Department of Pediatrics, Rostock University Medical Centre, Ernst-Heydemann Strasse 8, DE 18057, Rostock, Germany.
Pediatr Rheumatol Online J. 2021 Mar 6;19(1):23. doi: 10.1186/s12969-021-00509-1.
In adults with rheumatic diseases pulmonary complications are relevant contributors to morbidity and mortality. In these patients diffusion capacity for CO (DLCO) is an established method to detect early pulmonary impairment. Pilot studies using DLCO indicate that early functional pulmonary impairment is present even in children with rheumatic disease albeit not detectable by spirometry and without clinical signs of pulmonary disease. Since the lung clearance index (LCI) is also a non-invasive, feasible and established method to detect early functional pulmonary impairment especially in children and because it requires less cooperation (tidal breathing), we compared LCI versus DLCO (forced breathing and breath-holding manoeuvre) in children with rheumatic diseases.
Nineteen patients (age 9-17 years) with rheumatic disease and no clinical signs of pulmonary disease successfully completed LCI and DLCO during annual check-up. In 2 patients LCI and DLCO were within physiological limits. By contrast, elevated LCI combined with physiological results for DLCO were seen in 8 patients and in 9 patients both, the LCI and DLCO indicate early functional pulmonary changes. Overall, LCI was more sensitive than DLCO to detect early functional pulmonary impairment (p = 0.0128).
Our findings suggest that early functional pulmonary impairment is already present in children with rheumatic diseases. LCI is a very feasible and non-invasive alternative for detection of early functional pulmonary impairment in children. It is more sensitive and less cooperation dependent than DLCO. Therefore, we suggest to integrate LCI in routine follow-up of rheumatic diseases in children.
在患有风湿性疾病的成年人中，肺部并发症是导致发病率和死亡率升高的重要因素。在这些患者中，一氧化碳弥散量（DLCO）是检测早期肺损伤的一种已确立的方法。使用 DLCO 的初步研究表明，即使在患有风湿性疾病的儿童中，也存在早期功能性肺损伤，但这些损伤无法通过肺活量测定法检测到，也没有肺部疾病的临床迹象。由于肺清除指数（LCI）也是一种非侵入性、可行且已确立的方法，可用于检测早期功能性肺损伤，尤其是在儿童中，并且因为它需要较少的配合（潮气呼吸），我们比较了 LCI 与 DLCO（强制呼吸和屏气动作）在患有风湿性疾病的儿童中的应用。
19 名患有风湿性疾病且无肺部疾病临床迹象的患者在年度检查中成功完成了 LCI 和 DLCO。在 2 名患者中，LCI 和 DLCO 均在生理范围内。相比之下，8 名患者的 LCI 升高，同时 DLCO 结果也在生理范围内，9 名患者的 LCI 和 DLCO 均表明存在早期功能性肺变化。总体而言，LCI 比 DLCO 更能敏感地检测早期功能性肺损伤（p=0.0128）。
我们的发现表明，患有风湿性疾病的儿童中已经存在早期功能性肺损伤。LCI 是一种非常可行且非侵入性的替代方法，可用于检测儿童早期功能性肺损伤。它比 DLCO 更敏感，且对配合度的要求更低。因此，我们建议将 LCI 纳入儿童风湿性疾病的常规随访中。
