Value of fractional exhaled nitric oxide combined with impulse oscillometry in the diagnosis of asthma in preschool children
GUAN Zhi-Yuan, FENG Yong, HAN Xiao-Hua
Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China (Han X-H, Email: hanxh5519@163.com)
摘要 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
GUAN Zhi-Yuan,FENG Yong,HAN Xiao-Hua. Value of fractional exhaled nitric oxide combined with impulse oscillometry in the diagnosis of asthma in preschool children[J]. CJCP, 2022, 24(9): 1020-1026.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
