离线FeNO及潮气肺功能量化指标在<5岁儿童哮喘管理中的应用研究

Value of off-line fractional exhale nitric oxide and tidal breath pulmonary function in the management of asthma in children aged<5 years

目的探讨离线呼出气一氧化氮(FeNO)及潮气肺功能联合监测对年幼儿童哮喘控制的价值。方法回顾性研究。选取2017年10月至2019年10月于成都市妇女儿童中心医院哮喘门诊初次确诊的哮喘患儿81例,年龄范围为10~55个月(<5岁),其中男58例,女23例。选择同期儿童保健门诊非喘息健康体检儿童65名为对照组。比较2组血嗜酸粒细胞、总IgE、过敏原阳性率、离线FeNO及潮气肺功能的差异。哮喘组给予抗哮喘治疗3个月、6个月后,复查离线FeNO及潮气肺功能,比较两指标治疗前后的变化。结果(1)哮喘组患儿离线FeNO、过敏原阳性率均高于对照组,达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)均低于对照组,差异均有统计学意义(P值均<0.05)。(2)哮喘组治疗3个月随访肺功能TPTEF/TE、VPEF/VE与初期比较明显好转,差异均有统计学意义(P值均<0.05);离线FeNO变化不明显,差异无统计学意义(P>0.05)。治疗6个月随访,与治疗初期比较,离线FeNO明显下降,差异有统计学意义(P<0.05)。结论离线FeNO及潮气肺功能可作为<5岁哮喘儿童管理的量化指标。抗哮喘治疗后FeNO的改变滞后于肺功能的改善,FeNO及肺功能联合运用,更利于<5岁儿童哮喘的精准管理。

Objective To investigate the value of off-line fractional exhaled nitric oxide(FeNO)and tidal breath pulmonary function for asthma control in young children.Methods A total of 81 cases diagnosed asthma were selectedas subjects.Meanwhile the healthy children were seletced as the control group from October 2017 to October 2019 in the Chengdu Women and Children′s Central Hospital.The results of blood eosinophils,total IgE,skin pricktest,off-line FeNO and the tidal breath pulmonary function were analyzed.Off-line FeNO and tidal breath pulmonary function were analyzed repeatedly in asthma group after the anti-asthma treatment for 3 to 6 months.Results The values of off-line FeNO and the rate of allergen-positive in asthma group were significantly higher than the control group(all P<0.05).The time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),the volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)of asthma group were significantly lower than the control group(both P<0.05).After three months treatment,the TPTEF/TE and VPEF/VE were improved in asthma group(P<0.05).The values of off-line FeNO was not significantly declining in asthma group(P>0.05).After six months treatment,the values of off-line FeNO was significantly declining in asthma group(P<0.05).Conclusions Off-line FeNO and tidal lung function can be used as quantitative indicators for the management of asthma in children aged<5 years.The change of FeNO lags behind the improvement of lung function after anti-asthma treatment.The combination of FeNO and lung function is more conducive to the management of asthma.