控制不佳哮喘儿童运动激发前后胃食管反流负荷：一项48小时MII-pH研究
Gastroesophageal Reflux Burden Before and After Exercise Challenge in Children with Poorly Controlled Asthma: A 48-Hour MII-pH Study.
文献信息
| PMID | 42776700 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Urszula Jedynak-Wąsowicz |
| 作者单位 | Department of Pediatrics, Children's University Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland. |
| 期刊 | Advances in respiratory medicine |
| SCI 分区 | Q1 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 胃食管反流与运动诱发性支气管收缩（EIB）常与哮喘共存，但运动对反流的影响仍不清楚。我们旨在评估部分控制或未控制哮喘儿童中阻抗检测到的异常酸暴露的患病率、其与EIB的关联，以及运动激发试验（ECT）后反流参数的变化。
方法： 30例7-18岁患者接受了肺量计检查、跑台ECT和48小时多通道腔内阻抗-pH监测。EIB定义为FEV1下降≥10%，异常酸暴露定义为阻抗检测到的酸反流持续时间占记录时间的≥1.2%。
结果： 14/30例患者（46.7%）发现异常酸暴露，而EIB发生于6/30例（20.0%），两者之间无显著关联。在基于计数的分析中，ECT后反流发作的绝对次数更高（43.0 [35.2-69.8] vs. 33.5 [21.2-54.5]，p = 0.006）；然而，在敏感性分析中按可分析记录时间进行标准化后，这一发现未得到证实。超重或肥胖见于9例患者（30.0%），并与酸暴露呈正相关。年龄别BMI z评分与酸暴露呈正相关（ρ = 0.41，p = 0.025），但在多重检验校正后这些发现不再显著。
结论： 使用预先设定的酸暴露标准，该队列中异常酸暴露被频繁发现。未证明与EIB存在统计学显著关联；然而，EIB事件数量少限制了确定性结论。ECT后反流发作绝对计数较高未在基于发生率的敏感性分析中得到证实，且无法确立运动对反流的因果效应。
英文摘要
Background: Gastroesophageal reflux and exercise-induced bronchoconstriction (EIB) commonly coexist with asthma, but the effect of exercise on reflux remains unclear. We aimed to assess the prevalence of abnormal impedance-detected acid exposure in children with partially controlled or uncontrolled asthma, its association with EIB, and changes in reflux parameters after an exercise challenge test (ECT). Methods: Thirty patients aged 7-18 years underwent spirometry, treadmill ECT, and 48 h multichannel intraluminal impedance-pH monitoring. EIB was defined as a ≥10% fall in FEV1, and abnormal acid exposure as impedance-detected acid reflux lasting ≥1.2% of recording time. Results: Abnormal acid exposure was identified in 14/30 patients (46.7%), whereas EIB occurred in 6/30 (20.0%), with no significant association between them. The absolute number of reflux episodes was higher after ECT in the count-based analysis (43.0 [35.2-69.8] vs. 33.5 [21.2-54.5], p = 0.006); however, this finding was not confirmed after normalization to analyzable recording time in a sensitivity analysis. Overweight or obesity was present in 9 patients (30.0%) and correlated positively with acid exposure. BMI-for-age z-score correlated positively with acid exposure (ρ = 0.41, p = 0.025), but these findings did not remain significant after correction for multiple testing. Conclusions: Using the prespecified acid-exposure criterion, abnormal acid exposure was frequently identified in this cohort. No statistically significant association with EIB was demonstrated; however, the small number of EIB events limits definitive conclusions. The higher absolute post-ECT reflux episode count was not confirmed in a rate-based sensitivity analysis, and a causal effect of exercise on reflux cannot be established.