目的 探讨呼出气一氧化氮（fractional exhaled nitric oxide，FeNO）联合脉冲振荡（impulse oscillometry，IOS）肺功能检查对学龄前儿童哮喘的诊断价值，并建立最佳预测模型。 方法 回顾性纳入2019年9月至2020年12月收治的3~5岁喘息儿童156例，分为哮喘组（52例）和非哮喘组（104例）。对2组患儿的IOS参数、FeNO及临床资料进行分析比较，通过多因素logistic回归建立最佳预测模型。 结果 哮喘组频率5 Hz时呼吸系统总阻抗（respiratory system impedance at 5 Hz，Z5）、频率5 Hz和20 Hz时阻抗（resistance of respiratory system at 5 Hz and 20 Hz，R5和R20）、共振频率、电抗面积（reactance of area，AX）和FeNO水平均高于非哮喘组，频率5 Hz时电抗差值小于非哮喘组（P<0.05）。受试者工作特征曲线分析显示Z5、R5、R20和FeNO对哮喘诊断有价值（P<0.05）。多因素logistic回归分析建立的最佳预测模型为R20+AX+FeNO，其曲线下面积为0.858（P<0.05），灵敏度为78.8%，特异度为76.9%。 结论 FeNO联合IOS检查有助于学龄前儿童哮喘的诊断，由R20+AX+FeNO组成的模型在学龄前儿童哮喘的诊断中具有一定价值。 中国当代儿科杂志，2022，24（9）：1020-1026］
Abstract
Objective To evaluate the value of fractional exhaled nitric oxide (FeNO) combined with impulse oscillometry (IOS) in the diagnosis of asthma in preschool children, and to establish the optimal predictive model. Methods A retrospective analysis was performed on 156 children with wheezing, aged 3-5 years, who were admitted from September 2019 to December 2020. These children were divided into an asthma group with 52 children and a non-asthma group with 104 children. The two groups were compared in terms of IOS parameters, FeNO, and clinical data. The multivariate logistic regression analysis was used to establish the optimal predictive model. Results Compared with the non-asthma group, the asthma group had significantly higher total respiratory system impedance at 5 Hz (Z5), resistance of respiratory system at 5 Hz and 20 Hz (R5 and R20, respectively), resonance frequency, reactance area (AX), and FeNO and a significantly lower reactance difference at 5 Hz (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that Z5, R5, R20, and FeNO had a certain value in the diagnosis of asthma (P<0.05). The multivariate logistic regression analysis established the optimal predictive model of R20+AX+FeNO, with an area under the ROC curve of 0.858 (P<0.05), a sensitivity of 78.8%, and a specificity of 76.9%. Conclusions FeNO combined with IOS is helpful for the diagnosis of asthma in preschool children, and the model of R20+AX+FeNO has a certain value in the diagnosis of asthma in these children. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 1020-1026
关键词
支气管哮喘 /
呼出气一氧化氮 /
脉冲振荡 /
学龄前儿童
Key words
Bronchial asthma /
Fractional exhaled nitric oxide /
Impulse oscillometry /
Preschool child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 中华儿科杂志编辑委员会, 中华医学会儿科学分会呼吸学组, 中国医师协会儿科医师分会儿童呼吸专业委员会. 儿童支气管哮喘规范化诊治建议(2020年版)[J]. 中华儿科杂志, 2020, 58(9): 708-717. PMID: 32872710. DOI: 10.3760/cma.j.cn112140-20200604-00578.
2 Pedersen SE, Hurd SS, Lemanske RF, et al. Global strategy for the diagnosis and management of asthma in children 5 years and younger[J]. Pediatr Pulmonol, 2011, 46(1): 1-17. PMID: 20963782. DOI: 10.1002/ppul.21321.
3 Global Initiative for Asthma. Global strategy for asthma management and prevention (update 2021)[EB/OL]. (2021-04-28)[2022-03-29]. https://ginasthma.org/wp-content/uploads/2021/04/GINA-2021-Main-Report_FINAL_21_04_28-WMS.pdf.
4 全国儿科哮喘协作组. 中国疾病预防控制中心环境与健康相关产品安全所. 第三次中国城市儿童哮喘流行病学调查[J]. 中华儿科杂志, 2013, 51(10): 729-735. PMID: 24406223. DOI: 10.3760/cma.j.issn.0578-1310.2013.10.003.
5 刘传合, 洪建国, 尚云晓, 等. 中国16城市儿童哮喘患病率20年对比研究[J]. 中国实用儿科杂志, 2015, 30(8): 596-600. DOI: 10.7504/ek2015080609.
6 中华医学会儿科学分会呼吸学组肺功能协作组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺功能系列指南(二): 肺容积和通气功能[J]. 中华实用儿科临床杂志, 2016, 31(10): 744-750. DOI: 10.3760/cma.j.issn.2095-428X.2016.10.006.
7 Sol IS, Kim YH, Kim S, et al. Assessment of within-breath impulse oscillometry parameters in children with asthma[J]. Pediatr Pulmonol, 2019, 54(2): 117-124. PMID: 30536749. DOI: 10.1002/ppul.24201.
8 Medeiros D, Castro P, Bianca ACD, et al. Impulse oscillometry: pulmonary function assessment in preschool children[J]. Expert Rev Respir Med, 2020, 14(12): 1261-1266. PMID: 32852224. DOI: 10.1080/17476348.2020.1813573.
9 Navanandan N, Hamlington KL, Mistry RD, et al. Oscillometry for acute asthma in the pediatric emergency department: a feasibility study[J]. Ann Allergy Asthma Immunol, 2020, 125(5): 607-609. PMID: 32652127. PMCID: PMC7606793. DOI: 10.1016/j.anai.2020.07.002.
10 中华医学会儿科学分会呼吸学组肺功能协作组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺功能及气道非创伤性炎症指标系列指南(七): 呼出气体一氧化氮监测[J]. 中华实用儿科临床杂志, 2017, 32(21): 1622-1627. DOI: 10.3760/cma.j.issn.2095-428X.2017.21.006.
11 Guo FH, Comhair SA, Zheng S, et al. Molecular mechanisms of increased nitric oxide (NO) in asthma: evidence for transcriptional and post-translational regulation of NO synthesis[J]. J Immunol, 2000, 164(11): 5970-5980. PMID: 10820280. DOI: 10.4049/jimmunol.164.11.5970.
12 National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management[EB/OL]. (2021-03-22)[2022-03-29]. https://www.nice.org.uk/guidance/ng80.
13 方思, 陈树煜, 何熹, 等. 呼出气一氧化氮与脉冲振荡技术对亚急性咳嗽患者筛查咳嗽变异性哮喘的价值[J]. 中华医学杂志, 2017, 97(30): 2338-2343. PMID: 28822450. DOI: 10.3760/cma.j.issn.0376-2491.2017.30.005.
14 Liu L, Liu W, Liu C, et al. Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry[J]. Clin Respir J, 2018, 12(2): 483-490. PMID: 27606596. DOI: 10.1111/crj.12548.
15 Zeng J, Chen Z, Hu Y, et al. Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide[J]. Respir Med, 2018, 145: 8-13. PMID: 30509720. DOI: 10.1016/j.rmed.2018.10.009.
16 中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2016年版)[J]. 中华儿科杂志, 2016, 54(3): 167-181. PMID: 26957061. DOI: 10.3760/cma.j.issn.0578-1310.2016.03.003.
17 Wang EE, Milner RA, Navas L, et al. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections[J]. Am Rev Respir Dis, 1992, 145(1): 106-109. PMID: 1731571. DOI: 10.1164/ajrccm/145.1.106.
18 吴琳琳, 黄晗, 叶乐平. 学龄期儿童哮喘检测呼出气一氧化氮、肺功能及外周血嗜酸性粒细胞的价值[J]. 临床肺科杂志, 2021, 26(10): 1501-1506. DOI: 10.3969/j.issn.1009-6663.2021.10.010.
19 Bokov P, Bafunyembaka G, Medjahdi N, et al. Cross-sectional phenotyping of small airway dysfunction in preschool asthma using the impulse oscillometry system[J]. J Asthma, 2021, 58(5): 573-585. PMID: 31958254. DOI: 10.1080/02770903.2020.1719133.
20 Lauhkonen E, Riikonen R, T?rm?nen S, et al. Impulse oscillometry at preschool age is a strong predictor of lung function by flow-volume spirometry in adolescence[J]. Pediatr Pulmonol, 2018, 53(5): 552-558. PMID: 29484853. DOI: 10.1002/ppul.23977.
21 Chen L, Wu L, Lu D, et al. The value of fractional exhaled nitric oxide and impulse oscillometric and spirometric parameters for predicting bronchial hyperresponsiveness in adults with chronic cough[J]. J Asthma Allergy, 2021, 14: 1065-1073. PMID: 34447255. PMCID: PMC8384260. DOI: 10.2147/JAA.S326879.
22 Deng X, Ma J, Yuan Y, et al. Association between overweight or obesity and the risk for childhood asthma and wheeze: an updated meta-analysis on 18 articles and 73 252 children[J]. Pediatr Obes, 2019, 14(9): e12532. PMID: 31033249. DOI: 10.1111/ijpo.12532.
23 Xu D, Wang Y, Chen Z, et al. Prevalence and risk factors for asthma among children aged 0-14 years in Hangzhou: a cross-sectional survey[J]. Respir Res, 2016, 17(1): 122. PMID: 27677381. PMCID: PMC5039889. DOI: 10.1186/s12931-016-0439-z.
24 中华医学会变态反应分会儿童过敏和哮喘学组, 中华医学会儿科学分会呼吸学组哮喘协作组, 《中国实用儿科杂志》编辑委员会. 建立中国6岁以下儿童哮喘诊断标准的探讨[J]. 中国实用儿科杂志, 2018, 33(11): 870-876. DOI: 10.19538/j.ek2018110615.
25 武玉华, 李芳君, 菅旭禾, 等. 儿童喘息性疾病影响因素分析[J]. 现代医药卫生, 2020, 36(13): 1970-1972. DOI: 10.3969/j.issn.1009-5519.2020.13.005.
26 冯雍, 张皓, 尚云晓. 我国儿童肺功能的发展历程及展望[J]. 国际儿科学杂志, 2019, 46(9): 617-621. DOI: 10.3760/cma.j.issn.1673-4408.2019.09.001.
PDF(756 KB)
