Chen W, Yang Z, Liu C H, Jia X Y, Zhang Y T, Song X, Li S
Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, ChinaChen Wei is studying at Graduate School, School of Clinical Medicine of Shandong Second Medical University, Weifang 261000, China.
Zhonghua Er Ke Za Zhi. 2024 Mar 2;62(3):245-249. doi: 10.3760/cma.j.cn112140-20231012-00278.
To explore the cutoff value for assessing small airway dysfunction in children with asthma. A total of 364 asthmatic children aged 5 to 14 years, with normal ventilatory function, followed up at the Asthma Clinic of the Children's Hospital of Capital Institute of Pediatrics from January 2017 to January 2018, were selected as the case group. Concurrently, 403 healthy children of the same age range and without any symptoms in the community were chosen as the control group, and pulmonary function tests were conducted. The values of forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), forced expiratory flow at 50% of FVC (FEF), forced expiratory flow at 75% of FVC (FEF) and maximum mid-expiratory flow (MMEF) were compared between case group and control group. Statistical tests such as -test, test, or Mann-Whitney test were used to analyze the differences between the groups. Receiver operating characteristic (ROC) curves were constructed, and the maximum Youden Index was utilized to determine the optimal cutoff values and thresholds for identifying small airway dysfunction in asthmatic children. This study comprised 364 children in the case group (220 boys and 144 girls) and 403 children in the control group (198 boys and 205 girls). The small airway parameters (FEF%pred, FEF%pred, MMEF%pred) in the asthmatic group were significantly lower than in the control group (77% (69%, 91%) . 95% (83%, 109%), 67% (54%, 82%) 84% (70%, 102%), 76% (66%, 90%) 97% (86%, 113%), =12.03, 11.35, 13.66, all <0.001). The ROC curve area under the curve for FEF%pred, FEF%pred, MMEF%pred was 0.75, 0.74, and 0.79, respectively. Using a cutoff value of 80% for FEF%pred achieved a sensitivity of 56.9% and specificity of 81.4%. A cutoff value of 74% for FEF%pred resulted in a sensitivity of 67.3% and specificity of 69.2%. Finally, using a cutoff value of 84% for MMEF%pred achieved a sensitivity of 67.9% and specificity of 77.2%. In the presence of normal ventilatory function, utilizing FEF<80% predicted or MMEF<84% predicted can accurately serve as criteria for identifying small airway dysfunction in children with controlled asthma.
探讨评估哮喘患儿小气道功能障碍的截断值。选取2017年1月至2018年1月在首都儿科研究所附属儿童医院哮喘门诊随访的364例5至14岁通气功能正常的哮喘患儿作为病例组。同时，选取403例同年龄范围、社区中无任何症状的健康儿童作为对照组，并进行肺功能测试。比较病例组和对照组第1秒用力呼气容积（FEV）、用力肺活量（FVC）、FVC 50%时的用力呼气流量（FEF）、FVC 75%时的用力呼气流量（FEF）和最大呼气中期流量（MMEF）的值。采用t检验、u检验或Mann-Whitney u检验等统计方法分析组间差异。绘制受试者工作特征（ROC）曲线，并利用最大约登指数确定识别哮喘患儿小气道功能障碍的最佳截断值和阈值。本研究病例组有364例儿童（220例男孩和144例女孩），对照组有403例儿童（198例男孩和205例女孩）。哮喘组的小气道参数（FEF%pred, FEF%pred, MMEF%pred）显著低于对照组（77%（69%，91%）. 95%（83%，109%），67%（54%，82%） 84%（70%，102%），76%（66%，90%） 97%（86%，113%），=12.03，11.35，13.66，均<0.001）。FEF%pred、FEF%pred、MMEF%pred的ROC曲线下面积分别为0.75、0.74和0.79。FEF%pred的截断值为80%时，灵敏度为56.9%，特异度为81.4%。FEF%pred的截断值为74%时，灵敏度为67.3%，特异度为69.2%。最后，MMEF%pred的截断值为84%时，灵敏度为67.9%，特异度为77.2%。在通气功能正常的情况下，利用FEF<80%预计值或MMEF<84%预计值可准确作为识别病情得到控制的哮喘患儿小气道功能障碍的标准。
