLCOrb在儿童中易于操作，其值与DCLOsb高度相关。我们的初步结果支持在进一步验证后可能的临床应用。
