1 德阳市人民医院儿科，四川 德阳 618000
目的：探讨呼出气一氧化氮(fractional exhaled nitric oxide，FeNO)对儿童支气管哮喘的诊断及病情评估价值。方法：共收集德阳市人民医院2017年3月至2018年6月儿科收治的80例支气管哮喘急性发作期患儿，记为急性期组(n=80)，急性期患儿根据病情程度进一步分为轻度组(n=32)和中重度组(n=48)；选取同期收治的35例支气管哮喘非急性发作期患儿作为参照，记为非急性期组(n=35)。检测上述患儿FeNO浓度、第一秒用力呼气容积占预计值百分比(percentage of predicted forced expiatory volume in one second，FEV1%pred)、第1秒用力呼气容积占用力肺活量(forced vital capacity，FVC)百分比(forced expiratory volume in 1 second/forced，FEV1/FVC%)和炎症因子白介素-6(interleukin 6，IL-6)、C反应蛋白(C-reaction protein，CRP)水平，采用Pearman法分析急性期组FeNO浓度与FEV1%pred，FEV1/FVC%，IL-6，CRP的相关性，采用受试者工作特征(receiver operating characteristic，ROC)曲线分析FeNO诊断小儿支气管哮喘急性发作期的诊断效能。结果：所有受检患儿完成相关检测，急性期组患儿FeNO浓度和血清IL-6和CRP水平均高于非急性期组，FEV1%pred，FEV1/FVC%明显低于非急性期组，差异均有统计学意义(P<0.001)；轻度组和中重度组患儿FeNO浓度，FEV1%pred，FEV1/FVC%，IL-6，CRP比较，差异有统计学意义(P<0.001)。Spearman线性相关分析提示：急性期患儿FeNO浓度与FEV1%pred，FEV1/FVC%呈负相关，与炎症因子IL-6和CRP呈正相关。ROC曲线提示FeNO诊断急性发作期支气管哮喘患儿的最佳截断点为39.84 ppb，敏感度、特异度分别为82.36%，88.74%。结论：支气管哮喘急性发作期患儿FeNO浓度与肺功能和炎症水平有较好相关性，加强FeNO监测有助于诊断急性期早期和评估病情程度，对指导起始治疗有一定参考价值。关键词： 气管哮喘急性期；儿童；呼出气一氧化氮；炎症因子；诊断
Diagnostic value of exhaled nitric oxide in children with acute attack of bronchial asthma
CorrespondingAuthor: DAI Li Email: email@example.com
Foundation: This work was supported by fund from the Science and Technology Bureau of Dezhou City, China (2015SZ063).
Objective: To explore the value of fractional exhaled nitric oxide (FeNO) in the diagnosis and evaluation of children's asthma in acute stage. Methods: A total of 80 children with acute attack of bronchial asthma admitted to our hospital from March 2017 to June 2018 were recorded as acute group (n=80). According to the severity of the disease, children in acute stage were further divided into mild group (n=32) and moderate severe group (n=48). Thirty-five children in non-acute attack of bronchial asthma admitted at the same period were selected as reference and recorded as non-acute group (n=35). FeNO, FEV1% pred, FVC, IL-6 and CRP were measured in all asthmatic children, The correlation between FeNO concentration and FEV1% PRED, FEV1/FVC, IL-6, CRP in acute stage group was analyzed by Pearman method, and the diagnostic efficacy of FeNO in acute stage of childhood asthma was analyzed by receiver operating characteristic (ROC) curve. Results: All the children were tested. The levels of FeNO, IL-6 and CRP in the acute group were higher than those in the non-acute group, FEV1% pred and FEV1/FVC% were significantly lower than those in the non-acute group (P<0.001). There were significant differences in FeNO concentration, FEV1% pred, FEV1/FVC%, IL-6 and CRP between mild group and moderate group (P<0.001). Spearman linear correlation analysis showed that FeNO concentration was negatively correlated with FEV1% pred and FEV1/FVC%, and positively correlated with IL-6 and CRP. ROC curve suggested that the best cut-off point of FeNO in the diagnosis of asthma in children with acute attack was 39.84 ppb, with sensitivity and specificity of 82.36% and 88.74%. Conclusion: There is a good correlation between FeNO concentration and pulmonary function and inflammatory level in children with acute attack of asthma. Strengthening the monitoring of FeNO is helpful for the early diagnosis and assessment of the degree of disease in the acute stage, and has a certain reference value for guiding the initial treatment.Keywords： acute stage of bronchial asthma; children; exhaled nitric oxide; inflammatory factors; diagnosis