学龄期儿童哮喘检测呼出气一氧化氮、肺功能及外周血嗜酸性粒细胞的价值

Value of exhaled nitric oxide,pulmonary function and peripheral blood eosinophils in school-age children with asthma

目的检测学龄期儿童哮喘呼出气一氧化氮(FeNO)水平、肺功能及外周血嗜酸性粒细胞计数(EOS)水平,分析其临床应用价值。方法选择学龄期哮喘儿童共90例,分为急性发作组、慢性持续组和缓解组,以同时期同年龄门诊健康查体的正常儿童30例为对照组,各组均进行FeNO、肺功能、血EOS检测并比较,并采用Spearman相关分析FeNO与肺功能、血EOS的相关性;采用logistic回归分析影响哮喘发生的危险因素;应用ROC分析FeNO与EOS在哮喘中的诊断价值。结果持续组、发作组FeNO、外周血EOS水平均高于对照组,且缓解组外周血EOS水平高于对照组(P<0.0167),持续组、发作组FeNO均高于缓解组(P<0.0167),发作组外周血EOS水平分别高于缓解组、持续组(P<0.0167)。发作组FEV_(1)%、PEF%、FEF50%、FEF75%、MMEF75/25均低于对照组、缓解组和持续组(P<0.0167);缓解组和持续组FEV_(1)/FVC%、FEF50%、FEF75%、MMEF75/25均低于对照组(P<0.0167);且哮喘发作组、持续组、缓解组各项肺功能指标呈依次降低趋势。哮喘患儿及正常对照组FeNO与肺功能FEV_(1)%、FEV_(1)/FVC%、PEF%、FEF50%、FEF75%、MMEF75/25均无相关性(P>0.05);而哮喘患儿FeNO与外周血EOS存在弱正相关(P<0.01)。多因素logistics回归分析显示FeNO、FEF75%、EOS是影响学龄期儿童发生哮喘危险因素(P<0.05)。ROC曲线结果显示,FeNO、EOS诊断哮喘的曲下线面积(0.811、0.807),最佳截断值(21.5 ppb、0.26×10^(9)/L);两者联合诊断曲下线面积为0.821。结论FeNO结合外周血EOS可反映气道嗜酸性炎症,帮助哮喘早期诊断及疗效评估,且FeNO与肺功能二者结合能较全面反映哮喘控制水平。

Objective To detect the level of exhaled nitric oxide(FeNO),lung function and peripheral blood eosinophil count(EOS)in school-age children with asthma,and to analyze its clinical application value.Methods A total of 90 school-age asthmatic children were selected and divided into the acute attack group,the chronic persistent group and the remission group.30 healthy children at the same age who underwent physical examination outpatient clinic at the same time were selected as the control group.FeNO,pulmonary function and blood EOS were detected and compared in each group.Spearman correlation was used to analyze the correlation between FeNO and lung function and blood EOS.Logistic regression analysis was used to analyze the risk factors of asthma.ROC was used to analyze the diagnostic value of FeNO and EOS in asthma.Results The levels of FeNO and EOS in the persistent group and the attack group were higher than those in control group,and the level of EOS in the remission group were higher than that in the control group(P<0.0167),and FeNO level of the persistent group and the attack group was higher than that of the remission group(P<0.0167),the level of EOS in peripheral blood of the attack group was higher than that of the remission group and the persistent group(P<0.0167).FEV_(1)%,PEF%,PEF50%,PEF75%,and MMEF75/25 in the attack group were lower than those in the control group,the remission group and the persistent group(P<0.0167).FEV_(1)/FVC%,PEF50%,PEF75%,and MMEF75/25 in the remission group and the persistent group were lower than those in the control group(P<0.0167).The lung function indexes of the asthma attack group,the persistent group and the remission group decreased in turn.There was no correlation between FeNO and pulmonary function FEV_(1)%,FEV_(1)/FVC%,PEF%,FEF50%,FEF75%and MMEF75/25 in the asthmatic children and the normal control group(P>0.05),but there was a weak positive correlation between FeNO and EOS in peripheral blood in asthmatic children(P<0.01).Multivariate logistic regression analysis showed that FeNO,FEF75%and EOS were risk factors of asthma in school-age children(P<0.05).ROC curve showed that the area under curve of FeNO and EOS was 0.811 and 0.807,and the best cut-off values were 21.5 ppb and 0.26×10^(9)/L,respectively.The area under the combined diagnosis curve was 0.821.Conclusion The combination of FeNO and EOS in peripheral blood can reflect eosinophilic inflammation of airway,which can help early diagnosis and evaluation of curative effect of asthma,and the combination of FeNO and lung function can comprehensively reflect the control level of asthma.