Uysal Pınar, Güleç Köksal Zeynep, Gönenli Zeynep, Doğan Murat, Şahin Mustafa
Division of Allergy and Immunology, Department of Pediatric Allergy and Immunology, School of Medicine, Aydin Adnan Menderes University, 09010, Aydin, Turkey.
Department of Pediatrics, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey.
Eur Arch Otorhinolaryngol. 2023 Jan;280(1):207-217. doi: 10.1007/s00405-022-07521-5. Epub 2022 Jul 30.
To assess pulmonary impedance [resistance (zR5, zR20, R5-20, Fres, and AX) and reactance (zX5 and zX20)] using impulse oscillometry (IOS) in children with adenoid hypertrophy (AH) and its association with the degree of AH, and to evaluate subsequent changes in pulmonary function 3 months after adenoidectomy.
This prospective cross-sectional study was conducted with 170 preschool-age children [110 with AH and 60 sex- and age-matched healthy controls (HCs)]. Pulmonary function was analyzed using IOS at baseline (1st visit) in all participants and 3 months after adenoidectomy (2nd visit) in patients who underwent the operation.
The IOS parameters of zR5, zR20, R5-20, Fres, and AX were higher, but zX20 was lower, in children with AH compared to the HCs (p < 0.05 for all). The parameters of zR5, Fres, and AX were higher in children with grade IV AH than in those with grade I (p < 0.001). zR5, zR20, R5-20, Fres, and AX decreased, but zX20 increased, after adenoidectomy (2nd visit) compared to baseline (1st visit) (p < 0.05). Post-adenoidectomy (2nd visit) zR5, AX, Fres values were higher in children with AH compared to baseline values in the HCs (1st visit) (p < 0.05). The area under the ROC curve (AUC) value for estimating adenoidectomy was 0.741 for zX20 (CI 0.648-0.834, p < 0.001) with a cut-off value of ≤ -3.21, sensitivity of 68.8%, and specificity of 70%.
This study shows that IOS is a useful method for demonstrating subclinical bronchial obstruction in preschool-age children with AH with greater pulmonary impedance (resistance and reactance). Pulmonary impedance decreased 3 months after adenoidectomy, but remained higher than in the HCs. The IOS parameter of X20 may be predictive of adenoidectomy. This study evaluated the pulmonary functions of children with adenoid hypertrophy (AH) using impulse oscillometry (IOS) and the association with the scale of AH. Pulmonary functions were analyzed using IOS. The main IOS parameters include resistances (zR5 and zR20), reactance (zX5 and zX20), R5-20 (resistance at 5 Hz minus resistance at 20 Hz), resonant frequency (Fres), and AX. Fres is the point at which reactance is zero and is measured in Hz (1/s). The Reactance Area (AX - "Goldman Triangle") represents the integrated low-frequency respiratory reactance magnitude between 5 Hz and Fres. Faster frequencies of R (~ 20 Hz) reflect larger airways, regarded as resistance around the central airways. Lower frequencies of R (~ 5 Hz) providing information around the entire (small and large) airways. Peripheral (small) airway resistance is defined by R5-20. IOS parameters of zR5, zX20, Fres, and AX differed among AH grades I-IV and compared to the HCs (p < 0.001 for all).
采用脉冲振荡法（IOS）评估腺样体肥大（AH）患儿的肺阻抗[阻力（zR5、zR20、R5-20、Fres和AX）和电抗（zX5和zX20）]及其与AH程度的关系，并评估腺样体切除术后3个月肺功能的后续变化。
本前瞻性横断面研究纳入了170名学龄前儿童[110例AH患儿和60例性别及年龄匹配的健康对照（HCs）]。所有参与者在基线（第1次就诊）时采用IOS分析肺功能，接受手术的患者在腺样体切除术后3个月（第2次就诊）时也进行分析。
与HCs相比，AH患儿的IOS参数zR5、zR20、R5-20、Fres和AX较高，但zX20较低（所有参数p均<0.05）。IV级AH患儿的zR5、Fres和AX参数高于I级患儿（p<0.001）。与基线（第1次就诊）相比，腺样体切除术后（第2次就诊）zR5、zR20、R5-20、Fres和AX降低，但zX20升高（p<0.05）。腺样体切除术后（第2次就诊），AH患儿的zR5、AX、Fres值高于HCs的基线值（第1次就诊）（p<0.05）。用于评估腺样体切除术的ROC曲线下面积（AUC）值，zX20为0.741（95%CI 0.648-0.834，p<0.001），截断值≤-3.21，敏感性为68.8%，特异性为70%。
本研究表明，IOS是一种用于显示AH学龄前儿童亚临床支气管阻塞的有用方法，这些患儿具有更大的肺阻抗（阻力和电抗）。腺样体切除术后3个月肺阻抗降低，但仍高于HCs。X20的IOS参数可能是腺样体切除术的预测指标。本研究采用脉冲振荡法（IOS）评估腺样体肥大（AH）患儿的肺功能及其与AH程度的关系。采用IOS分析肺功能。主要的IOS参数包括阻力（zR5和zR20）、电抗（zX5和zX20）、R5-20（5Hz时的阻力减去20Hz时的阻力）、共振频率（Fres）和AX。Fres是电抗为零的点，以Hz（1/秒）为单位测量。电抗面积（AX - “戈德曼三角”）代表5Hz至Fres之间的低频呼吸电抗幅度积分。较高频率的R（20Hz）反映较大气道，被视为中央气道周围的阻力。较低频率的R（5Hz）提供关于整个（大小）气道的信息。外周（小）气道阻力由R5-20定义。AH I-IV级患儿的zR5、zX20、Fres和AX的IOS参数与HCs相比存在差异（所有参数p<0.001）。
