探讨支气管激发试验(BPT)在儿童哮喘管理中的应用价值。

选择2018年5月至2019年10月，河北省儿童医院门诊就诊的临床缓解期，并达到良好控制水平至少1年的39例哮喘患儿为研究对象。根据患儿小气道功能，将其分为研究组(n＝11，小气道功能下降)及对照组(n＝28，小气道功能正常)。回顾性分析2组患儿的临床病例资料，包括肺功能、Astograph法醋甲胆碱BPT结果、BPT后6个月随访期内不同情况下哮喘控制情况。采用独立样本t检验及Fisher确切概率法，对2组患儿BPT阳性率及基础气道阻力，以及不同情况下患儿哮喘控制情况进行统计学分析。本研究经河北省儿童医院医学伦理委员会批准(审批文号：医研伦审第120号)，入组时，征得患儿及其监护人知情同意。

① 2组患儿BPT阳性率比较，差异无统计学意义(P>0.05)；研究组患儿基础气道阻力为(6.21±1.69) cmH₂O/(L·s)(1 cmH₂O＝0.098 kPa)，显著高于对照组患儿的(4.97±1.42) cmH₂O/(L·s)，并且差异有统计学意义(t＝2.324、P＝0.026)。②28例BPT呈阳性患儿中，停药患儿哮喘复发率为64.3%(9/14)，显著高于采取原方案继续治疗患儿的21.4%(3/14)，并且差异有统计学意义(P＝0.027)；停药治疗的BPT呈阳性患儿哮喘复发率(64.3%，9/14)，显著高于停药治疗BPT呈阴性患儿的9.1%(1/11)，并且差异有统计学意义(P＝0.007)。

对于临床缓解期、达到良好控制水平的哮喘患儿，在监测肺功能的同时，建议监测其气道反应性。对于BPT呈阳性者，建议暂缓药物降级或者停药，以便更好控制其哮喘发作。

To explore application values of bronchial provocation test (BPT) in the management of childhood asthma.

A total of 39 asthmatic children treated in outpatient clinic of Hebei Children′s Hospital as clinical remission, and reached a well-controlled level for at least 1 year from May 2018 to October 2019, were selected as research subjects. According to small airway function, they were divided into research group (n=11, decreased small airway function) and control group (n=28, normal small airway function). Their clinical data were analyzed retrospectively, including lung function, the BPT results of methacholine by Astograph, and control level of asthma in different conditions during the follow-up period of 6 months after BPT. Independent-samples t test and Fisher exact probability method were used to statistically compare the BPT positive rate and basic airway resistance between two groups of children, as well as the asthma control level of children under different conditions. This study was approved by the Medical Ethics Committee of Hebei Children′s Hospital (Approval No. Medical Research Ethics Approval No. 120). All children and their guardians were informed and agreed at the time of enrollment.

①There was no significant difference in positive rate of BPT between two groups of children (P>0.05). The basic airway resistance of children in research group was (6.21±1.69) cmH₂O/(L·s) (1 cmH₂O=0.098 kPa), which was significantly higher than that of (4.97±1.42) cmH₂O/(L·s) in control group, and the difference was statistically significant (t=2.324, P=0.026). ② Among 28 children with BPT positive, the recurrence rate of asthma in children who discontinued treatment was 64.3% (9/14), which was significantly higher than that of 21.4%(3/14) in children who continued the original treatment, and the difference was statistically significant (P=0.027); The recurrence rate of asthma in BPT positive children who discontinued treatment (64.3%, 9/14) was significantly higher than that of 9.1%(1/11) in BPT negative children who discontinued treatment, and the difference was statistically significant (P=0.007).

For asthmatic children who are in clinical remission and have reached a well-controlled level, it is recommended to monitor their airway responsiveness while monitoring their lung function. For BPT positive asthmatic children, it is recommended to postpone the downgrading of drug or stop the treatment in order to control the asthma attack better.