呼出气一氧化氮监测评估儿童哮喘病情临床价值研究

Primary investigation of fractional concentration of exhaled nitric oxide in asthmatic children

目的通过对哮喘儿童呼出气一氧化氮(FENO)水平的监测,为哮喘的临床诊断治疗及病情评估提供帮助。方法选择2007年10月至2009年8月于首都儿科研究所附属儿童医院门诊确诊的哮喘患儿共358例,根据其哮喘发作与治疗情况分为哮喘发作组与非发作组、治疗组与未治疗组。设计临床观察表记录各组患儿治疗、发作、肺部喘鸣音情况,并进行FENO及1秒用力呼气容积(FEV1)、用力肺活量(FVC)及最大用力呼气中段流量(MMEF)等肺功能指标的测定。结果 358例哮喘患儿的FENO值为28.5(15.5～55.0)×10-9,其中男性为29.0(15.0～49.8.0)×10-9,女性为28.0(16.0～58.6)×10-9,男女相比差别无统计学意义(Z=-1.006,P>0.05)。111例11岁以上哮喘儿童FENO为36.0(20.0～65.0)×10-9,其中男性为30.0(26.0～63.0)×10-9,女性为40.5(17.7～73.8)×10-9,与395例正常儿童相比FENO明显增高,差异具有统计学意义(Z=-11.352,P<0.001)。358例哮喘患儿FENO与年龄呈正相关(r=0.206,P<0.01),与病程和FVC无相关性(r分别为-0.009和-0.086,P均>0.05),与FEV1及MMEF轻度负相关(r分别为-0.164和-0.176,P均<0.01)。哮喘发作组患儿FENO值高于非发作组[38.4(16.7～59.1)×10-9,26.0(15.0～51.0)×10-9;Z=-2.327,0.01<P<0.05],治疗组患儿FENO值显著低于未治疗组[24.0(13.0～48.5)×10-9,31.0(16.7～57.2)×10-9,Z=-2.215,P<0.05]。对11岁以上儿童作受试者工作特征曲线,选FENO值17.9×10-9为诊断界点时,灵敏度为0.802,特异度为0.825。96例肺功能正常患儿中,77例(80.2%)存在FENO异常升高,15例出现哮喘发作。结论 FENO值的升高可作为哮喘患儿存在非特异性气道炎症的可靠指标,可预示病情控制情况。对于临床无哮喘发作症状,肺功能正常,但气道炎症仍然存在的哮喘患儿,需要将FENO作为气道炎症及病情的监测指标。

Objective To investigate the level of exhaled nitric oxide in child asthma patients.Methods A total of 358 asthmatic children in our asthma clinic observed from October 2007 to August 2009 were divided into different groups as asthma attack group and non-attack group,and treatment group and non-treatment group.The therapy,attack symptoms and signs of them were recorded into clinical form.Tests of spiromety and FENO were performed at the same time.Results FENO in asthmatic children was 28.5（15.5～55.0）×10-9,there being no significant difference between male and female.FENO in asthmatic children older than 11 years was significantly higher than in normal children[36.0（20.0～65.0）×10-9,12.6（9.5～17.1）×10-9,Z = -11.352,P 0.001].FENO in asthmatic children was positively correlated with age （r = 0.206,P 0.01）,not related to asthma history course or FVC,but slightly negatively correlated with FEV1 and MMEF（r = -0.164,P 0.01,r = -0.176,P 0.01）.FENO in the group of asthma attack was significantly higher than the group of non-asthma attack [38.4（16.7～59.1）×10-9,26.0（15.0～51.0）×10-9;Z = -2.327,0.01 P 0.05];in the group of treatment it was significantly lower than in the non-treatment group [24.0（13.0～48.5）×10-9,31.0（16.7～57.2）×10-9,Z = -2.215,0.05 P 0.01].By analysis with ROC in children older than 11 years,the cut-off point was 17.9×10-9,sensitivity was 0.802,specificity was 0.825.Seventy-seven out of the 96 asthmatic children with normal lung function showed higher FENO and 15 out of them had asthma attack.Conclusion It is found that FENO in asthmatic children is significantly higher than in normal children.FENO is a useful method to identify non-specific inflammation in asthmatic children from the normal children.The patients who have asthma attack or non-treatment ones have a higher FENO.Higher FENO indicates bad control or even worse condition.Patients who have no symptoms but normal lung function still have abnormal FENO.The test of FENO can be used in asthma management and its control.