Ocak Ece, Halis Ece, Kartal Öztürk Gökçen, Girgin Dindar Bahar, Çoksüer Fevziye, Özaslan Mehmet Mustafa, Öğütçü Atacan, Dökümcü Ülküm Zafer, Özcan Coşkun, Gülen Figen
Department of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey.
Department of Pediatric Surgery, Faculty of Medicine, Ege University, Izmir, Turkey.
Eur J Pediatr. 2025 Jul 16;184(8):484. doi: 10.1007/s00431-025-06322-2.
Pectus deformities (PDs), including pectus excavatum and pectus carinatum, may affect pulmonary mechanics; however, spirometry often fails to detect subtle abnormalities. This study aimed to evaluate pulmonary function in children with PDs using both spirometry and impulse oscillometry (IOS). In this prospective cross-sectional study, 73 children with PDs and 80 age- and sex-matched healthy controls underwent spirometry and IOS testing. z-scores were calculated for all parameters using established reference equations. A possible restrictive ventilatory defect was defined as zFVC < - 1.645 with normal or elevated zFEV/zFVC. Children with PDs had significantly lower zFVC and zFEV values and higher zAX and zX15 compared with controls (p < 0.001, p = 0.008, p < 0.001, and p = 0.033, respectively). No child exhibited an obstructive pattern, while 61.6% had a possible restrictive ventilatory defect. In multivariate analysis, lower zBMI (OR 0.494; 95% CI 0.286-0.855; p = 0.012) and higher zAX (OR 1.528; 95% CI 1.112-2.100; p = 0.009) independently predicted restriction. ROC analysis identified a zAX cutoff of ≥ 4.97 (AUC 0.671, sensitivity 75.8%, specificity 53.8%).
These findings highlight the added value of IOS in detecting respiratory impairment in PDs. The combined use of IOS and spirometry may enable earlier identification of functional limitation, and zAX may serve as a useful marker in clinical decision-making and follow-up planning for affected children.
• Pectus deformities (PDs) may impair pulmonary function, but spirometry often yields inconsistent results. • Impulse oscillometry is a sensitive, effort-independent tool for assessing respiratory mechanics.
• IOS parameters indicated increased peripheral pulmonary airway reactance (zX5) and zAX, suggesting altered respiratory mechanics, while revealing no evidence of any obstructive pattern on spirometry. • The combined use of IOS and spirometry may be a useful pulmonary function test in clinical decision-making and follow-up planning for children with PDs.
胸壁畸形（PDs），包括漏斗胸和鸡胸，可能会影响肺力学；然而，肺活量测定法常常无法检测到细微异常。本研究旨在使用肺活量测定法和脉冲振荡法（IOS）评估患有胸壁畸形的儿童的肺功能。在这项前瞻性横断面研究中，73名患有胸壁畸形的儿童和80名年龄及性别匹配的健康对照者接受了肺活量测定法和IOS测试。使用既定的参考方程计算所有参数的z分数。将可能的限制性通气缺陷定义为zFVC < -1.645且zFEV/zFVC正常或升高。与对照组相比，患有胸壁畸形的儿童的zFVC和zFEV值显著更低，zAX和zX15更高（分别为p < 0.001、p = 0.008、p < 0.001和p = 0.033）。没有儿童表现出阻塞性模式，而61.6%的儿童存在可能的限制性通气缺陷。在多变量分析中，较低的zBMI（OR 0.494；95% CI 0.286 - 0.855；p = 0.012）和较高的zAX（OR 1.528；95% CI 1.112 - 2.100；p = 0.009）独立预测限制性通气缺陷。ROC分析确定zAX临界值≥4.97（AUC 0.671，敏感性75.8%，特异性53.8%）。
这些发现突出了IOS在检测胸壁畸形患者呼吸功能损害方面的附加价值。IOS和肺活量测定法的联合使用可能有助于更早地识别功能受限情况，并且zAX可能作为一个有用的指标用于受影响儿童的临床决策和随访计划。
• 胸壁畸形（PDs）可能损害肺功能，但肺活量测定法的结果常常不一致。
• 脉冲振荡法是一种评估呼吸力学的敏感、无需用力的工具。
• IOS参数表明外周肺气道电抗（zX5）和zAX增加，提示呼吸力学改变，同时肺活量测定法未显示任何阻塞性模式的证据。
• IOS和肺活量测定法的联合使用可能是一种用于胸壁畸形儿童临床决策和随访计划的有用的肺功能测试。
