Department of Paediatric Pulmonology, Allergy, and Clinical Immunology, Poznan University of Medical Sciences, Poznan, Poland.
Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland.
Pediatr Pulmonol. 2022 Jun;57(6):1466-1474. doi: 10.1002/ppul.25891. Epub 2022 Apr 8.
Pulmonary exacerbations (PE) tend to complicate the course of cystic fibrosis (CF) and worsen the disease prognosis. One of the diagnostic criteria for an exacerbation is the forced expiratory volume in the first second (FEV ) decline. Not all children, however, are able to perform spirometry. Therefore, the aim of this study was to evaluate alternative lung function tests in the diagnosis of PE.
We assessed retrospectively the results of impulse oscillometry (IOS) and lung clearance index in multiple breath washout (MBW) during 259 visits in 47 CF paediatric patients. The differences in the results were compared between patients diagnosed with PE (ΔPE) and those in stable condition (ΔS).
Among the whole group of patients, we found significant differences between the changes during exacerbation (ΔPEs) and stable condition (ΔSs) values for lung clearance index (LCI), S , R5Hz, R5-20Hz, X10Hz, AX, and Fres. The predictive values of Fres and X10Hz in IOS (AUC 0.71 both parameters) were higher than those of LCI (AUC 0.67). There was no difference in the predictive values (AUC ) of Δ LCI and IOS parameters in the subgroups of patients stratified based on FEV z-score cut-off value of -1.64. In both groups of patients, predictive values of LCI were slightly lower than of IOS parameters (AUC 0.66 for LCI vs. 0.69 for both ΔX10Hz z-score and Δ Fres z-score in patients with FEV z-score ≥-1.64 and AUC 0.67 for LCI vs 0.69 for both ΔX10Hz zscore and Δ Fres zscore in patients with FEV <1.64.
Both IOS and MBW measurements are useful in the assessment of pediatric CF patients with PE. LCI has a similar predictive value to IOS in children with CF independently of their FEV value.
肺部恶化（PE）往往会使囊性纤维化（CF）的病程复杂化，并使疾病预后恶化。恶化的诊断标准之一是第一秒用力呼气量（FEV ）下降。然而，并非所有儿童都能够进行肺活量测定。因此，本研究旨在评估替代肺功能测试在 PE 诊断中的作用。
我们回顾性评估了 47 例 CF 儿科患者 259 次就诊时的脉冲振荡（IOS）和多呼吸洗脱肺清除指数（MBW）的结果。将诊断为 PE 的患者（ΔPE）与处于稳定状态的患者（ΔS）的结果进行比较。
在整个患者组中，我们发现肺清除指数（LCI）、S 、R5Hz、R5-20Hz、X10Hz、AX 和 Fres 在恶化期间（ΔPEs）和稳定状态（ΔSs）值之间存在显著差异。IOS 中 Fres 和 X10Hz 的预测值（两个参数的 AUC 均为 0.71）均高于 LCI（AUC 为 0.67）。基于 FEV z-score 截断值-1.64 的患者分层后，ΔLCI 和 IOS 参数的预测值（AUC ）没有差异。在两组患者中，LCI 的预测值均略低于 IOS 参数（FEV z-score ≥-1.64 的患者中，LCI 的 AUC 为 0.66，ΔX10Hz z-score 和 Δ Fres z-score 的 AUC 为 0.69，FEV <1.64 的患者中，LCI 的 AUC 为 0.67，ΔX10Hz zscore 和 Δ Fres zscore 的 AUC 为 0.69）。
IOS 和 MBW 测量在评估患有 PE 的 CF 儿科患者时均有用。LCI 在 CF 儿童中具有与 IOS 相似的预测价值，与他们的 FEV 值无关。
