呼出气一氧化氮测定在IgE介导的儿童哮喘诊断中的价值  

The value of exhaled nitric oxide in the diagnosis of IgE-mediated asthma in children

作　　者：刘开来 殷小成[1] Kailai Liu;Xiaocheng Yin(The First Affliated Hospital of Nanhua University,Hengyang 421001,China;The First Hospital of Xiangtan,Xiangtan 411101,China)

机构地区：[1]南华大学第一附属医院,衡阳421001 [2]湘潭市第一人民医院,湘潭411101

出　　处：《湖南师范大学学报（医学版）》2022年第5期72-76,共5页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的 :探究呼出气一氧化氮(FeNO)测定应用于IgE介导的儿童哮喘诊断中的价值。方法 :收集127例2021年4月~10月在湘潭市第一人民医院就诊的疑似哮喘的患儿作为研究对象。采用支气管舒张试验作为诊断标准将患儿分为哮喘组和非哮喘组。分析哮喘组患儿FeNO与第1秒用力呼气量占预计值百分比(FEV1%)、总免疫球蛋白E(tIgE)之间的相关性。根据tIgE结果将哮喘组患儿分为IgE介导的哮喘组和非IgE介导的哮喘组。通过受试者工作特征曲线(ROC曲线)确定FeNO诊断儿童哮喘和鉴别IgE介导的儿童哮喘的最佳截断值。结果 :127例疑似病例中确诊为哮喘的患儿有86例,其中IgE介导的哮喘患儿有48例,非IgE介导的哮喘患儿有38例。哮喘组肺功能指标均低于非哮喘组,FeNO水平明显高于非哮喘组;哮喘组FeNO与FEV1%呈负相关,与tIgE值呈正相关;IgE介导的哮喘组肺功能指标低于非IgE介导的哮喘组,FeNO水平明显高于非IgE介导的哮喘组;FeNO诊断儿童哮喘的最佳截断值为19.5 ppb,灵敏度为89.5%,特异性为78.0%;FeNO区分IgE介导和非IgE介导的儿童哮喘的最佳截断值为36 ppb,灵敏度为89.6%,特异度为73.7%。结论 :在儿童哮喘的诊断和IgE介导的儿童哮喘的鉴别中,FeNO均具有较高的灵敏度和特异度。Objective To explore the value of fractional exhaled nitric oxide(FeNO) in the diagnosis of immunoglobulin E(IgE)-mediated asthma in children. Methods A total of 127 children with suspected asthma who were admitted to the First Hospital of Xiangtan from April to October 2021 were selected as the research objects, and divided into asthma group and non-asthma group using bronchial dilation test as diagnostic standard. Correlation analysis was performed among FeNO, forced expiratory volume in the first second as percentage of predicted value(FEV1%) and total immunoglobulin E(tIgE) in children with asthma. According to the results of tIgE, the asthma group was divided into IgE-mediated asthma group and non-IgE mediated asthma group. The receiver operating characteristic(ROC) curve was used to determine the optimal cut-off value of FeNO for diagnosing childhood asthma and identifying IgE-mediated childhood asthma. Results Among the 127 suspected cases, 86 children were diagnosed asthma, including 48 children with IgE-mediated asthma and 38 children with non-IgE mediated asthma. For children in asthma group, pulmonary function index was lower and FeNO level was significantly higher than that of non-mediated asthma group. FeNO value was negatively correlated with FEV1%, and positively correlated with IgE value(all P<0.05). For children in IgE-mediated asthma group, pulmonary function index was lower and FeNO level was higher than that of non-IgE mediated asthma group. The optimal cut-off value of FeNO in the diagnosis of childhood asthma was 19.5 ppb, with sensitivity of 89.5% and specificity of 78.0%. The optimal cut-off value of FeNO was 36 ppb for the differentiation between IgE-mediated asthma and non-IgE mediated asthma, with a sensitivity of 89.6% and a specificity of 73.7%. Conclusion Fe NO has high sensitivity and specificity in the diagnosis of childhood asthma and the identification of IgE-mediated childhood asthma.

关 键 词：呼出气一氧化氮测定 免疫球蛋白E 哮喘 儿童 

分 类 号：R725.6[医药卫生—儿科]