呼出气一氧化氮、外周血嗜酸性粒细胞在儿童喘息疾病中的应用价值

Application values of fractional exhaled nitric oxide and peripheral blood eosinophils in diagnosis of wheezing diseases in children

目的 探讨呼出气一氧化氮(FeNO)和外周血嗜酸性粒细胞(EOS)在5岁以下儿童喘息性疾病中的应用价值,帮助筛选哮喘高危儿童。方法 选取2019年4月至2020年3月我院收治的以“反复喘息”为主要临床表现的160例患儿为病例组研究对象,其中51例确诊为哮喘组,74例为支气管肺炎组,35例为喘息性支气管炎组;并选取同一时期于我院进行健康体检的76例儿童为健康对照组。比较四组儿童FeNO、EOS水平的差异,以及幼儿期和学龄前期喘息患儿间FeNO、EOS水平的差异性。结果 四组儿童间FeNO(H=143.681,P<0.001)和EOS水平(F=18.621,P<0.001)存在统计学差异;进一步行两两比较可知,FeNO水平在对照组、喘支组、肺炎组之间无统计学差异(H=1.571,P=0.456),而哮喘组与对照组、喘支组、肺炎组存在统计学差异(Z值分别是9.278、-7.085、9.185,P<0.001);EOS组间比较可知,哮喘组与对照组、喘支组、肺炎组存在统计学差异(P<0.001),而对照组、喘支组、肺炎组之间无统计学差异(P>0.05)。幼儿期和学龄前期病例组患儿的EOS计数均高于同年龄段对照组儿童,差异均有统计学意义(t值分别是2.675、5.079,P<0.05)。幼儿期和学龄前期病例组患儿的FeNO水平均高于同年龄段对照组儿童(Z值分别是-3.355、-6.156,P<0.05);此外,病例组中学龄前期患儿的FeNO水平高于幼儿期患儿,差异有统计学意义(Z=-5.460,P<0.01)。结论 FeNO水平的检测在诊断及鉴别诊断儿童喘息性疾病时具有一定作用,能够反映气道Ⅱ型炎症,可考虑联合EOS计数作为预测儿童哮喘发病风险的有效指标,值得临床应用推广。

Objective To explore application values of fractional exhaled nitric oxide(FeNO) and peripheral blood eosinophils(EOS) in diagnosis of wheezing diseases in children aged under 5 years, and to help to screen those children with high risk of asthma.Methods A total of 160 children with “repeated wheezing” as main clinical manifestations who admitted to our hospital from April 2019 to March 2020 were selected as research subjects(case group).Among them, 51 children were diagnosed as asthma(asthma group),74 children were diagnosed as bronchopneumonia(bronchopneumonia group),and 35 children were diagnosed as asthmatic bronchitis(asthmatic bronchitis group).76 children who received physical examination in the same period in our hospital were selected as control group.The general data of the children in the four groups were collected, the levels of FeNO and EOS among the four groups, and between the children with wheezing diseases in early childhood and preschool period were compared.Results There were significant differences in levels of FeNO(H=143.681,P<0.001) and EOS(F=18.621,P<0.001) of the children among the four groups.Further pairwise comparison showed that there was no significant difference in FeNO level among the control group, the asthmatic bronchitis group and the bronchopneumonia group(H=1.571, P=0.456),but there were significant differences between the asthma group and the control group, between the asthma group and the asthmatic bronchitis group, and between the asthma group and the bronchopneumonia group(Z=9.278,-7.085 and 9.185 respectively, all P<0.001).In EOS level, there were significant differences between the asthma group and the control group, between the asthma group and the asthmatic bronchitis group, and between the asthma group and the bronchopneumonia group(all P<0.001),but there was no significant difference among the control group, the asthmatic bronchitis group, and the bronchopneumonia group(P>0.05).The EOS counts of the children in the case group at early childhood and preschool period were higher than those in the control group at the same two age stages, and the differences were statistically significant(t=2.675 and 5.079 respectively, both P<0.05).Similarly, the FeNO levels of the children in the case group at early childhood and preschool period were higher than those in the control group at the same two age stages(Z=-3.355 and-6.156 respectively, both P<0.05).In addition, the FeNO level of the preschool children in the case group was higher than that of the children in early childhood, and the difference was statistically significant(Z=-5.460, P<0.001).Conclusion FeNO plays a certain role in diagnosis and differentiating diagnosis of wheezing diseases in children, because it can reflect type Ⅱ inflammation in the airway.Combination of FeNO with EOS counts can be used as a good indicator for early prediction of asthma in children, and it is worthy to be popularized in clinical practice.