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体描箱检测法在婴幼儿时期哮喘的应用价值
Application Value of Plethysmography in Infant Asthma
【作者】 陈萍;
【导师】 罗健;
【作者基本信息】 重庆医科大学 , 临床医学(专业学位), 2020, 硕士
【摘要】 目的:分析婴幼儿时期哮喘潮气呼吸肺功能检测指标及体描箱检测特有指标的变化情况,探讨潮气呼吸肺功能指标与体描箱特有指标的相关性,评估体描箱检测法在婴幼儿时期哮喘的应用价值。方法:选取2018.11.1-2019.7.31于我院住院明确诊断哮喘的患者70例作为病例组,选取我院烧伤整形科住院的身长、体重、年龄等基础参数与疾病组无明显差异且无呼吸系统疾病者30例作为正常对照组,分别测量潮气呼吸肺功能指标及体描箱指标,比较哮喘组与对照组各参数间有无差异、潮气呼吸指标与体描箱指标的相关性、潮气呼吸指标及体描箱指标在婴幼儿时期哮喘的灵敏度和特异度比较。结果:(1)哮喘组与对照组相比RR、VT/kg、TPTEF/TE、VPTEF/VE、FRCp、FRCp/kg、sReff、sReff/kg均有显著统计学差异(P<0.05),哮喘组与对照组比较Reff、Reff/kg差别无统计学意义(P>0.05);(2)TPTEF/TE与VPTEF/VE之间存在极显著的正相关,相关系数r=0.971(P<0.01);TPTEF/TE、VPTEF/VE与sReff呈负相关性,相关系数分别为r=-0.228(P<0.05),r=-0.251(P<0.05);TPTEF/TE与FRCp/kg、Reff的相关系数分别为r=-0.091(P>0.05)、r=-0.203(P>0.05),均无显著相关性,VPTEF/VE与FRCp/kg、Reff的相关系数分别为r=-0.091(P>0.05)、r=-0.203(P>0.05),均无显著相关性;FRCp/kg与sReff、Reff之间存在正相关性,相关系数分别为r=0.405(P<0.01)、r=0.263(P<0.05);(3)TPTEF/TE在婴幼儿时期哮喘中最佳截点为21.3%,支气管哮喘的ROC曲线下面积为0.865,确定TPTEF/TE≤21.3%为ROC曲线上的最佳临界点,对应的灵敏度为74.3%,特异度为90%;VPTEF/VE最佳截点为23.35%,支气管哮喘的ROC曲线下面积为0.847,确定VPTEF/VE≤23.35%为ROC曲线上的最佳临界点,对应的灵敏度为68.6%,特异度为90%;FRCp最佳截点为268.0ml,支气管哮喘的ROC曲线下面积为0.901,确定FRCp≥268.0ml为ROC曲线上的最佳临界点,对应的灵敏度为75.7%,特异度为93.3%;FRCp/kg最佳截点为25.0ml/kg,支气管哮喘的ROC曲线下面积为0.920,确定FRCp/kg≥25.0ml/kg为ROC曲线上的最佳临界点,对应的灵敏度为81.2%,特异度为93.3%;sReff最佳截点为0.64 kPa·s,支气管哮喘的ROC曲线下面积为0.745,确定sReff≥0.64 kPa·s为ROC曲线上的最佳临界点,对应的灵敏度为60.0%,特异度为76.7%。(4)FRCp/kg、sReff与TPTEF/TE、VPTEF/VE的ROC曲线下面积均无显著性差异(P>0.05),FRCp/kg与sReff的ROC曲线线面积有显著性差异(P<0.05)。结论:肺功能检测作为一种辅助检测手段在支气管哮喘的诊断、病情严重程度评估中具有重要价值,潮气呼吸肺功能检测指标:TPTEF/TE、VPTEF/VE仍是反映小气道阻塞情况的敏感指标,体描箱特有指标FRCp、FRCp/kg是反映小气道阻塞情况更敏感的指标,sReff及Reff可直接反映气道阻力,但Reff反映小气道阻塞情况的敏感性较差,不适用于协助婴幼儿时期哮喘等小气道阻塞疾病的诊断,sReff在一定程度上可以反映小气道阻塞的情况,可用于协助婴幼儿时期哮喘的诊断。
【Abstract】 Objectives: To analyze the changes of lung function indexes measured by tidal breathing and plethysmography in infant asthma,and explore the correlation between the indexes of infant plethysmography and tidal breathing,so we can evaluate the application value of plethysmography in infant asthma.Methods: We selected 70 cases of infant asthma from November 1,2018 to July 31,2019 as the disease group.Also,We selected 30 patients in the same period from the department of burn and plastic surgery of our hospital as the normal control group,which had no respiratory diseases and had no significant difference in body length,weight,age and other basic parameters from the disease group.We measured plethysmography parameters and tidal breathing parameters of each group,and hope to find the difference of the asthma group and control group,and the correlation between plethysmography parameters and tidal breathing parameters,and the diffrence in sensitivity and specificity of plethysmography parameters and tidal breathing parameters in infant asthma.Results:(1)There were statistical differences in RR,VT/kg,TPTEF/TE,VPTEF/VE,FRCp,FRCp/kg,sReff,sReff/kg between the asthma group and the control group(P<0.05),There was no significant difference in Reff and Reff/kg between asthma group and control group(P>0.05);(2)TPTEF/TE was positively correlated to VPTEF/VE in infant asthma(r=0.971,P<0.01);sReff was negatively correlated to TPTEF/TE,VPTEF/VE in infant asthma(r=-0.228 P<0.05,r=-0.251 P<0.05);TPTEF/TE was not correlated to FRCp/kg,Reff in infant asthma(r=-0.091 P>0.05,r=-0.203 P>0.05);VPTEF/VE was not correlated to FRCp/kg,Reff in infant asthma(r=-0.091 P>0.05;r=-0.203 P>0.05);FRCp/kg was positively correlated to sReff,Reff in infant asthma(r=0.405 P <0.01,r=0.263 P<0.05).(3)The area of roc curve line changing rate of TPTEF/TE was 0.865,the optimal cut-off point was 21.3%,the sensitivity was 74.3%,specificity was 90%;The area of roc curve line changing rate of VPTEF/VE was 0.847,the optimal cut-off point was 23.35%,the sensitivity was 68.6%,specificity was 90%;The area of roc curve line changing rate of FRCp was 0.901,the optimal cut-off point was 268.0ml,the sensitivity was 75.7%,specificity was 93.3%;The area of roc curve line changing rate of FRCp/kg was 0.920,the optimal cut-off point was 25.0ml/kg,the sensitivity was 81.2%,specificity was 93.3%;The area of roc curve line changing rate of sReff was 0.745,the optimal cut-off point was0.64kPa·s,the sensitivity was 60.0%,specificity was 76.7%;(4)There was no significant difference in the area under the roc curve between FRCp/kg,sReff,TPTEF/TE and VPTEF/VE(P >0.05),and there was a significant difference in the area under the roc curve between FRCp/kg and sReff(P<0.05).Conlusions: As an auxiliary detection method,pulmonary function test plays an important role in the diagnosis and severity evaluation of asthma.The indexes measured by tidal breathing such as TPTEF/TE and VPTEF/VE are still sensitive to reflect small airway obstruction.However FRCp and FRCp/kg can be more sensitive than TPTEF/TE and VPTEF/VE.Reff and sReff can directly reflect airway resistance,but Reff is less sensitive to reflect small airway obstruction,so sReff is suitable to assist the diagnosis of small airway obstruction diseases such as asthma,but Reff can not.