ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2016, Vol. 8 ›› Issue (3): 269-272.doi: 10.3969/j.issn.1674-3865.2016.03.006

• 临床论著 • 上一篇    下一篇

呼出气一氧化氮检测在儿童咳嗽变异性哮喘中的诊疗价值

牛文泽，杜许芳，孟柳明，黄亚平，袁西华，严梦瑶，黄卫良，周炯英   

  1. 215500 江苏 常熟，扬州大学第五临床医学院，常熟市第二人民医院儿科
  • 出版日期:2016-06-25 发布日期:2018-11-19
  • 通讯作者: 杜许芳，E-mail：duxufang516@163.com
  • 作者简介:牛文泽(1983-)，女，医学硕士，医师。研究方向：小儿呼吸系统疾病的诊治
  • 基金资助:
    常熟市科技局基金资助项目(CS201318)

Value of fractional exhaled nitric oxide in the diagnosis and treatment of children with cough variant asthma

NIU Wenze，DU Xufang，MENG Liuming，HUANG Yaping，YUAN Xihua，YAN Mengyao，HUANG Weiliang，ZHOU Jiongying   

  1. Department of Pediatrics，the Second People′s Hospital of Changshu Affiliated to the Fifth Clinical Medical College of Yangzhou University，Changshu 215500,China.
  • Online:2016-06-25 Published:2018-11-19

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摘要：
目的: 检测典型咳嗽变异性哮喘(CVA)患儿中呼出气一氧化氮(FeNO)的水平，探讨FeNO检测在儿童CVA中的诊疗价值。
方法: 2014年6月至2015年6月常熟市第二人民医院儿科收治因慢性咳嗽就诊的患儿174例，其中确诊CVA 106例，非CVA 68例。两组进行FeNO检测及血清总IgE的检查。绘制ROC曲线评价FeNO对CVA的诊断价值，分析诊断CVA的最佳界值。按指南推荐的方案治疗4周后随访，再次对FeNO进行评价。
结果: CVA组FeNO值为(28.16±10.89)μg/L，明显高于非CVA组(17.91±5.48)μg/L，差异有统计学意义(P<0.01)。应用FeNO诊断CVA的ROC曲线下面积为0.775，FeNO最佳界值为20.5 μg/L，此时的灵敏度为74.5％，特异度为84.5％。CVA患儿的FeNO值与血清总IgE呈明显的正相关(r=0.285，P=0.003)。两组治疗4周后，治疗后FeNO值(14.57±5.23)μg/L，明显低于治疗前(28.16±10.89)μg/L，差异有统计学意义(P<0.01)。
结论: FeNO测定对CVA的诊断具有较高的灵敏度和特异度，儿童CVA与过敏因素关系密切，CVA患儿若FeNO增高，对激素治疗有效。

关键词: 咳嗽变异性哮喘, 慢性咳嗽, 呼出气一氧化氮, 儿童

Abstract:
Objective: To examine the levels of fractional exhaled nitric oxide(FeNO) in children with cough variant asthma(CVA) and explore its value in the diagnosis and treatment of children with CVA.
Methods: From June 2014 to June 2015,174 cases of children with chronic cough identified in the Second People′s Hospital of Changshu were involved in the study.There were 106 cases of CVA and 68 cases of non-CVA.The levels of FeNO and total serum IgE were detected in two groups.Evaluate the diagnostic value of FeNO to CVA by drawing ROC curve,and analyze the best cutoff value of CVA.Follow-up and FeNO test were made after treatment of 4 weeks.
Results: The levels of FeNO for CVA group was (28.16±10.89) μg/L,significantly higher than the non-CVA group (17.91±5.48) μg/L,the difference being statistically significant(P<0.01).The area under the ROC curve was 0.775,and the optimal FeNO cutoff value was 20.5 μg/L with a sensitivity of 74.5% and a specificity of 84.5%.FeNO was positively related to total serum IgE in CVA children(r=0.285,P=0.003).After four weeks of treatment,the value of FeNO［(14.57±5.23)μg/L］ after treatment was significantly lower than that before treatment［(28.16±10.89)μg/L］,the difference being statistically significant(P<0.01).
Conclusion: FeNO test has a high sensitivity and specificity in the diagnosis of CVA.Children with CVA have a close connection with allergic factors.Furthermore,if the FeNO level of CVA children has increased,the therapy of ICS will be effected.

Key words: Cough variant asthma, Chronic cough, Fractional exhaled nitric oxide, Children