Determinants of inspiratory muscle function in healthy children
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摘要
Background: Children are affected by disorders that have an impact on the respiratory muscles. Inspiratory muscle function can be assessed by means of the noninvasive tension–time index of the inspiratory muscles(TTImus). Our objectives were to identify the determinants of TTImus in healthy children and to report normal values of TTImus in this population.Methods: We measured weight, height, upper arm muscle area(UAMA), and TTImusin 96 children aged 6–18 years. The level and frequency of aerobic activity was assessed by questionnaire.Results: TTImuswas significantly lower in male subjects(0.095 ± 0.038, mean ± SD) compared with female subjects(0.126 ± 0.056)(p = 0.002).TTImus was significantly lower in regularly exercising(0.093 ± 0.040) compared with nonexercising subjects(0.130 ± 0.053)(p < 0.001). TTImus was significantly negatively related to age(r =-0.239, p = 0.019), weight(r =-0.214, p = 0.037), height(r =-0.355, p < 0.001), and UAMA(r =-0.222, p = 0.030). Multivariate logistic regression analysis revealed that height and aerobic exercise were significantly related to TTImus independently of age, weight, and UAMA. The predictive regression equation for TTImus in male subjects was TTImus = 0.228-0.001 × height(cm), and in female subjects it was TTImus = 0.320-0.001 × height(cm).Conclusion: Gender, age, anthropometry, skeletal muscularity, and aerobic exercise are significantly associated with indices of inspiratory muscle function in children. Normal values of TTImus in healthy children are reported.
Background: Children are affected by disorders that have an impact on the respiratory muscles. Inspiratory muscle function can be assessed by means of the noninvasive tension–time index of the inspiratory muscles(TTImus). Our objectives were to identify the determinants of TTImus in healthy children and to report normal values of TTImus in this population.Methods: We measured weight, height, upper arm muscle area(UAMA), and TTImusin 96 children aged 6–18 years. The level and frequency of aerobic activity was assessed by questionnaire.Results: TTImuswas significantly lower in male subjects(0.095 ± 0.038, mean ± SD) compared with female subjects(0.126 ± 0.056)(p = 0.002).TTImus was significantly lower in regularly exercising(0.093 ± 0.040) compared with nonexercising subjects(0.130 ± 0.053)(p < 0.001). TTImus was significantly negatively related to age(r =-0.239, p = 0.019), weight(r =-0.214, p = 0.037), height(r =-0.355, p < 0.001), and UAMA(r =-0.222, p = 0.030). Multivariate logistic regression analysis revealed that height and aerobic exercise were significantly related to TTImus independently of age, weight, and UAMA. The predictive regression equation for TTImus in male subjects was TTImus = 0.228-0.001 × height(cm), and in female subjects it was TTImus = 0.320-0.001 × height(cm).Conclusion: Gender, age, anthropometry, skeletal muscularity, and aerobic exercise are significantly associated with indices of inspiratory muscle function in children. Normal values of TTImus in healthy children are reported.
Background: Children are affected by disorders that have an impact on the respiratory muscles. Inspiratory muscle function can be assessed by means of the noninvasive tension–time index of the inspiratory muscles(TTImus). Our objectives were to identify the determinants of TTImus in healthy children and to report normal values of TTImus in this population.Methods: We measured weight, height, upper arm muscle area(UAMA), and TTImusin 96 children aged 6–18 years. The level and frequency of aerobic activity was assessed by questionnaire.Results: TTImuswas significantly lower in male subjects(0.095 ± 0.038, mean ± SD) compared with female subjects(0.126 ± 0.056)(p = 0.002).TTImus was significantly lower in regularly exercising(0.093 ± 0.040) compared with nonexercising subjects(0.130 ± 0.053)(p < 0.001). TTImus was significantly negatively related to age(r =-0.239, p = 0.019), weight(r =-0.214, p = 0.037), height(r =-0.355, p < 0.001), and UAMA(r =-0.222, p = 0.030). Multivariate logistic regression analysis revealed that height and aerobic exercise were significantly related to TTImus independently of age, weight, and UAMA. The predictive regression equation for TTImus in male subjects was TTImus = 0.228-0.001 × height(cm), and in female subjects it was TTImus = 0.320-0.001 × height(cm).Conclusion: Gender, age, anthropometry, skeletal muscularity, and aerobic exercise are significantly associated with indices of inspiratory muscle function in children. Normal values of TTImus in healthy children are reported.
引文
1.Dassios T,Katelari A,Doudounakis S,Mantagos S,Dimitriou G.Respiratory muscle function in patients with cystic fibrosis.Pediatr Pulmonol 2013;48:865-73.
2.Hahn A,Ankermann T,Claass A,Mann M,Lindemann H,Neubauer BA.Non-invasive tension time index in relation to severity of disease in children with cystic fibrosis.Pediatr Pulmonol 2008;43:973-81.
3.Hayot M,Guillaumont S,Ramonatxo M,Voisin M,Préfaut C.Determinants of the tension-time index of inspiratory muscles in children with cystic fibrosis.Pediatr Pulmonol 1997;23:336-43.
4.Mulreany LT,Weiner DJ,McDonough JM,Panitch HB,Allen JL.Noninvasive measurement of the tension-time index in children with neuromuscular disease.J Appl Physiol 2003;95:931-7.
5.Chlif M,Keochkerian D,Mourlhon C,Choquet D,Ahmaidi S.Noninvasive assessment of the tension-time index of inspiratory muscles at rest in obese male subjects.Int J Obes(Lond)2005;29:1478-83.
6.Harikumar G,Egberongbe Y,Nadel S,Wheatley E,Moxham J,Greenough A,et al.Tension-time index as a predictor of extubation outcome in ventilated children.Am J Respir Crit Care Med 2009;180:982-8.
7.Mellies U,Stehling F,Dohna-Schwake C.Normal values for inspiratory muscle function in children.Physiol Meas 2014;35:1975-81.
8.Dimitriou G,Papakonstantinou D,Stavrou EF,Tzifas S,Vervenioti A,Athanassiadou A,et al.Angiotensin-converting enzyme gene polymorphism and respiratory muscle function in infants.Pediatr Pulmonol2010;45:1233-9.
9.Dassios T,Katelari A,Doudounakis S,Dimitriou G.Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis.Respir Med2013;107:684-90.
10.Orenstein DM,Franklin BA,Doershuk CF,Hellerstein HK,Germann KJ,Horowitz JG,et al.Exercise conditioning and cardiopulmonary fitness in cystic fibrosis.The effects of a three-month supervised running program.Chest 1981;80:392-8.
11.American Thoracic Society/European Respiratory Society.ATS/ERSStatement on respiratory muscle testing.Am J Respir Crit Care Med 2002;166:518-624.
12.Ramonatxo M,Boulard P,Préfaut C.Validation of a noninvasive tension-time index of inspiratory muscles.J Appl Physiol 1995;78:646-53.
13.Gaultier C.Tension-time index of inspiratory muscles in children.Pediatr Pulmonol 1997;23:327-9.
14.Black LF,Hyatt RE.Maximal respiratory pressures:normal values and relationship to age and sex.Am Rev Respir Dis 1969;99:696-702.
15.Kuczmarski RJ,Ogden CL,Guo SS.2000 CDC growth charts for the United States:methods and development.Vital and health statistics.Hyattsville,MD:Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Health Statistics;2002.
16.Ramsey BW,Farrell PM,Pencharz P.Nutritional assessment and management in cystic fibrosis:a consensus report.The Consensus Committee.Am J Clin Nutr 1992;55:108-16.
17.Frisancho AR.New norms of upper limb fat and muscle areas for assessment of nutritional status.Am J Clin Nutr 1981;34:2540-5.
18.Department of Health Physical Activity,Health Improvement and Protection.Start active,stay active:a report on physical activity from the four home countries’chief medical officers.Available at:https://www.sportengland.org/media/2928/dh_128210.pdf;2011[accessed01.12.2015].
19.U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,Division of Nutrition,Physical Activity and Obesity.Fact sheet for health professionals on physical activity guidelines for children and adolescents.Available at:https://www.cdc.gov/physicalactivity/downloads/pa_fact_sheet_adults.pdf;2008[accessed01.12.2015].
20.Dassios T.Determinants of respiratory pump function in patients with cystic fibrosis.Paediatr Respir Rev 2015;16:75-9.
21.Glenmark B,Nilsson M,Gao H,Gustafsson JA,Dahlman-Wright K,Westerblad H.Difference in skeletal muscle function in males vs.females:role of estrogen receptor-beta.Am J Physiol Endocrinol Metab 2004;287:E1125-31.
22.Maarsingh EJ,van Eykern LA,Sprikkelman AB,Hoekstra MO,van Aalderen WM.Respiratory muscle activity measured with a noninvasive EMG technique:technical aspects and reproducibility.J Appl Physiol2000;88:1955-61.
23.Stefanutti D,Fitting JW.Sniff nasal inspiratory pressure.Reference values in Caucasian children.Am J Respir Crit Care Med 1999;159:107-11.
24.Bridger GP,Proctor DF.Maximum nasal inspiratory flow and nasal resistance.Ann Otol Rhinol Laryngol 1970;79:481-8.
25.Younes M,Riddle W,Polacheck J.A model for the relation between respiratory neural and mechanical outputs.III.Validation.J Appl Physiol Respir Environ Exerc Physiol 1981;51:990-1001.
26.Amin R.Chronic respiratory failure.In:Chernick V,Wilmott R,Bush A,editors.Kendig’s disorders of the respiratory tract in children.7th ed.Philadelphia,PA:Saunders Elsevier;2006.p.243-58.
27.Chernick V,West JB.The functional basis of respiratory disease.In:Chernick V,Wilmott R,Bush A,editors.Kendig’s disorders of the respiratory tract in children.7th ed.Philadelphia,PA:Saunders Elsevier;2006.p.38-9.
28.Scott CB,Nickerson BG,Sargent CW,Platzker AC,Warburton D,Keens TG.Developmental pattern of maximal transdiaphragmatic pressure in infants during crying.Pediatr Res 1983;17:707-9.
29.Tomalak W,Pogorzelski A,Prusak J.Normal values for maximal static inspiratory and expiratory pressures in healthy children.Pediatr Pulmonol2002;34:42-6.
30.Szeinberg A,Marcotte JE,Roizin H,Mindorff C,England S,Tabachnik E,et al.Normal values of maximal inspiratory and expiratory pressures with a portable apparatus in children,adolescents,and young adults.Pediatr Pulmonol 1987;3:255-8.
31.Smyth RJ,Chapman KR,Rebuck AS.Maximal inspiratory and expiratory pressures in adolescents.Normal values.Chest 1984;86:568-72.
32.Gaultier C,Zinman R.Maximal static pressures in healthy children.Respir Physiol 1983;51:45-61.
33.Elliott MW,Mulvey DA,Green M,Moxham J.An evaluation of P0.1measured in mouth and oesophagus,during carbon dioxide rebreathing in COPD.Eur Respir J 1993;6:1055-9.
2.Hahn A,Ankermann T,Claass A,Mann M,Lindemann H,Neubauer BA.Non-invasive tension time index in relation to severity of disease in children with cystic fibrosis.Pediatr Pulmonol 2008;43:973-81.
3.Hayot M,Guillaumont S,Ramonatxo M,Voisin M,Préfaut C.Determinants of the tension-time index of inspiratory muscles in children with cystic fibrosis.Pediatr Pulmonol 1997;23:336-43.
4.Mulreany LT,Weiner DJ,McDonough JM,Panitch HB,Allen JL.Noninvasive measurement of the tension-time index in children with neuromuscular disease.J Appl Physiol 2003;95:931-7.
5.Chlif M,Keochkerian D,Mourlhon C,Choquet D,Ahmaidi S.Noninvasive assessment of the tension-time index of inspiratory muscles at rest in obese male subjects.Int J Obes(Lond)2005;29:1478-83.
6.Harikumar G,Egberongbe Y,Nadel S,Wheatley E,Moxham J,Greenough A,et al.Tension-time index as a predictor of extubation outcome in ventilated children.Am J Respir Crit Care Med 2009;180:982-8.
7.Mellies U,Stehling F,Dohna-Schwake C.Normal values for inspiratory muscle function in children.Physiol Meas 2014;35:1975-81.
8.Dimitriou G,Papakonstantinou D,Stavrou EF,Tzifas S,Vervenioti A,Athanassiadou A,et al.Angiotensin-converting enzyme gene polymorphism and respiratory muscle function in infants.Pediatr Pulmonol2010;45:1233-9.
9.Dassios T,Katelari A,Doudounakis S,Dimitriou G.Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis.Respir Med2013;107:684-90.
10.Orenstein DM,Franklin BA,Doershuk CF,Hellerstein HK,Germann KJ,Horowitz JG,et al.Exercise conditioning and cardiopulmonary fitness in cystic fibrosis.The effects of a three-month supervised running program.Chest 1981;80:392-8.
11.American Thoracic Society/European Respiratory Society.ATS/ERSStatement on respiratory muscle testing.Am J Respir Crit Care Med 2002;166:518-624.
12.Ramonatxo M,Boulard P,Préfaut C.Validation of a noninvasive tension-time index of inspiratory muscles.J Appl Physiol 1995;78:646-53.
13.Gaultier C.Tension-time index of inspiratory muscles in children.Pediatr Pulmonol 1997;23:327-9.
14.Black LF,Hyatt RE.Maximal respiratory pressures:normal values and relationship to age and sex.Am Rev Respir Dis 1969;99:696-702.
15.Kuczmarski RJ,Ogden CL,Guo SS.2000 CDC growth charts for the United States:methods and development.Vital and health statistics.Hyattsville,MD:Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Health Statistics;2002.
16.Ramsey BW,Farrell PM,Pencharz P.Nutritional assessment and management in cystic fibrosis:a consensus report.The Consensus Committee.Am J Clin Nutr 1992;55:108-16.
17.Frisancho AR.New norms of upper limb fat and muscle areas for assessment of nutritional status.Am J Clin Nutr 1981;34:2540-5.
18.Department of Health Physical Activity,Health Improvement and Protection.Start active,stay active:a report on physical activity from the four home countries’chief medical officers.Available at:https://www.sportengland.org/media/2928/dh_128210.pdf;2011[accessed01.12.2015].
19.U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,Division of Nutrition,Physical Activity and Obesity.Fact sheet for health professionals on physical activity guidelines for children and adolescents.Available at:https://www.cdc.gov/physicalactivity/downloads/pa_fact_sheet_adults.pdf;2008[accessed01.12.2015].
20.Dassios T.Determinants of respiratory pump function in patients with cystic fibrosis.Paediatr Respir Rev 2015;16:75-9.
21.Glenmark B,Nilsson M,Gao H,Gustafsson JA,Dahlman-Wright K,Westerblad H.Difference in skeletal muscle function in males vs.females:role of estrogen receptor-beta.Am J Physiol Endocrinol Metab 2004;287:E1125-31.
22.Maarsingh EJ,van Eykern LA,Sprikkelman AB,Hoekstra MO,van Aalderen WM.Respiratory muscle activity measured with a noninvasive EMG technique:technical aspects and reproducibility.J Appl Physiol2000;88:1955-61.
23.Stefanutti D,Fitting JW.Sniff nasal inspiratory pressure.Reference values in Caucasian children.Am J Respir Crit Care Med 1999;159:107-11.
24.Bridger GP,Proctor DF.Maximum nasal inspiratory flow and nasal resistance.Ann Otol Rhinol Laryngol 1970;79:481-8.
25.Younes M,Riddle W,Polacheck J.A model for the relation between respiratory neural and mechanical outputs.III.Validation.J Appl Physiol Respir Environ Exerc Physiol 1981;51:990-1001.
26.Amin R.Chronic respiratory failure.In:Chernick V,Wilmott R,Bush A,editors.Kendig’s disorders of the respiratory tract in children.7th ed.Philadelphia,PA:Saunders Elsevier;2006.p.243-58.
27.Chernick V,West JB.The functional basis of respiratory disease.In:Chernick V,Wilmott R,Bush A,editors.Kendig’s disorders of the respiratory tract in children.7th ed.Philadelphia,PA:Saunders Elsevier;2006.p.38-9.
28.Scott CB,Nickerson BG,Sargent CW,Platzker AC,Warburton D,Keens TG.Developmental pattern of maximal transdiaphragmatic pressure in infants during crying.Pediatr Res 1983;17:707-9.
29.Tomalak W,Pogorzelski A,Prusak J.Normal values for maximal static inspiratory and expiratory pressures in healthy children.Pediatr Pulmonol2002;34:42-6.
30.Szeinberg A,Marcotte JE,Roizin H,Mindorff C,England S,Tabachnik E,et al.Normal values of maximal inspiratory and expiratory pressures with a portable apparatus in children,adolescents,and young adults.Pediatr Pulmonol 1987;3:255-8.
31.Smyth RJ,Chapman KR,Rebuck AS.Maximal inspiratory and expiratory pressures in adolescents.Normal values.Chest 1984;86:568-72.
32.Gaultier C,Zinman R.Maximal static pressures in healthy children.Respir Physiol 1983;51:45-61.
33.Elliott MW,Mulvey DA,Green M,Moxham J.An evaluation of P0.1measured in mouth and oesophagus,during carbon dioxide rebreathing in COPD.Eur Respir J 1993;6:1055-9.