评估FeNO和CaNO对6~12岁咳嗽变异性哮喘(CVA)儿童的临床价值

Evaluation on the Clinical Value of FeNO and CaNO in Children with Cough Variant Asthma(CVA)Aged 6-12 Years

目的分析FeNO和CaNO检测对6~12岁咳嗽变异性哮喘(CVA)儿童的临床价值。方法方便选取2017年10月-2019年10月在该院确诊为CVA患儿197例患儿及50名健康儿童作为研究对象,年龄范围在6~12岁。通过对健康儿童和CVA的患儿进行呼出气NO(FeNO)测定,并根据健康对照组的FeNO浓度和CaNO浓度检测上限为切点,将CVA患者分为4组,分别为组I(FeNO正常+CaNO正常),组Ⅲ(FeNO升高+CaNO正常),组I(FeNO升高+CaNO升高),和组IV(FeNO正常+CaNO升高)。对比分析各组患儿的哮喘(咳嗽)控制率和发病率、过敏性反应及肺功能等,探讨大小气道炎症对临床CVA分型和CVA控制及治疗的意义。结果各组患儿的年龄,性别,BMI值比较,差异无统计学意义(P>0.05);哮喘控制测试评分(ACT),组Ⅲ最低,且组Ⅳ的评分极显著低于组Ⅱ和组(H=8.674,P<0.01),说明其与CaNO水平相关,而与FeNO水平影响无关;4组患儿的肺功能指标比较,差异无统计学意义(P>0.05),说明患儿eNO与肺功能无相关性;各组荧光酶免法阳性率差异显著,组Ⅱ阳性率93.2%(68例)极显著高于组Ⅰ的53.2%(42例)和组Ⅳ的50.0%(9例),差异有统计学意义(x^(2)=38.713,P<0.001),而对于CVA的发病率,组Ⅱ的61.6%(45例)极显著高于组Ⅰ的10.1%(8例)与组Ⅳ的22.2%(4例),差异有统计学意义(x^(2)=50.317,P<0.001),这些说明主要其受FeNO的影响,而与CaNO水平影响无关。关于ICS治疗,组Ⅱ的35.6%(26例)极显著低于组Ⅰ的74.7%(59例)和组Ⅳ的77.8%(14.例),差异有统计学意义(x^(2)=36.803,P<0.001),说明FeNO水平受ICS治疗的影响,而与CaNO水平无关。结论FeNO和CaNO测定有助于CVA分型,其中ICS治疗影响FeNO水平,且FeNO水平与患儿过敏体质和发病率有关,而CANO升高与CVA控制不良相关。

Objective To analyze the clinical value of FeNO and CaNO detection in children with cough variant asthma(CVA)aged 6-12 years.Methods From October 2017 to October 2019,convenient select 197 children with CVA and 50 healthy children who were diagnosed with CVA in the hospital were selected as the research subjects,ranging in age from 6 to 12 years old.By measuring the exhaled NO(FeNO)of healthy children and children with CVA,and according to the upper limit of FeNO concentration and CaNO concentration detection of healthy control group as the cut-off point,CVA patients were divided into 4 groups,namely group I(FeNO normal+CaNO normal),Group Ⅱ(FeNO elevated+CaNO normal),Group Ⅲ(FeNO elevated+CaNO elevated),and Group Ⅳ(FeNO normal+CaNO elevated).The control rate and incidence rate of asthma(cough),allergic reaction and lung function of children in each group were comparatively analyzed,and the significance of large and small airway inflammation on clinical CVA classification and CVA control and treatment was discussed.Results There was not statistically significant difference in the age,gender,and BMI value of the children in each group(P>0.05);the asthma control test score(ACT)was the lowest in group ⅡI,and the score of group Ⅳ was significantly lower than that of groupⅡand Group I(H=8.674,P<0.001),indicating that it is related to the level of CaNO,but had nothing to do with the level of FeNO;comparison of the lung function indexes of the four groups of children,the difference was not statistically significant(P>0.05),indicating that the children's eNO and eNO had no correlation in lung function;the positive rate of luciferase immunoassay in each group was significantly different,the positive rate of groupⅡwas 93.2%(68 cases)extremely significantly higher than 53.2%(42 cases)of groupⅠand 50.0%(9 cases)of group Ⅳ,the difference was statistically significant(x2=38.713,P<0.001),and for the incidence of CVA,61.6%(45 cases)in groupⅡwas extremely significantly higher than 10.1%(8 cases)in groupⅠand 22.2%(4 cases)in group Ⅳ,the difference was statistically significant(x2=50.317,P<0.001),the difference was statistically significant,these explanations were mainly affected by FeNO,and had nothing to do with the level of CaNO.Regarding ICS treatment,35.6%(26 cases)in groupⅡwere extremely significantly lower than 74.7%(59 cases)in groupⅠand 77.8%(14 cases)in group Ⅳ,the difference was statistically significant(x2=36.803,P<0.001),indicating that FeNO levels were affected by ICS treatment but had nothing to do with CaNO levels.Conclusion The determination of FeNO and CaNO is helpful for CVA classification.ICS treatment affects FeNO level,and FeNO level is related to children's allergies and morbidity,while elevated CANO is related to poor CVA control.