呼出气一氧化氮测定对儿童支气管哮喘的诊断价值  

The diagnostic value of the fractional exhaled nitric oxide test for asthma in children

作　　者：刘娜[1] 赵德育[1] 吴美思[1] 丁静[1] 

机构地区：[1]南京医科大学附属南京儿童医院呼吸科,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2011年第4期553-556,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京市医学重点科技发展资助(YKK07050)

摘　　要：目的:评估呼出气一氧化氮(FeNO)测定对儿童支气管哮喘诊断的临床价值。方法:选取2010年6月～9月就诊于南京市儿童医院疑似支气管哮喘的患儿87例,测定FeNO水平,以临床表现和支气管激发或舒张试验为哮喘诊断的金标准,绘制ROC曲线,结合ROC曲线明确FeNO的诊断临界点,以评价FeNO对儿童支气管哮喘的诊断价值。结果:87例患儿中诊断哮喘患儿52例,非哮喘患儿35例;哮喘组FeNO[(59.77±42.48)ppb]高于非哮喘组[(25.26±22.60)ppb,P<0.05]。FEV1%与FeNO无直线相关(r=-0.151,P>0.05)。FeNO与外周血嗜酸性粒细胞有相关性(r=0.546,P<0.01)。ROC曲线下面积是0.818,FeNO以34.5 ppb为阈值,敏感度0.712,特异度0.686,阳性预测值0.755,阴性预测值0.605,正确率0.689。结论:FeNO测定有助于儿童支气管哮喘的诊断和鉴别诊断。Objective：To explore the diagnostic value of the fractional exhaled nitric oxide（FeNO） for asthma in children.Methods：The patients with unkown-caused respiratory symptoms including wheezing,cough and breathlessness were enrolled from Jun to Sep in 2010.FeNO was measured by nitric oxide analyzer.Bronchial challenge test and bronchodilator test were defined as golden standard for asthma diagnosis in children.The diagnostic value of FeNO was assessed and the optimal operating point of FeNO testing was determined by the means of the receiver operating characteristic（ROC） curve.Results：A total of 87 patients were enrolled,in which 52 cases were diagnosed as asthma by positive result in bronchial challenge test or bronchodilator test,and the other 35 cases were non-asthma.The level of FeNO in asthma group was higher than non-asthma group[（59.77±42.48）ppb vs（25.26±22.60）ppb,P 0.05].The level of FeNO was correlated with the counts of eosinophile granulocyte（r=0.546,P 0.01） but not correlated with FEV1%（r=-0.151,P 0.05）.Area under ROC curve was 0.818.The optimal diagnostic cut-off point was 34.5 ppb which was capable of differentiating asthma and non-asthma with sensitivity of 0.712,specificity of 0.686,positive predictive value of 0.755,negative predictive value of 0.605 and accuracy of 0.689.Conclusion：Determination fo FeNO may be helpful in the diagnosis of asthma in children.

关 键 词：儿童支气管哮喘 呼出气一氧化氮 诊断 受试者工作特征曲线 

分 类 号：R562.2[医药卫生—呼吸系统]