FeNO检测在儿童支气管哮喘吸入性糖皮质激素治疗剂量调整中的作用

Value of FeNO measurement in the dose adjustment of inhaled corticosteroids in children with bronchial asthma

目的:探讨FeNO检测在儿童支气管哮喘吸入性糖皮质激素治疗剂量调整中的作用。方法:选取2019~2020年来本院就诊的60例初诊或已诊断为支气管哮喘但未接受规范哮喘治疗的患病儿童作为研究对象。按就诊顺序随机分为观察组(n=28)和对照组(n=32),定期对两组进行随访,每三个月为一个阶段,对照组采用以哮喘控制水平及肺功能检验分析为依据调整吸入性糖皮质激素的治疗剂量,观察组以FeNO检验联合哮喘控制水平及肺功能检验分析为依据调整吸入性糖皮质激素的治疗剂量,对两组肺功能(FEV1)、FeNO、C-ACT评分、复发率、停药率、及ICS治疗剂量在随访12个月的临床资料进行对比。结果:两组在随访开始前及随访结束时,两组肺功能(FEV1)、FeNO、C-ACT评分差异均无统计学意义(P>0.05)。随访3个月、6个月两组ICS治疗剂量均差异无统计学意义(P>0.05)。随访9个月、12个月观察组的ICS治疗剂量均比对照组低(P<0.05)。随访12个月后,两组复发率差异无统计学意义(P>0.05),观察组停药率比对照组高(P<0.05)。结论:FeNO检测可以较好地判断患支气管哮喘儿童的治疗效果,评价其病情的控制水平,在不影响治疗效果下显著降低ICS的治疗用量,减少对患儿的不良反应,在儿童支气管哮喘吸入性糖皮质激素治疗剂量调整中有较大价值。

Objective:To determine the value of FeNO measurement in the dose adjustment of inhaled corticosteroids(ICS)in children with bronchial asthma.Methods Included were 60 children with newly diagnosed asthma or previously diagnosed but treatment-na ve asthma registered to our hospital between 2019 and 2020.The subjects were randomly divided into the study group(n=28)and control group(n=32)according to the timeline of their visits.The two groups were followed up regularly on a 3-month basis.Dose of ICS was adjusted according to asthma control level and spirometry alone(control group)or plus FeNO measurement(study group).The clinical data,including the lung function(FEV1),FeNO,C-ACT score,recurrence,ICS discontinuation,and treatment dose of ICS during the 12-month follow-up were compared between the two groups.Results There were no significant differences in lung function(FEV1),FeNO and C-ACT scores between the two groups before and at the end of follow-up(P>0.05).There was no statistically significant difference in ICS treatment dose between the two groups at three and six months of follow-up(P>0.05).The treatment doses of ICS were lower in the study group than those in the control group at nine and 12 months of follow-up(P<0.05).At 12 months of follow-up,there was no significant difference in the recurrence rate between the two groups(P>0.05),but the rate of ICS discontinuation was higher in the study group than that in the control group(P<0.05).Conclusion:Measurement of FeNO may satisfactorily assess therapeutic efficacy and evaluate the asthma control level in children with bronchial asthm.Without compromise on therapeutic efficacy of ICS,FeNO measurement may lead to significant reduction on therapeutic dose of ICS and adverse reactions,and therefore is valuable in dose adjustment of ICS among asthmatic children.