支气管哮喘合并过敏性鼻炎患儿肺功能和呼出气一氧化氮特征及相关性分析

Characteristics and correlation analysis of pulmonary function and fractional exhaled nitric oxide in children with bronchial asthma complicated with allergic rhinitis

目的探讨支气管哮喘合并过敏性鼻炎(AR)患儿肺功能和呼出气一氧化氮(FeNO)特征及相关性。方法选取2021年12月至2022年12月于四川大学华西第二医院就诊的220例支气管哮喘患儿为研究对象,根据有无AR分为合并组(支气管哮喘合并AR)129例和哮喘组91例,比较两组患儿肺通气功能、气道阻力指标以及FeNO水平的差异,并对肺功能参数和FeNO水平进行相关性分析。结果两组患儿第1秒用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积与用力肺活量的比值占预计值百分比(FEV1/FVC%pred)、呼气峰流量占预计值百分比(PEF%pred)、用力呼出25%肺活量时的瞬间流量占预计值百分比(FEF25%pred)比较,差异无统计学意义(P>0.05)。两组患儿振荡频率为5 Hz时的气道黏性阻力(R5)、振荡频率为5 Hz时的呼吸总阻抗(Z5)、周边弹性阻力(X5)、振荡频率为20 Hz时的气道黏性阻力(R20)比较,差异无统计学意义(P>0.05)。合并组小气道功能指标用力呼出50%肺活量时的瞬间流量占预计值百分比(FEF50%pred)、最大呼气中期流量占预计值百分比(MMF%pred)、用力呼出75%肺活量时的瞬间流量占预计值百分比(FEF75%pred)低于哮喘组,差异有统计学意义(P<0.05);合并组FeNO水平高于哮喘组,差异有统计学意义(P<0.05);合并组FeNO水平与FEF50%pred、MMF%pred、FEF75%pred均呈负相关(P<0.05)。结论支气管哮喘合并AR患儿FeNO水平升高,小气道功能下降,肺功能和FeNO指标的检测有助于支气管哮喘合并AR的诊疗。

Objective To explore the characteristics and the correlation of pulmonary function and fractional exhaled nitric oxide(FeNO)in children with bronchial asthma complicated with allergic rhinitis(AR).Methods A total of 220 children with bronchial asthma in the West China Second University Hospital,Sichuan University from December 2021 to December 2022 were included in the study.According to the presence or absence of AR,the children were divided into combined group(129 cases,bronchial asthma complicated with AR)and asthma group(91 cases),and the differences in pulmonary function parameter,airway resistance and FeNO between the two groups were compared.The correlation between the pulmonary function and FeNO was analyzed.Results The differences in the forced expiratory volume in one second/predicted value ratio(FEV1%pred),forced vital capacity/predicted value ratio(FVC%pred),FEV1/FVC%pred,peak expiratory flow/predicted value ratio(PEF%pred),forced expiratory flow at 25%vital capacity/predicted value ratio(FEF25%pred),the airway resistance at 5 Hz(R5),total respiratory impedance at 5 Hz(Z5),peripheral elastic resistance(X5),the airway resistance at 20 Hz(R20)between the two groups were not statistically significant(P>0.05).The forced expiratory flow at 50%vital capacity/predicted value ratio(FEF50%pred),maximal mid-expiratory flow/predicted value ratio(MMF%pred),forced expiratory flow at 75%vital capacity/predicted value ratio(FEF75%pred)in the combined group were lower than those in the asthma group(P<0.05),and the level of FeNO in the combined group was higher than that in the asthma group(P<0.05).The level of FeNO was negatively correlated with FEF50%pred,MMF%pred and FEF75%pred in the combined group(P<0.05).Conclusion The level of FeNO in patients with bronchial asthma complicated with AR is elevated and the function of the small airway is reduced,and the detection of pulmonary function and FeNO is helpful for the diagnosis and treatment of bronchial asthma complicated with AR.