口鼻呼出气一氧化氮检测在儿童支气管哮喘控制评估及过敏性鼻炎诊断中的应用

Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children

摘要:

目的 探讨口呼出气一氧化氮（fractional exhaled nitric oxide，FeNO）与鼻呼出气一氧化氮（nasal nitric oxide，nNO）检测值和儿童支气管哮喘（简称哮喘）控制水平的关系，以及对过敏性鼻炎的诊断价值。 方法 以上海市儿童医院呼吸科门诊就诊的5~12岁哮喘和/或过敏性鼻炎患儿，以及健康体检儿童共186例为研究对象：哮喘组52例，哮喘合并过敏性鼻炎组60例，过敏性鼻炎组36例，对照组38例。比较各组FeNO、nNO及肺功能等指标。 结果 哮喘合并过敏性鼻炎组、哮喘组和过敏性鼻炎组的FeNO值均高于对照组（P<0.05）。哮喘合并过敏性鼻炎组和过敏性鼻炎组nNO值均高于对照组及哮喘组（P<0.05）。哮喘未控制组及部分控制组FeNO及nNO值均高于哮喘控制组（P<0.05）。受试者工作特征曲线分析显示，nNO可协助诊断哮喘患儿合并过敏性鼻炎（P<0.05），曲线下面积为0.91，灵敏度为80.0%，特异度为89.5%。 结论 FeNO与nNO联合检测有助于评估儿童哮喘控制情况；nNO检测可协助诊断哮喘患儿合并过敏性鼻炎。

Abstract:

Objective To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children. Methods A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups. Results The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05). Conclusions The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.