肺功能结合呼出气一氧化氮检测在婴幼儿小气道病变诊断与治疗中的价值  

Value of pulmonary function combined with fractional exhaled nitric oxide in diagnosis and treatment of small airway lesions in infants

作　　者：张丽芳 顾小丽[1] 杨洁[1] 张欧[1] 王凡 张曼萍 ZHANG Li-fang;GU Xiao-li;YANG Jie;ZHANG Ou;WANG Fan;ZHANG Man-ping(Department of Respiratory and Critical Care Medicine,Kunming Children's Hospital,Kunming,Yunnan 650034,China)

机构地区：[1]昆明市儿童医院呼吸与危重症医学科,云南昆明650034

出　　处：《中国临床研究》2020年第7期980-983,共4页Chinese Journal of Clinical Research

基　　金：昆明市卫生科技人才培养暨“十百千”工程项目[2018-SW(后备)-5]。

摘　　要：目的探讨肺功能结合呼出气一氧化氮(FeNO)检测在婴幼儿小气道病变诊断与治疗中的临床价值。方法将2018年6月至2019年6月收治的、以支气管激发试验(BPT)、支气管镜、高分辨率CT(HRCT)等综合诊断确诊的480例小气道病变婴幼儿纳入观察组,将同期收治的无小气道病变的480例婴幼儿纳入对照组。比较两组间以及观察组治疗前后婴幼儿肺功能指标[第1秒用力呼气容积占预计值百分比(FEV1%)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)、吸呼比(Ti/Te)、呼气峰流速占预计值百分比(PEF%)]及FeNO检测结果,进一步对肺功能联合FeNO与BPT对婴幼儿小气道病变的诊断效能进行比较。结果观察组婴幼儿FEV1%、TPTEF/TE、VPTEF/VE、PEF%检测结果均显著低于对照组(P<0.01,P<0.05),FeNO水平显著高于对照组[(31.92±6.71)ppb vs(19.38±2.61)ppb,P=0.007];观察组婴幼儿治疗后FEV1%、TPTEF/TE、VPTEF/VE、PEF%检测结果均显著高于本组治疗前(P<0.01,P<0.05),FeNO检测结果显著低于本组治疗前[(16.64±3.23)ppb vs(31.92±6.71)ppb,P=0.004]。以BPT、支气管镜、HRCT等综合诊断结果为准,肺功能联合FeNO诊断婴幼儿小气道病变的特异度(93.75%vs 77.08%,P=0.021)、准确率(92.71%vs 81.25%,P=0.018)、阳性预测值(93.62%vs 78.85%,P=0.035)显著高于BPT。结论肺功能结合FeNO检测能够为婴幼儿小气道病变的诊断与治疗提供可靠的指导参数,临床应用价值较高。Objective To explore the clinical value of pulmonary function combined with fractional exhaled nitric oxide(FeNO)in the diagnosis and treatment of infantile small airway lesion.Methods A total of 480 infants with small airway lesion diagnosed comprehensively by bronchial provocation test(BPT),bronchoscopy,high-resolution CT(HRCT)and treated from June 2018 to June 2019 were included as observation group,and 480 infants without small airway lesion were served as control group in the same time.The results of pulmonary function indexes(FEV1%,TPTEF/TE,VPTEF/VE,Ti/Te,PEF%)and FeNO were observed and compared between two groups and also compared before and after treatment in observation group.Furthermore,the diagnostic efficacy of pulmonary function combined with FeNO versus BPT was observed.Results The levels of FEV1%,TPTEF/TE,VPTEF/VE,PEF%in observation group were significantly lower than those in control group(P<0.01,P<0.05),and level of FeNO was higher than that in control group[(31.92±6.71)ppb vs(19.38±2.61)ppb,P=0.007];Compared with before treatment,the levels of FEV1%,TPTEF/TE,VPTEF/VE,PEF%increased significantly(P<0.01,P<0.05),and level of FeNO decreased[(16.64±3.23)ppb vs(31.92±6.71)ppb,P=0.004]after treatment in observation group.Based on the comprehensive diagnosis results of BPT,bronchoscope and HRCT,the specificity(93.75%vs 77.08%,P=0.021),accuracy(92.71%vs 81.25%,P=0.018),positive predictive value(93.62%vs 78.85%,P=0.035)of pulmonary function combined with FeNO were significantly higher than those of BPT.Conclusion In the diagnosis and treatment of infants with small airway diseases,pulmonary function combined with FeNO can provide reliable guidance parameters and have a higher clinical application value.

关 键 词：婴幼儿 小气道病变 诊断 治疗 肺功能 呼出气一氧化氮 

分 类 号：R725.6[医药卫生—儿科]