食管闭锁(EA)是一种先天性异常,与整个儿童期的肺部发病率有关。
这项研究的目的是评估59名5至15岁儿童和青少年的肺部并发症,这些儿童和青少年患有手术矫正的先天性EA。
参与者接受了结构化的面试,肺活量测定,身体体积描记术,甘露醇挑战试验,皮肤点刺试验,以及扩散能力的测量,气道阻力,呼出NO的分数,血清中特异性免疫球蛋白E。对照组由25名接受胃食管反流病评估的儿童组成。
在EA患者中,33例(55.9%)有呼吸道症状,31人(53.4%)有至少三次肺炎的病史,32例(54.2%)报告咳嗽发作频率高于同龄人。强迫肺活量(FVC)为预测的84.9%±13.2%,1秒用力呼气容积(FEV1)为预测值的78.2%±12.4%,在EA患者中,用力呼气分数25-75%(FEF25-75%)是预测值的71.5±17.8%,低于疾病对照组(全部P<0.0001)。此外,EA患者的总肺活量(TLC)低于对照组(P<0.0001)。15例(28.8%)EA患者存在阻塞性通气障碍,与9例(17.3%)限制性通气障碍患者相比,而其中一个有组合。
本研究表明,EA患者的肺部特征显着降低。EA中发生的限制性通气障碍可能是由于开胸手术后肺部生长不良。没有单因素预测EA儿童和青少年的通气障碍。PediatrPulmonol.2017;52:98-106。©2016威利期刊,Inc.
Esophageal atresia (EA) is a congenital anomaly associated with substantial pulmonary morbidity throughout childhood.
The aim of this study was to evaluate pulmonary complications among 59 five to 15-year-old children and adolescents with surgically corrected congenital EA.
Participants underwent a structured interview, spirometry, body
plethysmography, mannitol challenge test, skin prick test, as well as measurements of the diffusion capacity, airway resistance, fraction of exhaled NO, and specific immunoglobulin E in serum. A control group consisted of 25 children being evaluated for gastroesophageal reflux disease.
Among the EA patients 33 (55.9%) had respiratory symptoms, 31 (53.4%) had a history of at least three pneumonias, and 32 (54.2%) reported more frequent cough episodes than peers. The Forced Vital Capacity (FVC) was 84.9% ± 13.2% of predicted, forced expiratory volume 1 sec (FEV1) was 78.2% ± 12.4% of predicted, and forced expiratory fraction 25-75% (FEF25-75%) was 71.5 ± 17.8% of predicted in EA patients, lower than disease controls (P < 0.0001 for all). In addition, the total lung capacity (TLC) was lower in patients with EA than in the controls (P < 0.0001). Fifteen patients (28.8%) with EA had obstructive ventilatory impairment, compared to nine patients (17.3%) with restrictive ventilatory impairment, while one had a combination.
The present study demonstrated significantly decreased pulmonary characteristics in EA patients. Restrictive ventilatory impairment occurring in EA is probably due to poor lung growth after thoracotomy. No single factor predicted ventilatory impairment in children and adolescents with EA. Pediatr Pulmonol. 2017;52:98-106. © 2016 Wiley Periodicals, Inc.