呼出气一氧化氮检测在儿童哮喘管理中的价值  

Value of fractional exhaled nitric oxide test in management of childhood asthma

作　　者：顾剑华[1] 金晓群[1] 徐艳娜[1] 李永莲[1] 桂丽琼[1] 金殊 

机构地区：[1]上海市普陀区人民医院儿科,200060

出　　处：《中国医药》2015年第6期812-815,共4页China Medicine

基　　金：上海市普陀区卫生系统自主创新项目（普KW12303）

摘　　要：目的 评价呼出气一氧化氮（FeNO）检测在儿童哮喘管理中的价值.方法 选取未规范治疗的哮喘患儿60例（哮喘组）,给予沙美特罗氟替卡松气雾剂（舒利迭,每揿含50μg沙美特罗和100μg氟替卡松,2次/d）治疗6个月,检测治疗前及治疗后1、3、6个月的FeNO、血清嗜酸粒细胞阳离子蛋白（ECP）、第1秒用力肺活量占预计值百分比（FEV1％）,进行哮喘控制测试问卷（ACT）评分.同期选取40例非呼吸道疾病患儿为对照组,检测FeNO、ECP及FEV1％.比较2组患儿FeNO、ECP、FEV1％水平差异.结果 治疗前哮喘组FeNO、ECP水平明显高于对照组[FeNO：（53±27） μg/L比（10±5） μg/L,ECP：（21.6±3.0）μg/L比（4.9±1.2）μg/L,FEV1％明显低于对照组[（79±21）％比（98±8）％],差异均有统计学意义（均P＜0.05）.与治疗前比较,哮喘组治疗后1、3、6个月FeNO、ECP明显降低,FEV1％及ACT评分明显升高[FeNO：（33±19）、（23±14）、（21±10） μg/L比（53 ±27）μg/L,ECP：（16.0±3.3）、（9.4±3.2）、（7.2±2.0）μg/L比（21.6±3.0）μg/L,FEV1％：（91±12）％、（96±12）％、（99±10）％比（79±21）％,ACT评分：（22.7±3.8）、（25.4±2.2）、（26.2±1.6）分比（17.6±3.3）分],差异有统计学意义（P＜0.01）.治疗前哮喘组FeNO与ECP呈正相关（r=0.850,P＜0.01）,与ACT评分呈负相关（r=-0.728,P＜0.01）,与FEV1无相关性（r=-0.216,P＞0.05）.治疗1、3、6个月后,哮喘组FeNO与ECP仍呈正相关（r =0.695,P＜0.01;r=0.624,P＜0.01;r=0.665,P＜0.01）,与FEV1及ACT评分均无相关性（均P＞0.05）.结论 FeNO是一种较理想的反映气道嗜酸性炎症的生物学指标,其检测有助于评估哮喘的控制情况.Objective To evaluate the value of fractional exhaled nitric oxide （FeNO） in the management of childhood asthma.Methods Totally 60 cases of asthmatic children without standard medication treatment （asthmatic group） and 40 non respiratory children （control group） were recruited.Asthmatic group was administrated with Shah Mette Lo fluticasone propionate aerosol （50 μg Shah Mette Lo and 100 μg fluticasone/press,2 times/d） for 6 months.The FeNO,serum eosinophil cationic protein （ECP）,lung function （FEV1 %） and asthma control test （ACT） were determined and compared between the two groups before and 1,3 and 6 month after treatment.Results Before treatment,the FeNO,ECP were significantly higher and FEV1% were significantly lower in asthmatic group compared with those in control group [（53 ± 27） μg/L vs （10 ± 5） μg/L,（21.6 ± 3.0） μg/L vs （4.9 ±1.2） μg/L,（79 ±21）% vs （98 ±8）%,P〈0.05].In asthmatic group,the FeNO and ECP were significantly reduced,the FEV1 % and ACT score were significantly increased 1,3 and 6 months after treatment compared with those before treatment [（33 ± 19）,（23 ± 14）,（21 ± 10） μg/L vs （53 ± 27） μg/L,（16.0±3.3）,（9.4±3.2）,（7.2±2.0） μg/L vs （21.6±3.0） μg/L,（91 ±12）%,（96±12）%,（99±10）% vs （79±21）%,（22.7±3.8）,（25.4±2.2）,（26.2±1.6） scores vs （17.6±3.3） scores] （P〈0.01）.In asthma group,the FeNO level was positively correlated with ECP level （r =0.850,P 〈0.01）;it was negatively correlated with ACT score （r =-0.728,P 〈 0.01） and was not correlated with FEV1 % （r =-0.216,P =0.097） before treatment.After 1,3 and 6 months of treatment,the FeNO level was still positively correlated with ECP （r =0.695,P 〈0.01;r =0.624,P 〈0.01;r =0.665,P 〈0.01）,but it showed no significant correlation with FEV1 % and ACT score（all P 〉 0.05）.Conclusion FeNO is an ideal biological indicator for eosinophilic airway inflammation,which is helpful for ass

关 键 词：呼出气一氧化氮 哮喘 儿童 

分 类 号：R725.6[医药卫生—儿科]