呼出气一氧化氮检测在小儿支气管哮喘早期诊断及病情评估中的应用

Application of exhaled nitric oxide detection in early diagnosis and evaluation of disease conditions in children with bronchial asthma

目的探讨呼出气一氧化氮(FeNO)对早期诊断小儿支气管哮喘及病情评估的应用价值。方法前瞻性选取130例支气管哮喘患儿作为研究对象,将90例急性发作期患儿纳入急性期组,将40例缓解期患儿纳入缓解期组,并将急性期组患儿按病情程度的不同分为轻度组(n=32)、中度组(n=35)和重度组(n=23)。比较急性期组和缓解期组、不同病情程度急性期患儿的FeNO、最大呼气流量占预计值百分比(PEF%)、第1秒用力呼气量占预计值百分比(FEV 1%)和免疫球蛋白E(IgE)水平,并采用Pearson法分析FeNO与PEF%、FEV 1%、IgE水平的相关性。结果急性期组FeNO(68.30±9.21)ppb、IgE(279.32±78.05)kU/L分别高于缓解期组(39.27±5.38)ppb、(185.70±52.36)kU/L,而PEF%(73.50±9.85)%、FEV 1%(78.53±9.76)%分别低于缓解期组(89.65±6.53)%、(90.12±6.74)%,差异均有统计学意义(P<0.05);轻度组、中度组和重度组患儿FeNO、PEF%、FEV 1%、IgE组间两两比较,差异有统计学意义(P<0.05)。Pearson法分析显示,急性期支气管哮喘患儿FeNO与PEF%、FEV 1%呈显著负相关(r=-0.827、-0.793,P<0.05),与血清IgE呈显著正相关(r=0.780,P<0.05)。结论支气管哮喘患儿急性期FeNO异常升高,且与肺功能指标PEF%、FEV 1%和血清IgE有显著相关性,可为临床早期诊断支气管哮喘和评估病情提供重要依据。

Objective To explore the value of fractional exhaled nitric oxide(FeNO)in the early diagnosis and assessment of children′s asthma.Methods A prospective study was conducted for 130 children with bronchial asthma diagnosed in our department.A total of 90 cases in acute attack stage and 40 cases in remission stage were separately selected as acute stage group and remission stage group.Children in acute stage were subdivided into mild group(n=32),moderate group(n=35)and severe group(n=23)according to the degree of illness.The levels of FeNO,ratio of peak expiratory flow to predicted value(PEF%),ratio of forced expiratory volume in one second to predicted value(FEV 1%)and immunoglobulin E(IgE)were compared in children in the acute group and remission group,as well as those with different degrees of illness.The correlations between FeNO and PEF%,FEV 1%,IgE were analyzed by Pearson method.Results The levels of FeNO and IgE were(68.30±9.21)ppb and(279.32±78.05)kU/L in the acute group,which were higher than(39.27±5.38)ppb and(185.70±52.36)kU/L,in the remission group.PEF%and FEV 1%were(73.50±9.85)%and(78.53±9.76)%,in the acute group,which were significantly lower than(89.65±6.53)%and(90.12±6.74)%,in the remission group,the differences were statistically significant(P<0.05).There were significant between-group differences in FeNO,PEF%,FEV 1%,IgE among mild,moderate and severe groups(P<0.05).Pearson analysis showed that FeNO was negatively correlated with PEF%and FEV 1%(r=-0.827,-0.793,P<0.01)and positively correlated with serum IgE(r=0.780,P<0.01).Conclusion The abnormal elevation of FeNO in children with asthma in acute stage is significantly correlated with PEF%,FEV 1%of pulmonary function and serum IgE,which provides an important basis for clinical early diagnosis of asthma and disease assessment.