Establishment Of Predictive Reference Equations For Pulmonary Ventilation Function Parameters Of Children Aged 0-12 Years In Chongqing And The Value Of Pft In Children With Asthmatic Disease

PART 1 ESTABLISHMENT OF PREDICTIVE REFERENCE EQUATIONS FOR PULMONARY VENTILATION FUNCTION PARAMETERS OF INFANT AND TODDLER,PRE-SCHOOL AND SCHOOL-AGE CHILDREN IN CHONGQING Objective: To Establish of reference equations for pulmonary ventilation function parameters of infant and toddler,pre-school children and primary school-age children(6-12 years old)in Chongqing.Methods: The PFT of 225 infant and toddler and 458 children aged 3-12 years from Chongqing were measured using JAEGER Master Screen Babybody and Master Screen Pead system with standardized protocols.Measurement parameters for infant and toddler include RR,VT,PEF,TEF75,TEF50,TEF25,TPTEF/TE,VPTEF/VE,PF/TEF25,PF/VT,ME/MI,TI/TE,FRCP and Reff.Measurement parameters for pre-school and primary school age children include FVC,FEV1,FEV1%FVC,FEV0.5,PEF,MEF75,MEF50,MEF25,MMEF and MVV.All statistical analyses were performed using SAS Statistics version 9.4.Association between each lung function index and the known or potential influencing factors(gender,age,body length,weight,birth weight,Family history of allergic diseases,caesarean section,gestational age and tobacco exposure)were analyzed using Pearson correlations.After the normality test of PFT parameters,univariate linear regression was used to analysis the influence of each factor on each PFT parameters.Reference equations adjusted for gender,age,length and weight were built using stepwise regression model.Results: Age,length and weight were correlated with absolute values(RR,VT,PEF,TEF75,TEF50,TEF25,FRCP and Reff)in infant and toddler,gender was only correlated with PF/TEF25 and FRCp,tobacco exposure was correlated with FRCP,ratio parameters TPTEF/TE,VPTEF/VE,PF/TEF25 had no significant correlation with either age,length or weight.The following equations describe our tidal breathing PFT parameters in relation to age(A),length(L),weight(W)and gender(S,m=1,f=0)for infant and toddler: RR=47.87938-0.02919A-0.23657 L,VT=-55.64379+9.11092S+1.28224L+3.50528 W,PF/VT=259.90443-8.53589S-1.80268 L,PEF=17.66602+0.52652L+3.67198 W,TEF75=36.80937+5.42331 W,TEF50=10.38947+0.63829L+2.82707 W,TEF25=1.99250+0.64166L+1.84567 W,FRCP=-266.14730+25.38651S+5.89272 L,Reff=-3.53776-0.03157L+0.20665 W.The median(quartile spacing)of TPTEF/TE,VPTEF/VE and PF/TEF25 were 30.16(25.64,36.52),31.50(28.10,37.04)and 132.30(123.00,147.84)respectively.Age,length and weight were correlated with each PFT parameters(excepted MEF25)in pre-school children,gender was correlated with FVC?FEV0.5?FEV1?PEF?MEF75 and MVV.The predicted reference equations were established as follows: FVC=-1.32781+0.00434A+0.05925S+0.01781L+0.01359 W,FEV1=-1.31773+0.04774S+0.02137 L,FEV1%FVC=108.46984-0.19264A-0.33349 W,FEV0.5=-0.81832+0.01502 L,PEF=-5.11305+0.01202A+0.16271S+0.0331L+0.08152 W,MEF75=-2.39455+0.04293 L,MEF50=-0.87371+0.02759L-0.01055 A,MMEF=-0.80056-0.01008A+0.02453 L,MVV=-27.24252+0.28764A+3.73185S+0.37838 L.In school-age children,Age,length and weight were correlated with each PFT parameters excepted MMEF,gender was correlated with FVC,FEV1,FEV0.5,MEF25 and MVV.The predicted reference equations were established as follows: FVC=-2.23176+0.04181A+0.13398S+0.02589L+0.01197 W,FEV1=-1.81944+0.04144A+0.04776S+0.02215L+0.00716 W,FEV1%FVC=91.59332-3.09569S-0.11846 W,FEV0.5=-1.03895+0.04279A+0.01363L+0.00638 W,PEF=-2.65371+0.16728A+0.03508L+0.01872 W,MEF75=-2.63694+0.13808A+0.03803 L,MEF50=-1.60283+0.08268A+0.02363 L,MEF25=-0.64224+0.04115A-0.11555S+0.01011 L,MVV=-88.50417+4.37128S+1.06648 L.Conclusion: Age,length and weight were the main variables affecting the absolute value of tidal breathing pulmonary in infant and toddler.Ratio parameters TPTEF/TE,VPTEF/VE,PF/TEF25 had no significant correlation with age,length or weight.Age,weight,length and sex were the main variables affecting the normal values of most parameters of PFT for preschool and school-age children.Gender affects only a few parameters.Establishment of predicted reference equations of PFT parameters should be based on different age groups.PART 2 CHARACTERISTICS OF TIDAL BREATHING PULMONARY FUNCTION AND SIGNIFICANCE OF PARAMETERS IN INFANT AND TODDLER WITH WHEEZING Objective: To analyze the characteristics of tidal breathing PFT in infant and todler with wheezing diseases,and to explore the significance of tidal PFT parameters.Methods: From April 2014 to June 2017,149 children aged 0-3 with wheezing were selected from the respiratory department of Children's Hospital of Chongqing Medical University,including 17 cases of BO,26 cases of acute asthmatic bronchitis,38 cases of capillary bronchitis,37 cases of central airway stenosis and 31 cases of airway foreign body.Tidal breathing PFT was detected in all patients.The five groups were divided into small airway lesion group(BO,acute asthmatic bronchitis,capillary bronchitis)and central airway lesion group(central airway stenosis,airway foreign body)according to the location of lesions.The results of PFT in different groups were compared and analyzed.Results: The age of children diagnosed with BO,acute asthmatic bronchitis and capillary bronchitis were(21.41±7.26)months,[8.50(6.00,12.25)] months and(7.95±3.99)months respectively;the age of children diagnosed with airway foreign body and central airway stenosis were(20.32±5.22)months and(19.35±10.63)months,respectively.Male were the main patients in each group.Obstructive ventilation dysfunction showed in children with both central and small airway lesion,changes of parameters showed that TPTEF/TE,VPTEF/VE,ME/MI,TI/TE decreased and FRCp increased.Compared with central airway lesions,the value of TPTEF/TE and VPTEF/VE were lower,PF/TEF25 and PF/VT were higher in small airway lesions.TI/TE in BO was significantly lower than that in children with central airway lesions and other two types of small airway lesions,and the FRCp value was significantly higher than that in other four groups.There was no significant difference in Reff among all groups.The TBFV shape of acute asthmatic bronchitis and capillary bronchitis showed that the peak of expiratory phase moved forward.The TBFV of BO showed not only the forward move of expiratory phase peak,but also the depression of expiratory phase to the transverse axis.TBFV of central airway stenosis and airway foreign body showed the forward of expiratory peak,but the slope of descending branch of expiratory phase had no significant increased,and the shape is closer to that of healthy children.Conclusions: TPTEF/TE,VPTEF/VE,PF/TEF25,PF/VT,ME/MI,TI/TE and FRCp are abnormal when central or small airway obstructive lesions occured.Reff is not a sensitive indicator of airway obstruction.Changes of TPTEF/TE,VPTEF/VE,PF/TEF25 and PF/VT values will be more significant when the obstruction occurs in small airway.PF/TEF25 is a sensitive index reflecting small airway obstruction.When evaluating the results of tidal PFT,all the relevant parameters should be taken into account and make a co MPrehensive judgment combined to the shape of TBFV.PART 3 CHARACTERISTICS OF TIDAL BREATHING PULMONARY FUNCTION IN INFANT AND TODDLER WITH MYCOPLASMA PNEUMONIAE PNEUMONIA Objective: To summarize the characteristics of pulmonary function in infant and toddler with Mycoplasma pneumoniae pneumonia(MPP),and to explore the role of tidal breathing PFT in the assessment of MPP.Methods: This was a case-control study included inpatients with MPP and common bronchopneumonia in the respiratory department of the Children's Hospital of Chongqing Medical University from Jaunary 2014 to June 2018.The medical history,general data and PFT on the day after admission and diacharge were compared.The tidal PFT of MPP was followed up for 2 weeks and 4 weeks after discharge.Logistic regression was applied to evaluate the PFT parameters associated with MPP.Results: 187/81 MPP and 167/87 bronchopneumonia children completed TBFV/ FRCp test respectively on the day of admission,168/82 MPP and 113/43 bronchopneumonia children completed TBFV/ FRCp test respectively on the day of discharge.After 2 and 4 weeks of discharge,106/52 and 49/33 MPP children completed TBFV curve/FRCp test,respectively.The family allergy history of MPP was higher than that of control group.TPTEF/TE,VPTEF/VE,TI/TE,TEF25 and VT/kg values of MPP decreased while PF/TEF25,PF/VT,RR,PEF,TEF75,Reff and FRCp/kg increased significantly compared with the control group at the day after admission and diacharge.The values of TPTEF/TE,VPTEF/VE and PF/VT in MPP children tend to be normal with the prolongation of recovery time.The PF/TEF25 value remained decrease at 4 weeks after diacharge.the value of RR,PEF?TEF75?VT?Reff and FRC improved on the day of discharge.There was no significant difference about the values between 2 weeks after discharge and the day of discharge except TPTEF/TE,VPTEF/VE,PF/VT and TI/TE.The values of TEF50 and TEF25 at 4 weeks after discharge were significantly higher while Reff and FRCp were lower than those at admission and the day of discharge.For children of 0-12 m,variables associated with MPP were: gestational age,birth weight,PF/TEF25,PF/VT and FRCp/kg.For children aged 12-36 m,the independent variables were: gestational age,RR,VPTEF/VE and FRCp/kg.Conclusions: At the early stage of the course,PFT of MPP and bronchopneumonia showed obstructive ventilation dysfunction in infant and toddler,more serious dysfunction was found in children with MPP.The dysfunction recovered basically in bronchopneumonia after the disappearance of clinical symptoms while the obstructive ventilation dysfunction of MPP persisted for more than 4 weeks.The characteristic changes of PFT and low gestational age may indicate the possibility of MP infection in infant and toddler.The characteristic pulmonary function of MPP in 0-12 m infants was increased in RR,PF/TEF25,PF/VT and FRCp/kg,and the characteristic pulmonary function of MPP in 12-36 m toddlers was increased in RR,FRCp/kg and decreased in VPTEF/VE.PART 4 RISK OF AIRWAY REMODELING IN ASTHMATIC CHILDREN WITH PERSISTENT AHR Objective: To assess the possibility of airway remodeling in children with asthma who persist in AHR after standardized treatment for more than two years,provide the basis for clinical adjustment of treatment.Methods: Children over 6 years old with asthma in the asthma outpatient department of our hospital from September 2017 to January 2019 were selected as the disease group.All the children were strictly followed the doctor's advice for more than two years of standardized treatment,BPT showed moderate or severe positive reaction.Children over 6 years old with bronchopneumonia treated in the asthma outpatient department of our hospital at the same period were selected as the control group.Induced sputum of all subjects was collected,TGF-?1 and IL-13 level in the supernatant was detected by ELISA.Brg1,E-Cadherin and Vimentin were detected by RT-q RCR.Results: 23 asthma and 24 bronchopneumonia patients were successfully enrolled.Normal(56.5%)and small airway dysfunction(30.4%)were the main categories of pulmonary ventilation function in asthmatic children,and moderate positive reaction(87.0%)was the main BPT result.Normal(57.9%)and small airway dysfunction(31.6%)were the main PFT result for control group,and BPT showed the ratio of negative was 78.9%.The expression of Brg1,Vimentin,TGF-?1 and IL-13 in the sputum of asthmatic children was significantly increased,and the expression of E-Cadherin was significantly decreased compared with the control group.Conclusions: Airway remodeling changes have been observed in asthmatic children with persistent AHR after more than two years of standardized treatment,and the existence of airway remodeling can be suggested by BPT.