儿童咳嗽变异性哮喘29例危险因素及其诊断价值研究

Study on risk factors and diagnostic value of cough variant asthma in 29 children

目的探讨儿童咳嗽变异性哮喘(cough variant asthma,CVA)相关危险因素,提高临床医生对CVA的早期识别。方法选择2021年10月至2022年10月在山西白求恩医院儿科门诊因慢性咳嗽就诊的病儿81例,分为CVA组29例,非CVA组52例,收集病史及相关临床检验指标,对两组资料进行回顾性分析。结果性别、湿疹史、过敏史、过敏性疾病家族史、咳嗽特征在两组间均差异有统计学意义(P<0.05),CVA组呼出气一氧化氮(FeNO)、外周血嗜酸性粒细胞计数(AEC)及百分比(sEOS%)、血清总IgE水平[FeNO:36.40(20.65,50.25)×10^(-9)mol/L、AEC:0.31(0.19,0.91)×10^(9)/L、总IgE:150.70(76.64,626.36)IU/mL]均高于非CVA组[FeNO:9.80(6.83,15.60)×10^(-9)mol/L、AEC:0.14(0.09,0.19)×10^(9)/L、总IgE:40.61(15.05,116.75)IU/mL](P<0.05)。FeNO水平与AEC、sEOS%、IgE存在显著线性正相关(均P<0.001)。二分类logistic回归分析结果显示过敏性疾病家族史、IgE、FeNO是CVA发生的独立危险因素(P<0.05)。当FeNO取18.65×10^(-9)mol/L时诊断CVA的曲线下面积(AUC)为0.90,此时诊断灵敏度为82.8%,特异度为84.6%(P<0.05)。FeNO联合IgE诊断CVA的AUC为0.91,灵敏度为82.8%,特异度为92.3%(P<0.05)。结论嗜酸性粒细胞(EOS)炎症和IgE参与CVA的发生发展,FeNO更能直接地反映CVA气道过敏和EOS炎症。存在过敏性疾病家族史、IgE、FeNO水平升高是CVA发生的独立危险因素。单项指标FeNO较AEC、sEOS%、IgE诊断CVA效能最佳,FeNO与任一单项指标联合可提高CVA诊断的阳性预测值。

Objective To investigate the risk factors of cough variant asthma(CVA)in children,and improve the early identification of CVA.Methods A total of 81 children with chronic cough who visited the pediatric clinic of Shanxi Bethune Hospital from October 2021 to October 2022 were selected and divided into CVA group(n=29)and non-CVA group(n=52).The medical history and related clinical laboratory indicators were collected,and the data of the two groups were retrospectively analyzed.Results There were significant differences between the two groups in gender,eczema history,allergy history,family history of allergic diseases and cough characteristics(P<0.05).Fractional concentration of exhaled nitric oxide(FeNO),absolute eosinophils count(AEC)and percentage(sEOS%),and serum total IgE level in the CVA group[FeNO:36.40(20.65,50.25)×10^(-9)mol/L,AEC:0.31(0.19,0.91)×10^(9)/L,total IgE:150.70(76.64,626.36)IU/mL]were higher than those in the non-CVA group[FeNO:9.80(6.83,15.60)×10^(-9)mol/L,AEC:0.14(0.09,0.19)×10^(9)/L,total IgE:40.61(15.05,116.75)IU/mL](P<0.05).There was a significant linear positive correlation between FeNO level and AEC,sEOS%,IgE(all P<0.001).Binary Logistic regression analysis showed that family history of allergic disease,IgE and FeNO lever were independent risk factors for CVA(P<0.05).The area under curve for FeNO diagnosing CVA was 0.90,and the sensitivity and specificity were 82.8%and 84.6%when the optimal cut-off value was 18.65×10^(-9)mol/L(P<0.05).The AUC of FeNO combined with IgE in the diagnosis of CVA was 0.91,the sensitivity was 82.8%,and the specificity was 92.3%(P<0.05).Conclusions Eosinophils(EOS)inflammation and IgE are involved in the occurrence and development of CVA.FeNO can more directly reflect the airway allergy of CVA and EOS inflammation.Family history of allergic diseases and elevated levels of IgE and FeNO are independent risk factors for CVA.The diagnostic efficacy of single index FeNO is better than that of AEC,sEOS%and IgE in the diagnosis of CVA.The combination of FeNO and any single indicator can improve the positive predictive value of CVA diagnosis.