呼出气一氧化氮分数联合气道反应性测定对儿童咳嗽变异性哮喘早期鉴别价值分析

Analysis of the early identification value of exhaled nitric oxide combined with airway reactivity measurement in children with cough variant asthma

目的探讨呼出气一氧化氮分数(FeNO)联合气道反应性测定对儿童咳嗽变异性哮喘早期鉴别价值。方法选择2019年9月至2021年9月在苏州大学附属第二医院就诊的86例学龄前咳嗽变异性哮喘患儿为病例组,以性别、年龄(±2岁)进行1∶1配对选择同期就诊的呼吸道感染后慢性咳嗽患儿为对照组进行分析。收集患儿呼出气一氧化氮(FeNO)、潮气肺功能检测结果及咳嗽症状积分。比较两组上述各指标,并以ROC法评估FeNO及潮气肺功能检测指标对儿童咳嗽变异性哮喘的诊断价值。结果病例组患儿FeNO与咳嗽症状积分均高于对照组,差异有统计学意义(t=18.200、5.548,P<0.05)。病例组患儿VT/kg、TPTEF/TE、VPTEF/VE均低于对照组,差异有统计学意义(t=-5.728、-6.522、-6.527,P<0.05)。相关性分析结果显示:FeNO与咳嗽症状积分呈正相关关系(r>0,P<0.05);VT/kg、TPTEF/TE、VPTEF/VE均与咳嗽症状积分呈负相关关系(r<0,P<0.05)。ROC分析结果显示:FeNO、VT/kg、TPTEF/TE、VPTEF/VE对儿童咳嗽变异性哮喘患者鉴别诊断的截断值分别为29.68 ppb、7.25 mL/kg、26.84%、29.03%;曲线下面积(AUC)分别为0.901、0.881、0.796、0.756,联合诊断的AUC为0.962,其诊断效能高于各指标单独检测(P<0.05)。结论咳嗽变异性哮喘患儿FeNO、VT/kg、TPTEF/TE、VPTEF/VE与呼吸道感染后慢性咳嗽患儿具显著差异,上述指标均可用作咳嗽变异性哮喘的早期鉴别,联合检测可提高诊断效能。

Objective To investigate the value of exhaled nitric oxide combined with determination of airway reactivity in early identification of cough variant asthma in children.Methods A total of 86 preschool children with cough variant asthma who were treated in our hospital from September 2019 to September 2021 were selected as the case group,and 1∶1 matching was performed according to gender and age(±2 years old)to select the respiratory tract infections who visited the clinic during the same period.Post-chronic cough children were retrospectively analyzed as the control group.The exhaled nitric oxide(FeNO),tidal pulmonary function test results and cough symptom scores were collected.The above indexes were compared between the two groups,and the diagnostic value of FeNO and tidal pulmonary function test indexes in children with cough variant asthma was evaluated by ROC method.Results FeNO and cough symptom scores in the case group were higher than those in the control group,and the difference was statistically significant(t=18.200、5.548,P<0.05).The VT/kg,TPTEF/TE and VPTEF/VE in the case group were lower than those in the control group,and the difference was statistically significant(t=-5.728、-6.522、-6.527,P<0.05).The results of correlation analysis showed that Fe NO was positively correlated with cough symptom score(r>0,P<0.05);VT/kg,TPTEF/TE,VPTEF/VE were all negatively correlated with cough symptom score(r<0,P<0.05).The results of ROC analysis showed that the cut-off values of Fe NO,VT/kg,TPTEF/TE,and VPTEF/VE for differential diagnosis of children with cough variant asthma were 29.68 ppb,7.25 m L/kg,26.84%,and 29.03%,respectively.The areas under the curve(AUC)were 0.901,0.881,0.796,and 0.756,respectively.The AUC of combined diagnosis was 0.962,and its diagnostic efficiency was higher than that of the individual indicators(P<0.05).Conclusion Fe NO,VT/kg,TPTEF/TE,VPTEF/VE in children with cough variant asthma are significantly different from those with chronic cough after respiratory infection.The above indicators can be used for early identification of cough variant asthma,and combined detection can improve the diagnosis efficacy.