鼻呼出气一氧化氮在慢性鼻窦炎儿童纤毛运动障碍诊断中的价值  

作　　者：谢菲 慈军 王昌阳 楚士东 管骅 

机构地区：[1]浙江大学医学院附属杭州市胸科医院,310006

出　　处：《浙江临床医学》2022年第9期1331-1332,共2页Zhejiang Clinical Medical Journal

基　　金：杭州市农业与社会发展一般项目(20201203B222);浙江省医药卫生科技计划项目(2020RC097)。

摘　　要：目的探讨鼻呼出气一氧化氮(nNO)值在慢性鼻窦炎(CRS)儿童纤毛运动障碍(CD)诊断中的价值.方法选择2019年7月至2021年8月经电镜证实纤毛超微结构异常的43例继发性CD(SCD)和3例原发性CD(PCD)患儿,检测患儿的nNO值.结果与SCD患儿相比,PCD患儿nNO值降低,差异有统计学意义(P<0.001).3例PCD患儿均有鼻塞流脓涕及咳嗽咳痰,nNO值明显呈现持续性低下特点;鼻窦CT均示双侧全组鼻窦炎;电镜下上气道黏膜上皮纤毛动力臂缺失;保守治疗无效后2例行扁桃体部分切除伴腺样体消融术,1例行功能性鼻内镜手术;术后上述症状均改善,nNO值回升但仍远低于正常值.结论nNO检测比透射电镜检查更便捷,重复性、特异性、敏感性更高.对于CRS儿童,nNO可作为PCD的筛查方式及CRS治疗反应的参考.Objective To investigate the value of nasal nitric oxide(nNO)in the diagnosis of cilary dyskinesia(CD)in children with chronic sinusitis(CRS).Methods 43 children with secondary CD(SCD)and 3 children with primary CD(PCD)with abnormal ciliary ultrastructure confirmed by electron microscope were selected to detect the nNO value of the children during July 2019 to August 2021.Results Compared with children with SCD,the value of nNO in children with PCD was significantly lower,and the difference was statistical significance(P<0.001).All the 3 children with PCD had nasal obstruction,purulent discharge,cough and expectoration,and the value of nNO was significantly lower.CT scan of paranasal sinuses showed bilateral sinusitis.The ciliated power arm of the upper airway mucosa was absent under electron microscope.After conservative treatment failed,2 cases underwent partial tonsillectomy with adenoid ablation,and 1 case underwent functional endoscopic sinus surgery.The above symptoms were improved after operation,and the value of nNO increased but was still far below the normal value.Conclusion The detection of nNO is more convenient than transmission electron microscopy,with higher repeatability,specificity and sensitivity.For children with CRS,nNO can be used as a reference for the screening of PCD and the treatment response ofCRS.

关 键 词：鼻呼出气一氧化氮 纤毛运动障碍 慢性鼻窦炎 儿童 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]