潮气呼吸肺功能、呼出气一氧化氮及哮喘预测指数在反复喘息儿童随访评估中的应用价值

Application value of tidal breathing lung function,fractional exhaled nitric oxide and asthma predictive index in follow-up evaluation of children with recurrent wheezing

目的:探讨潮气呼吸肺功能、呼出气一氧化氮(FeNO)及哮喘预测指数(API)在反复喘息儿童随访评估中的应用价值。方法:选择546例反复喘息的住院患儿作为研究对象,按照哮喘预测指数分API阳性组和API阴性组,对API阳性组出院后,是否继续吸入糖皮质激素(ICS),分为ICS治疗组与ICS未治疗组,并以69例正常儿童作为对照组。测定反复喘息患儿急性期、缓解期肺功能与FeNO水平,API阳性组予随访1、2、3、6、9、12个月复查潮气呼吸肺功能及FeNO水平;在6岁时诊断为哮喘的儿童测肺功能和FeNO;对照组测定一次肺功能和FeNO。结果:API阳性组急性期和缓解期达峰时间比(TPEF/TE)和达峰容积比(VPEF/VE)均明显低于同期API阴性组和对照组(均P<0.05),而FeNO水平高于同期API阴性组和对照组(均P<0.05)。API阳性组随访1年中TPEF/TE和VPEF/VE逐渐升高,FeNO水平逐渐降低,比较有统计学差异(均P<0.05)。API阳性ICS治疗组随访3个月FeNO、TPEF/TE及VPEF/VE基本恢复;而API阳性ICS未治疗组FeNO 6个月后才恢复,TPEF/TE、VPEF/VE 9个月才恢复。API阳性规范ICS治疗组喘息发作急诊就诊和再住院率均降低(均P<0.05)。API阳性两亚组患哮喘率比较无统计学差异(P>0.05)。结论:API阴性组FeNO和肺功能恢复快;API阳性组未治疗组气道高反应持续约6个月,肺功能异常持续9个月;API阳性组早期ICS干预治疗肺功能参数可逐渐升高,FeNO水平逐渐下降,有利于改善预后,但不能改变自然病程;应重视API阳性反复喘息儿童后续规范管理及长期随访。

Objective:To explore the application value of tidal breathing lung function,fractional exhaled nitric oxide(FeNO)and Asthma Prediction Index(API)in the follow-up evaluation of children with recurrent wheezing.Methods:546 hospitalized children with recurrent wheezing were selected as the research object.According to the asthma prediction index,they were divided into API-positive group and API-negative group.After discharge,the API-positive group was divided into ICS-treated group and ICS-untreated group according to whether or not to continue inhaling glucocorticoid(ICS).69 normal children were taken as the control group.Pulmonary function and FeNO level were measured in acute phase and remission phase of children with recurrent wheezing.Lung function and FeNO levels were measured in children with recurrent wheezing during acute phase and remission.The API-positive group was followed up for 1,2,3,6,9,and 12 months to review tidal breathing lung function and FeNO level.In children diagnosed with asthma at the age of 6 years,lung function and FeNO were measured.Lung function and FeNO were measured once in the control group.Results:The TPEF/TE and VPEF/VE in acute phase and remission phase of API-positive group were significantly lower than those of API-negative group and control group(all P<0.05),while the FeNO level was higher than that of API-negative group and control group(all P<0.05).After 1 year of follow-up,TPEF/TE and VPEF/VE increased gradually,and FeNO level decreased gradually in API-positive group(P<0.05).FeNO,TPEF/TE and VPEF/VE recovered after 3 months of follow-up in ICS-treated group,while FeNO recovered after 6 months and TPEF/TE and VPEF/VE after 9 months in ICS-untreated group.The rate of emergency visits and rehospitalization for wheezing episodes was reduced in ICS-treated group(all P<0.05).There was no significant difference in the incidence of asthma between the two subgroups with API-positive(P>0.05).Conclusion:FeNO and lung function recovered rapidly in API-negative group.Airway hyperresponsiveness lasted for about 6 months and abnormal lung function lasted for 9 months in API-positive group without treatment.Early ICS intervention in API-positive group can gradually increase lung function parameters and decrease FeNO level,which is beneficial to improve prognosis,but cannot change the natural course of disease.Attention should be paid to the follow-up standardized management and long-term follow-up of API-positive children with recurrent wheezing.