中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (4): 296-299.

• 论著 • 上一篇    下一篇

呼出气一氧化氮检测对儿童哮喘
诊断价值评价研究

余嘉璐，邓    力，林俊宏，温惠虹   

  1. 广州市妇女儿童医疗中心儿童院区呼吸科，广州   510120
  • 出版日期:2012-04-06 发布日期:2012-04-16

Evaluation of the diagnostic value of exhaled nitric oxide test in children with asthma.

  • Online:2012-04-06 Published:2012-04-16

摘要：

目的    将呼出气一氧化氮（FeNO）浓度检测与肺功能测定进行比较，评估其对儿童支气管哮喘诊断的临床价值。方法    收集广州市儿童医院呼吸科门诊2009年6月至2010年5月反复咳嗽、间伴喘息等疑似支气管哮喘的患儿93例。使用FeNO测定仪（Medisoft  Hypair FeNo）进行测定，操作严格按照美国胸科协会制定指南进行；同时采用Medisoft hyp`Air 型肺功能仪行基础肺功能检查，并进行支气管激发及舒张试验。根据结果并结合临床作为诊断儿童哮喘的标准，并以此作为FeNO诊断价值的参照，评价FeNO对支气管哮喘的鉴别诊断价值。结果    93例中激发试验阳性53例，支气管舒张试验阳性14例，结合临床最后均诊断为支气管哮喘。其余26例为激发试验阴性，诊断为非哮喘。哮喘组FeNO高于非哮喘组［（43.60±38.86）×10-9 mol／L对（26.16±17.00）×10-9 mol／L，P < 0.05］。哮喘患儿FeNO与第1秒用力呼气容积（FEV1）占预计值百分比（FEV1%）之间无显著相关性（ r = 0.06 ， P > 0.05）。激发试验阳性者FeNO值与PD20FEV1之间存在线性关系。结论    FeNO测定对支气管哮喘的诊断和鉴别诊断具有重要意义，但与肺功能、支气管激发试验检测相比仍存在一定局限性。

关键词: 支气管哮喘, 呼出气一氧化氮, 支气管激发试验, 支气管舒张试验, 诊断

Abstract:

Objective    Compare exhaled nitric oxide （FeNO） levels test with current lung function test in order to assess the clinical value of FeNO at the asthma diagnosis. Method    Collect 93 suspected asthma patients who have repeated coughing，occasionally with wheexing in our hospital  from May 2009 to June 2010 . Use the NO analyzer （Medisoft  Hypair FeNo） to test FeNO levels， and the test process sticked to the  American Thoracic Society guidelines. At the same time use Medisoft hyp `Air-type pulmonary function instruments to do the basic pulmonary function tests， bronchial provocation and dilation test.The results combined with the clinical information were regarded as the “gold standard” as well as the reference of FeNO diagnosis value， in order to evaluate  the FeNO in asthma differential diagnosis. Result    Among 93 patients，53 patients in bronchial provocation test were positive and 14 cases in bronchodilation test were postive，who had final diagnosis of bronchial asthma. The remained 26 cases who were negative in bronchial provocation test were diagnosed as non-asthma. The level of FeNO in asthma group was higher than non-asthma group ［（43.60±38.86）×10-9 mol／L VS （26.16±17.00） ×10-9 mol／L，P < 0.05］. There was no significant correlation between exhaled NO and FEV1 % in asthmatic children （ r =0.06 ， P >0.05）.A linear correlation of FeNO with PD20FEVl was revealed in the cases with who were positive in bronchial provocation test.  Conclusion    FeNO has its significance in diagnosis and differential diagnosis of asthma， but compared with  conventional lung function and bronchial provocation test，it still has some limitations， which needs further study.

Key words: bronchial asthma, exhaled nitric oxide, bronchial provocation test, bronchodilation test, diagnosis