过敏性哮喘患儿呼出气一氧化氮和吲哚胺2,3双加氧酶水平及其临床意义

The expression and clinical significance of fractional exhaled nitric oxide and indoleamine 2,3 dioxygenase in children with allergic asthma

目的探讨过敏性哮喘患儿呼出气一氧化氮(FeNO)水平和吲哚胺2,3双加氧酶(IDO)的表达水平及其对过敏性哮喘的诊断价值。方法选取2016年至2019年洛阳市妇幼保健院收治的过敏性哮喘患儿60例为观察组,选取同期于医院体检的健康儿童60例为对照组。观察两组FeNO、IDO、嗜酸性粒细胞水平、肺功能情况。分析FeNO、IDO水平与嗜酸性粒细胞水平、肺功能的相关性,并通过受试者工作特征曲线分析FeNO、IDO水平对过敏性哮喘的诊断价值。结果观察组FeNO水平高于对照组(P<0.05),IDO活性水平低于对照组(P<0.05);观察组第1秒用力呼气容积(FEV1)/用力肺活量(FVC)水平低于对照组(P<0.05),嗜酸性粒细胞计数高于对照组(P<0.05)。过敏性哮喘患儿FeNO水平与FEV1/FVC呈负相关(r=-0.667,P<0.05),与嗜酸性粒细胞计数呈正相关(r=0.813,P<0.05);IDO水平与FEV1/FVC呈正相关(r=0.725,P<0.05),与嗜酸性粒细胞计数呈负相关(r=-0.583,P<0.05)。通过受试者工作特征曲线分析,单独FeNO、单独IDO、FeNO联合IDO对儿童过敏性哮喘均有一定诊断价值,FeNO联合IDO对儿童过敏性哮喘诊断价值最高,AUC为0.937,灵敏度为83.3%,特异度为100.0%。结论过敏性哮喘患儿FeNO水平升高,IDO活性水平降低,FeNO联合IDO检测对儿童过敏性哮喘具有较高的诊断价值。

Objective To investigate the expression of fractional exhaled nitric oxide (FeNO) and indoleamine 2, 3 dioxygenase (IDO) in children with allergic asthma and their diagnostic values for the disease.Methods Sixty children with allergic asthma hospitalized and treated in Luoyang Maternal and Child Health Hospital from 2016 to 2019 were selected as observation group, and 60 healthy children who underwent physical examination during the same time period in the hospital were selected as control group. The levels of FeNO, IDO, eosinophils and lung function of the two groups were observed, and the correlation among them was also analyzed. Then the diagnostic values of FeNO and IDO levels for allergic asthma were analyzed by receiver operating characteristics (ROC) curve.Results The observation group has higher FeNO level and lower IDO activity than the control group (P<0.05). The forced expiratory volume in 1 second (FEV1)/ forced vital capicity (FVC) levels in the observation group were significantly lower than those in the control group (P<0.05), and the eosinophil count was significantly higher than that in the control group (P<0.05). FeNO levels were negatively correlated with FEV1/FVC in children with allergic asthma (r=-0.667, P<0.05), and positively correlated with eosinophil count (r=0.813, P<0.05). The level of IDO was positively correlated with FEV1/FVC (r=0.725, P<0.05), and negatively correlated with eosinophil count (r=-0.583, P<0.05). ROC curve analysis showed that single FeNO, single IDO and FeNO combined with IDO had certain diagnostic value for allergic asthma in children. However, FeNO combined with IDO has the highest diagnostic value for allergic asthma in children, with area under curve, sensitivity and specificity as 0.937, 83.3%, and 100%, respectively.Conclusions Children with allergic asthma have increased FeNO level and decreased IDO activity, and the combined detection of FeNO and IDO has high diagnostic value for allergic asthma in children.