潮气肺功能联合呼出气一氧化氮检测在呼吸道合胞病毒肺炎患儿中的应用

Application value of tidal lung function combined with fractional exhaled nitric oxide in children with respiratory syncytial virus pneumonia

目的探讨潮气肺功能联合呼出气一氧化氮(FeNO)检测在呼吸道合胞病毒(RSV)肺炎患儿中的应用价值。方法收集2019年4月至2020年10月在上海浦东新区公利医院诊治的65例RSV肺炎患儿的临床资料,根据肺炎严重指数(PSI)分为重度组(PSI评分>130分,19例)、轻中度组(PSI评分≤130分,46例),另选取同期健康体检儿童72例为正常对照组。比较三组白细胞介素(IL)-8、IL-6、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平和潮气肺功能参数及FeNO水平,分析其相关性及对病情程度的评估价值。结果重度组FeNO水平高于轻中度组、正常对照组[(23.04±5.49)ppb比(15.75±8.24)、(9.28±3.51)ppb],重度组每千克体质量潮气量(VT/kg)、达峰时间比(TPEF/TE)、达峰容积比(VPEF/VE)低于轻中度组、正常对照组[(6.21±1.89)ml/kg比(8.40±1.27)、(9.39±3.04)ml/kg;(16.39±6.61)%比(21.73±5.39)%、(38.65±7.20)%;(22.81±6.39)%比(25.62±5.30)%、(39.67±4.04)%],差异均有统计学意义(P<0.05)。相关性分析结果显示,VT/kg、TPEF/TE、VPEF/VE与IL-6(r=-0.584、-0.519、-0.528)、IL-8(r=-0.521、-0.542、-0.567)、TNF-α(r=-0.559、-0.534、-0.572)、hs-CRP(r=-0.528、-0.567、-0.533)水平呈负相关(P<0.01);FeNO水平与IL-6、IL-8、TNF-α、hs-CRP水平呈正相关(r=0.672、0.639、0.641、0.672,P<0.01);VT/kg、TPEF/TE、VPEF/VE与RSV肺炎患儿PSI评分呈负相关(r=-0.842、-0.713、-0.741,P<0.05);FeNO水平与RSV肺炎患儿PSI评分呈正相关(r=0.809,P<0.05)。VT/kg、TPEF/TE、VPEF/VE联合FeNO评估RSV肺炎患儿病情程度的曲线下面积为0.888,灵敏度、特异度分别为73.68%、91.30%。结论肺功能参数、FeNO与RSV肺炎病情程度密切相关,两者联合检测可作为评估RSV肺炎病情程度的客观依据。

Objective To explore the application value of tidal lung function combined with fractional exhaled nitric oxide(FeNO)in children with respiratory syncytial virus(RSV)pneumonia.Methods The clinical data of 65 children with RSV pneumonia in Shanghai Pudong New Area Gongli Hospital from April 2019 to October 2020 were retrospectively collected.According to the pneumonia severity index(PSI),they were divided into severe group(PSI score>130 points,19 cases),mild to moderate group(PSI score≤130 points,46 cases),and 72 healthy children in the same period were selected as the normal control group.The levels of interleukin(IL)-8,IL-6,tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)and tidal lung function parameters and FeNO were compared among the three groups and analyzed their correlation and evaluated the value in disease severity.Results The level of FeNO in the severe group was higher than that in the mild to moderate group and the normal control group:(23.04±5.49)ppb vs.(15.75±8.24),(9.28±3.51)ppb;the levels of tidal volume per kilogram of body mass(VT/kg),peak time ratio(TPEF/TE),peak volume ratio(VPEF/VE)in the severe group were lower than those in the mild to moderate group and the normal control group:(6.21±1.89)ml/kg vs.(8.40±1.27),(9.39±3.04)ml/kg;(16.39±6.61)%vs.(21.72±5.39)%,(38.65±7.20)%;(22.81±6.39)%vs.(25.62±5.30)%,(39.67±4.04)%,there were statistical differences(P<0.05).The correlation analysis results showed that the VT/kg,TPEF/TE,VPEF/VE were negatively correlated with IL-6(r=-0.584,-0.519,-0.528;P<0.01),IL-8(r=-0.521,-0.542,-0.567;P<0.01),TNF-α(r=-0.559,-0.534,-0.572;P<0.01)and hs-CRP(r=-0.528,-0.567,-0.533;P<0.01);the level of FeNO was positively correlated with IL-6,IL-8,TNF-α,hs-CRP(r=0.672,0.639,0.641,0.672;P<0.01);the levels of VT/kg,TPEF/TE,VPEF/VE were negatively correlated with PSI scores in children with RSV pneumonia(r=-0.842,-0.713,-0.741;P<0.05);the level of FeNO was positively correlated with PSI scores in children with RSV pneumonia(r=0.809,P<0.05).The area under the curve of VT/kg,TPEF/TE,VPEF/VE combined with FeNO to assess the severity of RSV pneumonia in children with RSV pneumonia was 0.888,and the sensitivity and specificity were 73.68%and 91.30%,respectively.Conclusions Tidal lung function parameters and FeNO are closely related to the severity of RSV pneumonia.The combined detection can be used as an objective basis for assessing the severity of RSV pneumonia.