呼出气一氧化氮在4～9岁支气管哮喘儿童诊断及治疗中的价值

The Value of FeNO in the Diagnosis and Treatment of Children with asthma Aged 4-9 Years Old

目的探讨呼出气一氧化氮(FENO)在4~9岁儿童支气管哮喘诊断及治疗中的价值。方法抽取上海市嘉定区南翔医院2014年2月—2016年2月收治的240例4~9岁存在咳嗽、胸闷及喘息等症状患儿作为本次研究对象,其中支气管哮喘者为甲组144例,首次诊断者105例,为Ⅰ组,规律治疗且>4周者39例为Ⅱ组;96例非哮喘患儿为乙组。采用NIOX NO检测仪检测各组FENO,以GINA标准为诊断金标准,并绘制受试者工作曲线(ROC),结合ROC曲线评价FENO诊断价值。Ⅰ组给予药物治疗,分别给予舒利迭+顺尔宁、舒利迭治疗,检测两种不同方法治疗前后FENO和肺功能变化。结果Ⅰ组、Ⅱ组和乙组三组间FENO水平和第1s用力呼气容积(FEV1%)占预计值百分比相比较,有显著统计学意义(P<0.05);ROC曲线下面积为0.897,最佳FENO诊断临界点为31.7 ppb。患者经治疗后FENO水平明显低于治疗前,FEV1%水平明显高于治疗前,联合用药与单药治疗间FEV1%、FENO水平比较,无统计学意义。结论 FENO水平对4~9岁儿童支气管哮喘具有较高诊断价值,可较好地评价临床治疗效果。

OBJECTIVE To explore the value of exhaled nitric oxide（FENO） in the diagnosis and treatment of bronchial asthma in children aged 4～9 years.METHODS 240 children aged 4～9 years with cough,chest tightness,and wheezing,who were admitted to our hospital from February 2014 to February 2016,were included in this study.Among them,144 patients with bronchial asthma were group A,and the first diagnosis was 105 patients in group Ⅰ were treated with regular therapy and 39 patients in group Ⅱ were treated with regular therapy; 96 patients with non-asthma group were in group B.The NIOX NO detector was used to detect FENO in each group.The GINA standard was used as the gold standard for diagnosis.The receiver operating curve （ROC） was plotted.The diagnostic value of FENO was evaluated by combining with the ROC curve,and the FENO diagnostic critical point was defined.Patients in group Ⅰ were given drug treatment.They were treated with sullitide＋swollenin and sultidi,respectively,and FENO and pulmonary function were measured before and after treatment with two different methods.RESULTS The FENO levels in the Ⅰ,Ⅱ,and B groups were compared with the predicted percentage of the first expiratory forced-vessel volume （FEV1%）,P〈0.05; the area under the ROC curve was 0.897,and the optimal FeNO diagnostic critical point was 31.7 ppb.After treatment,FENO levels were significantly lower than that before treatment,and FEV1% levels were significantly higher than before treatment,FEV1% and FENO levels between combination therapy and monotherapy were compared,CONCLUSION FeNO level had a higher diagnostic value for bronchial asthma in children aged 4～9 years,and could better evaluate the clinical treatment effect.