呼出气一氧化氮在儿童支气管哮喘诊疗中的应用进展

Research about application of exhaled nitric oxide in the diagnosis and remedy of children with bronchial asthma

目的检测典型支气管哮喘(简称哮喘)以及咳嗽变异性哮喘(CVA)患儿中呼出气一氧化氮(eNO)的水平以及和肺功能(PEF)两者的相关性,并探讨eNO检测在儿童哮喘以及CVA中的诊疗价值。方法采用电化学法对6～16岁患有典型哮喘(n=23)、CVA(n=29)的患者进行eNO测定,同时测定呼气峰流速(PEF)。37例无特异性疾病史和家族过敏史,且近两周内无急性呼吸道感染史的儿童作为对照组。结果典型哮喘组,CVA组的eNO水平均明显高于对照组(P<0.01),典型哮喘组和CVA的PEF水平均明显低于对照组(P<0.05);CVA组的eNO水平高于典型哮喘组(P<0.05),PEF水平高于典型哮喘组(P<0.05);但是eNO水平与PEF水平无相关性(r=0.061,P>0.05);29例CVA患者中,有21例eNO水平>30ppb(正常水平为5～25ppb)。给予上述29例患者舒利迭或是都保治疗1个月,发现21例eNO水平偏高的患者中,有19例反复咳嗽症状明显减轻,2例症状改善。其余8例,有3例症状减轻,其余5例未见明显疗效。结论典型哮喘患者以及CVA患者的eNO水平均较高,eNO水平和PEF水平无相关性;CVA患者若eNO增高,对激素治疗有效。

Objective The study examined the levels of exhaled nitric oxide （eNO） and maximum peak flow （PEF） as well as the correlation between the both in children between the year of 6 and 16 with bronchial asthma （asthma） and chronic cough variant asthma （CVA）. Furthermore,the research study the diagnosis and remedy value of exhaled nitric oxide of children with asthma and CVA. Methods The eNO level was measured with electrochemical photometry in 23 cases diagnosed as asthma, 29 cases diagnosed as CVA and 37 cases without atopic disease and acute respiratory infection as well as without family history of atopic disease served as the control group. Results The levels of eNO in the asthma and the CVA groups were significant higher than those in the control group （ P 〈0.01） ,and the levels of PEF in the asthma and the CVA groups were significant lower than those in the control group （ P〈0.05）. The level of eNO and PEF in the CVA groups were higher than those in the asthma （ P〈0.01）. However the level of eNO was not correlated with PEF （ r =0. 061, P〉0.05）. In the CVA group,the eNO level of 21 patients was higher than 30 ppb （the normal level is between 5 and 25 ppb）. After one month of ICS therapy, the symptoms of 19 cases was obviously relieved, 2 cases was relieved. Meanwhile,among the rest 8 cases,three of them was relieved, 5 cases have no great effect. Conclusions The patients with asthma and CVA have high levels of eNO. However the level of eNO was not correlated with PEF. Furthermore, if the eNO level of CVA patients has improved,the therapy of ICS will be effected.