학동 전기 소아 천식에서 기도가역성 측정을 위한 ΔFEV0.75와 ΔFEV0.5의 유용성
Usefulness of ΔFEV0.75 and ΔFEV0.5 for Airway Reversibility in Preschoolers with Asthma
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목 적:천식은 ΔFEV1≥12%로 정의되는 기도가역성 여부를 평가하여 진단할 수 있다. 그러나 학동 전기 소아에서는 노력성 호기 호흡이 1초 이내에 끝나는 경우가 많아FEV1 이외에 FEV0.75나 FEV0.5의 평가가 유용하다고 알려져 있다. 본 연구에서는 천식 진단 및 기도가역성의 측정에대한 ΔFEV0.75와 ΔFEV0.5의 임상적 유용성을 알아보고자하였다. 방 법 : 세브란스 어린이병원 소아 천식 아토피 클리닉에내원한 7세 미만의 학동 전기 연령 401명의 천식군과 150명의 대조군을 대상으로 이들의 일반적 특성과 폐활량 검사결과를 의무기록에 근거하여 후향적으로 분석하였다. 의사에 의해천식으로 진단받은 환자들 중 최근1년동안Ame-rican Thoracic Society (ATS) 증상설문지5개 중4개이상 해당하는 경우를 천식군으로 정의하였다. 결 과: ΔFEV1, ΔFEV0.75 그리고 ΔFEV0.5는 천식군에서6.2 (1.1-11.9), 7.3 (1.8-13.3), 8.8 (2.4-15.8), 대조군에서2.3 (-0.7-4.9), 3.3 (0.6-6.6), 5.1 (1.0-9.5)로 모두유의하게 천식군에서 더 높은 수치를 보였다. ΔFEV1, ΔFEV0.75, ΔFEV0.5을 12%를 기준으로 나눈 후 천식 진단에대한 ROC곡선을 이용한 AUC 비교 분석에서 ΔFEV1은0.60 (95% 신뢰구간, 0.57-0.62), ΔFEV0.75는 0.61 (0.58-0.65), ΔFEV0.5는 0.60 (0.56-0.64)로 세 변수 사이에 유의한 차이를 보이지 않았다. 천식 진단에 대한 절단값은 ΔFEV1는 8.6%, ΔFEV0.75는 7.9% 그리고 ΔFEV0.5는 14.2%였다. 또한 ΔFEV1≥12%를 정의로하는기도가역성을예측하는 것에 대한ΔFEV0.75와 ΔFEV0.5의ROC 곡선을 구하였을 때 ΔFEV0.75는 0.91 (0.88-0.94), ΔFEV0.5는 0.77(0.73-0.82)였으며, ΔFEV0.75가 유의하게 더 큰 AUC값을보였다.(P <0.0001) 절단값은ΔFEV0.75는12.3%, ΔFEV0.5는 13.4%였다. 기도가역성을 ΔFEV1≥8.6%으로 정의하였을 때도 ΔFEV0.75의 AUC는 0.90 (0.87-0.92), ΔFEV0.5는0.79 (0.75-0.82)로 ΔFEV0.75가 통계적으로 유의하게 더높은 AUC 값을 보였고 절단값은 ΔFEV0.75는 8.4%, ΔFEV0.5는 11.3%였다. 결 론:학동기전 연령 소아에서 ΔFEV0.75 또는 ΔFEV0.5는 천식 진단과 기도가역성의측정에있어서ΔFEV1를 대체하는 수단이 될 수 있을 것으로 생각된다.
Abstract
Purpose : Preschoolers complete forced expiration in a short time, sometimes more quickly than in 1 second, and therefore the importance of forced expiatory volume in 0.75 seconds (FEV0.75)or forced expiatory volume in 0.5 seconds (FEV0.5) has been raised. The purpose of this study is to evaluate the clinical usefulness of ΔFEV0.75 and ΔFEV0.5. Methods : We analyzed 401 subjects of an asthma group, and 150 subjects of a control group under 7 years of age. Results :ΔFEV1, ΔFEV0.75 and ΔFEV0.5 values of the asthma group were significantly higher than those of the control group, respectively (P <0.0001). ΔFEV1 (0.60; 95% confidence interval [CI],0.57 to 0.62), ΔFEV0.75 (0.61; 0.58 to 0.65), and ΔFEV0.5 (0.60; 0.56 to 0.64) showed no significant difference in the diagnostic ability of asthma when airway reversibility is defined as ΔFEVt≥12%. Cutoff values for asthma were 8.6% in ΔFEV1, 7.9% in ΔFEV0.75 and 14.2% in ΔFEV0.5. ΔFEV0.75(0.91; 0.88 to 0.94) showed significantly higher area under curve (AUC) than ΔFEV0.5 (0.77; 0.73to 0.82) when stratified by 12%, in predicting airway reversibility defined as ΔFEV1≥12%. Cutoff values were 12.3% in ΔFEV0.75, and 13.4% in ΔFEV0.5. When airway reversibility is defined as ΔFEV1≥8.6%, ΔFEV0.75 (0.90; 0.87 to 0.92) also showed significantly higher AUC than ΔFEV0.5 (0.79;0.75 to 0.82), and Cutoff values were 8.4% in ΔFEV0.75, and 11.3% in ΔFEV0.5. Conclusion: ΔFEV0.75 or ΔFEV0.5 can be a means to replace ΔFEV1 for diagnosis of asthma and assessment of airway reversibility in preschool children.
참고문헌 (39)
- Global initiative for asthma. Global strategy for asthma management and prevention, "National Institutes of Health, National Heart, Lung, and Blood Institute", National Institutes of Health, National Heart, Lung, and Blood Institute, 18~ (2010)
- American Thoracic Society, "Standardization of Spirometry", Am J Respir Crit Care Med, 152, pp.1107~1136 (1995)
- Quanjer PH, "Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society", Eur Respir J Suppl, 16, pp.5~40 (1993)
- Expert Panel Report 2. Guidelines for the diagnosis and management of asthma, "National Institutes of Health, National Heart, Lung, and Blood Institute", National Institutes of Health, National Heart, Lung, and Blood Institute, 17~19 (1997)
- American Thoracic Society, "Lung function testing: selection of reference values and interpretative strategies", Am Rev Respir Dis, 144, pp.1202~1218 (1991)
- Kanengiser S, "Forced expiratory maneuvers in children aged 3 to 5 years", Pediatr Pulmonol, 18, pp.144~149 (1994)
- Merkus PJ, "Interrupter resistance in preschool children: measurement characteristics and reference values", Am J Respir Crit Care Med, 163, pp.1350~1355 (2001)
- Vilozni D, "The role of computer games in measuring spirometry in healthy and "asthmatic" preschool children", Chest, 128, pp.1146~1155 (2005)
- Aurora P, "Quality control for spirometry in preschool children with and without lung disease", Am J Respir Crit Care Med, 169, pp.1152~1159 (2004)
- 서현경, "학동 전기 소아에서 폐활량 측정의 질관리와 성공률", Korean Journal of Pediatrics, 52(11), pp.1267~1272 (2009), 대한소아과학회
- Nèeve V, "Spirometry in 3-5- year-old children with asthma", Pediatr Pulmonol, 41, pp.735~743 (2006)
- Eigen H, "Spirometric pulmonary function in healthy preschool children", Am J Respir Crit Care Med, 163(3), pp.619~623 (2001)
- Nystad W, "Feasibility of measuring lung function in preschool children", Thorax, 57, pp.1021~1027 (2002)
- Vilozni D, "An interactive computer-animated system (SpiroGame) facilitates spirometry in preschool children", Am J Respir Crit Care Med, 164, pp.2200~2205 (2001)
- Jones MH, "Forced expiratory maneuvers in very young children. Assessment of flow limitation", Am J Respir Crit Care Med, 159, pp.791~795 (1999)
- Zapletal A, "Forced expiratory parameters in healthy preschool children (3-6 years of age)", Pediatr Pulmonol, 35, pp.200~207 (2003)
- Marostica PJ, "Spirometry in 3- to 6-year-old children with cystic fibrosis", Am J Respir Crit Care Med, 166, pp.67~71 (2002)
- Crenesse D, "Spirometry in children aged 3 to 5 years: reliability of forced expiratory maneuvers", Pediatr Pulmonol, 32, pp.56~61 (2001)
- Gracchi V, "Spirometry in young children: should computer- animation programs be used during testing?", Eur Respir J, 21, pp.872~875 (2003)
- Kozlowska W, "The use of computer-animation programs during spirometry in preschool children", Eur Respir J, 23, pp.494~495 (2004)
- Pesant C, "Spirometric pulmonary function in 3- to 5-year-old children", Pediatr Pulmonol, 42, pp.263~271 (2007)
- Piccioni P, "Reference values of forced expiratory volumes and pulmonary flows in 3-6 year children: a cross- sectional study", Respir Res, 8, pp.14~ (2007)
- Beydon N, "An official American Thoracic Society", European Respiratory Society statement: pulmonary function testing in preschool children, 2007, pp.175, 1304~1345
- Malmberg LP, "Assessing changes in airway obstruction during challenge tests in child asthmatics-which spirometric indices?", Eur Respir J, 14, pp.12~ (1999)
- 임대현, "학동전기 소아에서 스파이로미트리 폐기능 검사", 대한의사협회지, 53(5), pp.417~423 (2010), 대한의사협회
- Song TW, "Utility of impulse oscillometry in young children with asthma", Pediatr Allergy Immunol, 19, pp.763~768 (2008)
- 이지현, "소아 천식에서 측정기기에 따른 호기산화질소 농도의 비교", Allergy Asthma & Respiratory Diseases, 21(1), pp.17~23 (2011), 대한 소아알레르기 호흡기학회
- 백지영, "소아 천식에서 유도 객담 내 CXCL13의 의의", Allergy Asthma & Respiratory Diseases, 19(4), pp.420~428 (2009), 대한 소아알레르기 호흡기학회
- Chernick V, "Kendig's disorders of the respiratory tract in children. 7th ed" (2006), Saunders Elsevier
- 서동인, "알레르기비염과 천식 소아에서의 기관지확장제 반응 및 기관지과민성과의 연관성", Allergy Asthma & Respiratory Diseases, 20(1), pp.59~67 (2010), 대한 소아알레르기 호흡기학회
- Dales RE, "Clinical interpretation of airway response to a bronchodilator. Epidemiologic considerations", Am Rev Respir Dis, 138, pp.317~320 (1988)
- Strachan DP, "Repeatability of ventilatory function measurements in a population survey of 7 year old children", Thorax, 44, pp.474~479 (1989)
- Dundas I, "Diagnostic accuracy of bronchodilator responsiveness in wheezy children", Thorax, 60, pp.13~16 (2005)
- Galant SP, "Value of the bronchodilator response in assessing controller naïive asthmatic children", J Pediatr, 151, pp.457~462 (2007)
- Hanley JA, "The meaning and use of the area under a receiver operating characteristic (ROC) curve", Radiology, 143, pp.29~36 (1982)
- Warwick WJ, "Pulmonary function in healthy Minnesota children", Minn Med, 60, pp.435~440 (1977)
- Chipps BE, "Asthma in infants and children", Clin Cornerstone, 8, pp.44~61 (2008)
- Castro-Rodríiguez JA, "A clinical index to define risk of asthma in young children with recurrent wheezing", Am J Respir Crit Care Med, 162(4), pp.1403~1406 (2000)
- Beydon N, "Pulmonary function testing in young children", Paediatr Respir Rev, 10, pp.208~213 (2009)