儿童慢性咳嗽呼出气一氧化氮水平检测与气道高反应性的相关性研究  

Relationship between expired nitric oxide and bronchial hyper-reactivity in children with chronic cough

作　　者：张家伟[1] 孟帅[1] 刘群[1] 徐小评[1] 

机构地区：[1]成都市第二人民医院儿科,四川成都610017

出　　处：《实用医院临床杂志》2016年第4期76-79,共4页Practical Journal of Clinical Medicine

摘　　要：目的 研究慢性咳嗽患儿呼出气一氧化氮（fraction of expired nitric oxide,Fe NO）水平与支气管激发试验结果的相关性,探讨能否应用Fe NO预测慢性咳嗽患儿气道高反应性。方法 选择我院小儿呼吸内科门诊就诊的300名慢性咳嗽患儿,进行Fe NO、肺功能和乙酰甲胆碱为激发剂的支气管激发试验检查,根据激发试验结果进行分组,其中支气管激发试验阳性组135例,阴性组165例。结果 阳性组患儿的Fe NO值为21.5 ppb（16.0~36.5 ppb）,阴性组的Fe NO值为17.0 ppb（12.0~22.5ppb）,差异有统计学意义（P=0.000）;Fe NO预测气道激发试验结果的最佳阈值为30.5 ppb,敏感性为29.2%,特异性为96.6%,阳性预测值88.9%,阴性预测值65.0%;Fe NO与FEV1%下降20%时吸入的乙酰甲胆碱累积剂量（PD20-FEV1）之间不存在剂量相关性（r=-0.0.86,P=0.345）。结论 慢性咳嗽患儿的Fe NO值对于气道高反应性有一定的预测作用。当Fe NO〉30.5 ppb时预测支气管激发试验阳性的准确性较高,提示患儿存在气道高反应性;当Fe NO〈30.5 ppb时,不能对支气管激发试验阳性或阴性做出预测,需进一步行支气管激发试验以判断气道的反应性。Objective The aim of this study was to investigate the relationship between fraction of expired nitric oxide （ Fe-NO） and bronchial provocation test in order to evaluate whether detection of FeNO could predict bronchial hyper -responsiveness in chronic cough children .Methods We conducted a study on 300 chronic cough children to measure their FeNO concentrations and per-form pulmonary function tests and bronchial provocation test base on methacholine .The children were divided into bronchial provocation test positive group （n =135） and negative group （n =65）.Results The FeNO concentration in the positive group was 21.5 ppb （16.0~36.5 ppb） while 17.0 ppb （12.0~22.5 ppb） was found in the negative group .The difference was statistically significant （ P=0.000 ） .We found that FeNO cut-off value was 30.5 ppb that was able to identify bronchial hyper-responsiveness with 96.6%speci-ficity,29.2%sensitivity,88.9%positive predictive value and 65.0%negative predictive value .There was no relationship between the methacholine provocative dose causing a 20%fall in FEV1（PD20-FEV1） and the level of FeNO （r=-0.086,P =0.345）.Conclu-sion FeNO measurement has some predictable effects for bronchial hyper-reactivity in children with chronic cough .When the value of FeNO is larger than 30.5 ppb,it has a high predictive value.However,when FeNO was less than 30.5 ppb,it could not make a predic-tion and further bronchial provocation test is required .

关 键 词：呼出气一氧化氮 支气管激发试验 气道高反应性 慢性咳嗽 儿童 

分 类 号：R562.25[医药卫生—呼吸系统]