Clinical value of fractional exhaled nitric oxide in management of asthma in children
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摘要:目的 分析哮喘儿童呼出气一氧化氮(FeNO)水平与哮喘控制情况及肺功能的相关性。方法 选取4~12岁哮喘患儿53例为研究对象。根据FeNO浓度测定结果分为FeNO低水平组、FeNO中水平组及FeNO高水平组。评估患儿哮喘控制水平, 根据控制结果分为控制欠佳患儿和控制良好患儿。测定并记录FeNO及肺功能相关指标最佳值[第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、用力肺活量占预计值百分比(FVC%)、呼气峰流速占预计值百分比(PEF%)、用力呼25%肺活量时的速度占预计值百分比(PEF25%)]; 分析FeNO水平与哮喘控制情况及肺功能之间的相关性; 分析FeNO对哮喘控制欠佳患儿的诊断价值。结果 控制良好患儿的哮喘控制率在FeNO低水平组、中水平组、高水平组中呈降低趋势，差异有统计学意义(P＜0.05)。FeNO与患儿哮喘控制情况存在相关性(P＜0.05)。FeNO诊断哮喘控制欠佳患儿的曲线下面积(AUC)为0.697, 敏感度、特异度分别为76.2%、71.9%。FeNO低水平组、中水平组及高水平组的肺功能相关指标比较，差异无统计学意义(P>0.05)。FeNO测定值与FEV1%、FVC%、PEF%及PEF25%均无相关性(P>0.05)。结论 哮喘儿童的FeNO水平与其哮喘控制情况具有相关性。FeNO水平对控制欠佳患儿诊断价值较高。Abstract:Objective To analyze the relationship of fractional exhaled nitric oxide (FeNO) level with asthma control and lung function in asthmatic children.Methods Fifty-three children aged 4 to 12 years with asthma were selected as research objects. According to FeNO concentration measurement results, they were divided into low FeNO level group, medium FeNO level group and high FeNO level group. The control level of asthma was evaluated, and the children were divided into poorly controlled children and well controlled children according to the results. FeNO and pulmonary function related indexs optimal values[percentage of the forced expiratory volume in one second (FEV1) to the estimated value (FEV1%), percentage of forced vital capacity to the estimated value (FVC%), the percentage of peak expiratory flow rate to estimated value (PEF%), the 25% percentage of peak expiratory flow rate to estimated value (PEF25%)]were measured and recorded; the correlations of FeNO level with asthma control and pulmonary function were analyzed; the diagnostic value of FeNO in children with poorly controlled asthma was analyzed.Results The asthma control rate of well-controlled children was significantly decreased in the low, medium and high FeNO groups (P < 0.05). FeNO was correlated with asthma control in children (P < 0.05). The area under the curve (AUC) of FeNO in children with poorly controlled asthma was 0.697, and sensitivity and specificity were 76.2% and 71.9%, respectively. There were no significant differences in pulmonary function related indexes of FeNO low level group, medium level group and high level group (P>0.05). There were no correlations of FeNO with FEV1%, FVC%, PEF% and PEF25% (P>0.05).Conclusion FeNO level is correlated with asthma control in asthmatic children. FeNO level has higher diagnostic value for children with poor control.
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Keywords:
- asthma /
- fractional exhaled nitric oxide /
- asthma control level /
- pulmonary function
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表 1 不同FeNO水平患儿的哮喘控制情况[n(%)]
组别 n 控制良好 控制欠佳 FeNO低水平组 24 19(79.2) 5(20.8) FeNO中水平组 9 6(66.7)* 3(33.3)* FeNO高水平组 20 7(35.0)*# 13(65.0)*# FeNO: 呼出气一氧化氮。与FeNO低水平组比较, * P＜0.05; 与FeNO中水平组比较, #P＜0.05。 
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表 2 不同FeNO水平患儿的肺功能检测情况(x±s)
组别 n FEV1% FVC% PEF% PEF25% FeNO低水平组 24 105±14 97±13 94±14 97±18 FeNO中水平组 9 99±15 95±11 84±18 82±18 FeNO高水平组 20 100±10 93±8 91±21 96±23 FVC%: 用力肺活量占预计值百分比; FEV1%: 第1秒用力呼气容积占预计值百分比; PEF%: 呼气峰流速占预计值百分比; PEF25%: 用力呼25%肺活量时的速度占预计值百分比。
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表 3 FeNo水平与肺功能的相关性
肺功能指标 FeNo水平 r P FEV1% -0.190 0.216 FVC% -0.173 0.173 PEF% -0.055 0.694 PEF25% -0.027 0.847 FVC%: 用力肺活量占预计值百分比; FEV1%: 第1秒用力呼气容积占预计值百分比; PEF%: 呼气峰流速占预计值百分比; PEF25%: 用力呼25%肺活量时的速度占预计值百分比。
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