离线法呼出气一氧化氮测定在儿童哮喘早期预测中的应用价值

摘要

目的：探讨离线法呼出气一氧化氮（ FENO ）测定在儿童哮喘早期预测中的应用价值。方法选取2014年10月—2015年5月到天津医科大学第二医院儿科哮喘门诊就诊的喘息患儿80例，年龄18~36个月，其中男42例，女38例。按就诊时喘息发作次数分为喘息组（既往喘息次数为1~2次，n＝40）和反复喘息组（既往喘息次数≥3次，n＝40）。另选取同期在本院进行体检的非喘息健康儿童30例为对照组。比较3组FENO、总IgE（TIgE）水平及其他因素。80例喘息患儿中符合哮喘预测指数（ API）评估入选标准的患儿70例，据API评估结果分为API阳性组（n＝40）和API阴性组（n＝30），比较两组FENO、TIgE水平及其他因素。80例喘息患儿按FENO水平分为高FENO组（n＝48）和正常FENO组（n＝32），比较两组高TIgE比例。结果反复喘息组FENO水平高于喘息组和对照组，反复喘息组TIgE水平高于对照组，差异均有统计学意义（ P﹤0.05）；而3组早产、被动吸烟、母乳喂养比例间差异无统计学意义（P﹥0.05）。API阳性组FENO、TIgE水平及高FENO比例均高于API阴性组，被动吸烟比例低于API阴性组，差异有统计学意义（P﹤0.05）；而两组早产、母乳喂养比例间差异无统计学意义（P﹥0.05）。高FENO组高TIgE比例高于正常FENO组，差异有统计学意义（P﹤0.05）。结论3岁及以下喘息患儿高FENO水平与API阳性、高TIgE水平及反复喘息有关。离线法FENO检测可作为预测婴幼儿喘息发展为儿童哮喘的参考指标之一。%Objective To investigate the application value of fractional exhaled nitric oxide( FENO)by the offline method in the early prediction of asthma in children. Methods From October 2014 to May 2015,we enrolled 80 wheezing children who received treatment in the asthma clinic of the Second Hospital of Tianjin Medical University. These children were aged 18 to 36 months,including 42 males and 38 females. According to the number of wheezing episodes during treatment,these children were divided into wheezing group(previous wheezing times 1 -2,n =40)and repeated wheezing group(previous wheezing times≥3,n=40). 30 healthy children without wheezing who received physical treatment in the same period in the hospital were enrolled. Comparison was made in the levels of FENO and TIgE and other factors among the three groups. Among 80 wheezing children, 70 children accorded with the inclusion criteria of asthma predictive index assessment. According to assessment results,the children were divided into API positive group(n = 40)and API negative group(n = 30),and comparison was made between the two groups in the levels of FENO and TIgE and other factors. According to FENO level,the 80 wheezing children were divided into high FENO group(n=48)and normal FENO group(n=32),and comparison was made in the proportion of high TIgE between the two groups. Results Repeated wheezing group was higher than wheezing group and control group in FENO level,and repeated wheezing group was higher than control group in TIgE level(P﹤0. 05);the three groups were not significantly different in the proportions of premature delivery,passive smoking,and breast feeding(P﹥0. 05). API positive group was higher than API negative group in the levels of FENO and TIgE and the proportion of high FENO,and was lower than API negative group in the proportoin of passive smoking( P ﹤0. 05 ), and the two groups were not significantly different in the proportions of premature delivery and breast feeding( P ﹥0. 05 ) . High FENO group was higher than normal FENO group in the proportion of high TIgE( P﹤0. 05 ) . Conclusion The high FENO level of wheezing children aged 3 years and younger is correlated with API positive,high serum TIgE level and repeated wheezing. Offline FENO detection can be used as a reference index for the development of asthma in wheezing children.