在儿科现场研究中评估双示踪剂气体单次呼吸洗脱试验。
Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study.
机构信息
Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Intensive Care and Neonatology and Children's Research Center, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland.
出版信息
Chest. 2024 Feb;165(2):396-404. doi: 10.1016/j.chest.2023.09.006. Epub 2023 Sep 15.
BACKGROUND
The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren.
RESEARCH QUESTION
Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW-derived ventilation inhomogeneity estimate in unselected schoolchildren?
STUDY DESIGN AND METHODS
In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIII) is derived. We assessed feasibility, repeatability, and associations of SIII with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), Feno, FEV, and FEV/FVC.
RESULTS
In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIII was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIII was higher by 0.049 g.mol.L in children with wheeze compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIII was not associated with Feno, FEV, and FEV/FVC.
INTERPRETATION
The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level.
TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03659838; URL: www.
CLINICALTRIALS
gov.
背景
慢性肺部疾病的早期起源被认为发生在外周小气道。通气不均质性的预测因子，即外周气道功能的替代指标，在学龄儿童中研究较少。
研究问题
双示踪气体单次呼吸洗脱（DTG-SBW）测量在儿科现场研究环境中是否可行？在未选择的学龄儿童中，DTG-SBW 衍生的通气不均质性估计值的预测因子是什么？
研究设计和方法
在这项前瞻性的横断面现场研究中，一个移动肺功能测试单元访问了瑞士的参与学校。我们应用了 DTG-SBW、呼出气一氧化氮（Feno）和肺活量测定法测量。DTG-SBW 基于氦和六氟化硫的潮气吸入，衍生出相位 III 斜率（SIII）。我们评估了可行性、可重复性以及 SIII 与潜在预测因子（人体测量学、喘息存在（即父母报告过去一年有一次或多次喘息发作）、Feno、FEV 和 FEV/FVC）之间的相关性。
结果
在 1782 名儿童中，获得了 5223 次 DTG-SBW 试验。在 1449 名儿童（81.3%）中，DTG-SBW 是可以接受的；变异系数为 39.8%。SIII 与年龄和 BMI 独立但呈弱正相关。在 276 名儿童（21.2%）中报告了喘息。与没有喘息的儿童相比，有喘息的儿童的 SIII 高 0.049 g·mol·L-1，并且在调整年龄和 BMI 后的多元线性回归模型中，SIII 仍然与喘息相关。SIII 与 Feno、FEV 和 FEV/FVC 无关。
解释
DTG-SBW 在儿科现场研究环境中是可行的。在人群水平上，年龄、身体成分和喘息是未选择的学龄儿童外周气道功能的独立预测因子。DTG-SBW 的变化可能限制了其在个体水平上的当前适用性。
试验注册
ClinicalTrials.gov；编号：NCT03659838；网址：www.clinicaltrials.gov。
临床试验
无。
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