中国实用儿科杂志

中国实用儿科杂志

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在社区儿童哮喘诊断与管理中呼出气一氧化氮测定应用研究

邵明军，刘传合，沙莉，李硕，罗雁青，宋欣，李志英，陈育智   

  1. 作者单位： 首都儿科研究所，北京 100020
  • 出版日期:2014-06-06 发布日期:2014-06-04
  • 通讯作者: 刘传合 
  • 基金资助:

    首都医学发展科研基金（2009-1048）

Application of exhaled nitric oxide in community children with asthma and its importance in asthma management.

SHAO Ming-jun， LIU Chuan-he， SHA Li， LI Shuo， LUO Yan-qing， SONG Xin， LI Zhi-ying， CHEN Yu-zhi.   

  1. Capital Institute of Pediatrics， Beijing 100020，China
  • Online:2014-06-06 Published:2014-06-04

摘要：

目的 探讨呼出气一氧化氮（exhaled nitric oxide， eNO）体积分数在社区儿童的改变及对哮喘诊断与管理的价值。方法 2011年10月至2011年12月对来自北京西城区小学的7~12岁132例非哮喘儿童和93例哮喘儿童进行eNO测定、肺功能检测、过敏原皮肤点刺检查（skin prick test， SPT）以及病史询问和常规体检，观察eNO在社区非哮喘儿童和哮喘儿童的改变、影响因素及与临床情况的相关性。结果 非哮喘儿童与哮喘儿童eNO体积分数分别为（11.63±1.88）×10-9和（19.68±2.31）×10-9，其差异有统计学意义（P < 0.01）。在非哮喘儿童中，有鼻炎儿童的eNO为（17.49±2.02）×10-9，显著高于无鼻炎儿童（10.42±1.76）×10-9；特应性儿童的eNO为（16.12±1.98）×10-9，显著高于非特应性儿童（9.60±1.66）×10-9，差异均有统计学意义（P均 < 0.01）。在哮喘儿童中，伴有鼻炎与不伴有鼻炎儿童，其eNO水平分别为（19.54±2.31）×10-9、（20.09±2.25）×10-9，差异无统计学意义；但特应性儿童eNO水平显著高于非特应性儿童［分别为（23.06±2.18）×10-9、（8.75±1.86）×10-9，P < 0.01］；哮喘未控制儿童eNO为（25.09±2.31）×10-9，显著高于哮喘控制儿童［（17.21±2.22）×10-9，P < 0.05］；曾使用吸入激素与未曾使用吸入激素儿童，其eNO水平差异无统计学意义。无论是非哮喘儿童，还是哮喘儿童，其eNO水平与肺功能各参数间均无相关性。结论 eNO在社区特应性哮喘儿童中显著升高，并与哮喘控制与否有关。特应性是影响eNO水平的突出因素。在社区儿童中测定eNO有利于对儿童哮喘的进行早期诊断和分型，全面了解其过敏情况，从而改善哮喘的管理。

关键词: 儿童, 呼出气一氧化氮, 哮喘, 特应性, 社区

Abstract:

 Objective    To explore the change of exhaled nitric oxide （eNO） in children from community and its importance in asthma management. Methods    The study was conducted from October 2011 to December 2011. Totally 133 non-asthmatic children and 94 asthmatic children aged 7~12 years old from elementary schools in Beijing Xicheng District were included in the study. The eNO， skin prick test （SPT）， lung function and physical examination were carried out and information of medical history was collected in all children. The eNO level between non-asthmatic children and asthmatic children， and its association with atopy， rhinitis， lung function and asthma control were analyzed. Results    eNO levels of non-asthmatic children and asthmatic children were 11.63±1.88 ppb， and 19.68±2.31 ppb respectively and the difference between them was statistically significant （P<0.01）. In non-asthmatic children， the level of eNO in children with rhinitis was significantly higher than in children without rhinitis ［（17.49±2.02）×10-9 vs. （10.42±1.76）×10-9， P<0.01］ and eNO level in atopic children was higher than non-atopic children ［（23.06±2.18）×10-9 vs. （9.60±1.66）×10-9， P<0.01）. In asthmatic children， the difference in eNO level was not significant in children with rhinitis and without rhinitis ［（19.58±2.34）×10-9 vs. （20.09±2.25）×10-9］， but the eNO levels in atopic children （23.06±2.18）×10-9 was significantly higher than non-atopic children ［（8.75±1.86）×10-9， P<0.01］. The level of eNO of uncontrolled asthmatic children was significantly higher than controlled asthmatic children ［（25.09±2.31）×10-9 vs. （17.21±2.22）×10-9， P<0.05］. There was no significant difference in eNO level between children who used and those who did not use inhaled corticosteroid. The eNO level was not related to lung function parameters either in non-asthmatic or in asthmatic children. Conclusion    The eNO level increases significantly in children with asthma or rhinitis and  is associated with asthma control status. Atopy is an important factor on eNO level as well. Measuring eNO level would help improve the diagnosis of asthma and atopy and management of asthma and rhinitis in children from community.

Key words: children, exhaled nitric oxide, asthma, atopy, community

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