呼出气一氧化氮浓度测定在儿童支气管哮喘和咳嗽变异性哮喘中的诊断价值

Diagnostic values of fractional exhaled nitric oxide for typical bronchial asthma and cough variant asthma in children

目的分析呼出气一氧化氮(Fe NO)对于支气管哮喘和咳嗽变异性哮喘的诊断价值,并探讨能否应用Fe NO区分支气管哮喘和咳嗽变异性哮喘。方法选取2012年6月至2014年6月150例初诊为支气管哮喘的患儿以及120例初诊为咳嗽变异性哮喘的患儿为研究对象,对两组患儿进行Fe NO检测、肺功能检查以及支气管激发试验;同期选取150例健康儿童为对照组,对对照组儿童行Fe NO检测。采用受试者工作特征曲线(ROC)分析Fe NO对于支气管哮喘和咳嗽变异性哮喘的诊断价值。结果支气管哮喘和咳嗽变异性哮喘组患儿的Fe NO值均高于对照组(P<0.01),支气管哮喘组的Fe NO值显著高于咳嗽变异性哮喘组(P<0.01);支气管哮喘组FEV1/FVC%、FEV1%pred、PD20较咳嗽变异性哮喘组均降低(P<0.01)。Fe NO诊断支气管哮喘的最佳阈值为19.5 ppb,敏感度为83.3%,特异度为86.7%;Fe NO诊断咳嗽变异性哮喘的最佳阈值为15.5 ppb,敏感度为67.5%,特异度为78.0%;Fe NO区别支气管哮喘和咳嗽变异性哮喘的最佳阈值为28.5 ppb,敏感度为60.7%,特异度为82.5%。结论 Fe NO测定可用于支气管哮喘和咳嗽变异性哮喘的诊断和鉴别诊断。

Objective To study the diagnostic values of fractional exhaled nitric oxide（Fe NO） for typical bronchial asthma and cough variant asthma in children, and to explore whether Fe NO can be applied to differentiate typical bronchial asthma from cough variant asthma in children. Methods A total of 150 children who were newly diagnosed with typical bronchial asthma between June 2012 and June 2014, as well as 120 children who were newly diagnosed with cough variant asthma during the same period, were selected as subjects. Fe NO measurement, spirometry, and methacholine provocation test were performed for both groups. Meanwhile, 150 healthy children were selected as the control group, and their Fe NO was measured. The diagnostic values of Fe NO for typical bronchial asthma and cough variant asthma were analyzed using the receiver operating characteristic curve. Results The Fe NO values in the typical bronchial asthma and cough variant asthma groups were significantly higher than in the control group（P0.01）, and the Fe NO value in the typical bronchial asthma group was significantly higher than in the cough variant asthma group（P0.01）. FEV1/FVC%, FEV1%pred, and PD20 were significantly lower in the typical bronchial asthma group than in the cough variant asthma group（P0.01）. The optimal cut-off value of Fe NO was 19.5 ppb for the diagnosis of typical bronchial asthma, with a sensitivity of 83.3% and a specificity of 86.7%; the optimal cut-off value of Fe NO was 15.5 ppb for the diagnosis of cough variant asthma, with a sensitivity of 67.5% and a specificity of 78.0%; the optimal cut-off value of Fe NO was 28.5 ppb for the differentiation between typical bronchial asthma and cough variant asthma, with a sensitivity of 60.7% and a specificity of 82.5%. Conclusions Measurenment of Fe NO may be useful in the diagnosis and differential diagnosis of typical bronchial asthma and cough variant asthma.