潮气肺功能和呼出气一氧化氮检测在毛细支气管炎中的作用

Roles of tidal lung function and FeN O detection in bronchiolitis

目的探讨潮气肺功能、呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)检测在毛细支气管炎中的作用。方法收集2016年1月-2017年2月郑州大学附属郑州中心医院收治的毛细支气管炎患儿69例为研究对象,依据就诊时病情严重程度分为轻度组(24例)、中度组(26例)以及重度组(19例);德国JAEGER公司生产的MasterScreen肺功能仪监测3组潮气量、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、呼吸频率,Sunvou-D100纳库仑(无锡尚沃医疗)一氧化氮分析仪检测3组患儿FeNO,采用受试者工作特征曲线(ROC)分析潮气肺功能联合FeNO评估毛细支气管炎病情严重程度的价值,Pearson相关系数分析毛细支气管炎患儿FeNO与潮气肺功能的关系。结果轻度组、中度组、重度组的潮气量比较差异无统计学意义(P>0.05);但轻度组TPTEF/TE、VPEF/VE较中度组、重度组明显升高,且中度组也明显高于重度组(均P<0.05);轻度组、中度组呼吸频率明显低于重度组(均P<0.05),但轻度组、中度组比较差异无统计学意义(P>0.05);轻度组、中度组、重度组FeNO依次升高(均P<0.05)。ROC曲线分析提示,TPTEF+VPEF+FeNO联合检测评估支气管炎病情严重程度的ROC曲线下面积较三者单一检测高,支气管炎患者FeNO水平与其肺功能指标TPTEF/TE、VPEF/VE呈负相关关系(r=-0.385、-0.314,均P<0.05)。结论潮气肺功能结合呼出气一氧化氮(FeNO)检测可有效反映毛细支气管炎病情严重程度,两者联合检测或可作为毛细支气管炎病情程度的有效评估方案。

Objective To investigate the roles of tidal lung function and fractional exhaled nitric oxide(FeNO)detection in bronchiolitis.Methods Children with bronchiolitis who were treated in pediatric department of the hospital from January 2016 to February 2017 were enrolled.The 69 children with bronchiolitis were divided into mild group(24 cases),moderate group(26 cases)and severe group(19 cases)according to disease severity at visit time.MasterScreen spirometer produced by German JAEGER company was performed to monitor tidal volume,ratio of time to peak(TPTEF/TE),ratio of volume to peak(VPEF/VE)and respiratory rate in three groups.Sunvou-D100 Nacolon(Wuxi Shangwo Medicine)Nitric Oxide Analyzer was performed to detect FeNO in three groups.The receiver operating characteristic(ROC)curves were performed to analyze value of tidal lung function combined with FeNO for assessing severity of bronchiolitis.Pearson correlation coefficient analysis was performed to analyze relationship between FeNO and tidal lung function in bronchiolitis children.Results There was no significant difference in tidal volume among mild group,moderate group and severe group(all P>0.05).However,TPTEF/TE and VPEF/VE in mild group were significantly larger than those in moderate group and severe group.The above indexes in moderate group were also significantly higher than those in severe group(all P<0.05).The respiratory rate in mild group and moderate group was significantly lower than that in severe group(all P<0.05).There was no significant difference between mild group and moderate group(P>0.05).FeNO in mild,moderate and severe groups was significantly increased in turn(all P<0.05).ROC curve analysis indicated that the area under the ROC curve of TPTEF+VPEF+FeNO combined detection for assessing bronchitis severity was significantly higher than that of any one of the three.FeNO level in bronchitis patients was significantly negatively correlated with their pulmonary function indexes such as TPTEF/TE and VPEF/VE(r=-0.385,-0.314,all P<0.05).Conclusion Tidal lung function combined with FeNO detection can effectively reflect severity of bronchiolitis.The combination detection of the two may be an effective evaluation method for severity of bronchiolitis.