上下气道呼出气一氧化氮与哮喘控制水平的相关性研究

母东勤; 潘家华

doi:10.7499/j.issn.1008-8830.2019.05.005

PDF(1112 KB)

HTML

中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (5) : 426-430. DOI: 10.7499/j.issn.1008-8830.2019.05.005

论著·临床研究

上下气道呼出气一氧化氮与哮喘控制水平的相关性研究

母东勤, 潘家华

作者信息 +

Correlation of fractional exhaled nitric oxide in the upper and lower airways with the level of asthma control

MU Dong-Qin, PAN Jia-Hua

Author information +

文章历史 +

摘要

目的探讨联合检测呼出气一氧化氮（FeNO）及鼻呼出气一氧化氮（FnNO）的临床价值及其与哮喘控制水平的关系。方法选取2018年1~6月诊断为哮喘并处于慢性持续期的患儿120例为研究对象。所有患儿进行儿童哮喘控制测试（C-ACT），得分 > 23分为控制组，20~23分为部分控制组，≤ 19分为未控制组，每组各40例；同时依据哮喘患儿有无合并过敏性鼻炎分为未合并鼻炎组（n=55）和合并鼻炎组（n=65）；同期收集健康体检儿童40例为对照组。哮喘患儿及对照组儿童均检测FeNO与FnNO水平。结果不同水平控制组内FeNO值以未控制组最高，部分控制组其次，控制组最低（P < 0.05），其中未控制组及部分控制组FeNO值高于对照组（P < 0.05）；未控制组与部分控制组FnNO值高于完全控制组及对照组（P < 0.05），完全控制组FnNO值高于对照组（P < 0.05）。合并鼻炎组FeNO与FnNO值均高于未合并鼻炎组（P < 0.05）。结论 FeNO可用来评估哮喘控制情况，与FnNO联合可评估上下气道炎症情况，为上下气道联合治疗提供依据。

Abstract

Objective To study the clinical value of combined measurement of fractional exhaled nitric oxide (FeNO) and nasal fractional exhaled nitric oxide (FnNO) and its correlation with the level of asthma control. Methods A total of 120 children who were diagnosed with asthma from January to June, 2018 and were in the chronic persistent stage were enrolled as subjects. The childhood asthma control test (C-ACT) was performed for all the 120 children. According to the C-ACT score, these children were divided into 4 groups:complete control group with a C-ACT score of > 23, partial control group with a C-ACT score of 20-23, and uncontrolled group with a C-ACT score of ≤ 19 (n=40 each). According to the presence or absence of allergic rhinitis, they were divided into 2 groups:non-rhinitis group with 55 children and rhinitis group with 65 children. A total of 40 children who underwent physical examination during the same period of time were enrolled as the control group. FeNO and FnNO levels were measured for all the 120 children. Results The uncontrolled group had the highest level of FeNO, followed by the partial control group and the complete control group (P < 0.05). The uncontrolled and partial control groups had a significantly higher level of FeNO than the control group (P < 0.05). The uncontrolled and partial control groups had a significantly higher level of FnNO than the complete control and control groups (P < 0.05). The rhinitis group had significantly higher FeNO and FnNO levels than the non-rhinitis group (P < 0.05). Conclusions FeNO can be used to assess the level of asthma control in children, and its combination with FnNO may be useful for the evaluation of the degree of inflammation in the upper and lower airways and provide a basis for the combined treatment of the upper and lower airways.

导出引用

母东勤, 潘家华. 上下气道呼出气一氧化氮与哮喘控制水平的相关性研究[J]. 中国当代儿科杂志. 2019, 21(5): 426-430 https://doi.org/10.7499/j.issn.1008-8830.2019.05.005

MU Dong-Qin, PAN Jia-Hua. Correlation of fractional exhaled nitric oxide in the upper and lower airways with the level of asthma control[J]. Chinese Journal of Contemporary Pediatrics. 2019, 21(5): 426-430 https://doi.org/10.7499/j.issn.1008-8830.2019.05.005

参考文献

[1] 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.
[2] Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention[EB/OL]. (2016). https://ginasthma.org/wp-content/uploads/2016/04/wms-GINA-2016-main-report-final.pdf.
[3] 中华医学会儿科学会呼吸学组. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2016, 54(3):167-180.
[4] Horváth I, Barnes PJ, Loukides S, et al. A European Respiratory Society technical standard:exhaled biomarkers in lung disease[J]. Eur Respir J, 2017, 49:1600965.
[5] 侯萍, 单丽沈, 蔡栩栩, 等. 哮喘儿童呼出气一氧化氮与肺功能及哮喘控制测试相关性研究[J]. 中国实用儿科杂志, 2014, 29(9):707-712.
[6] Hanson JR, De Lurgio SA, Williams DD, et al. Office-based exhaled nitric oxide measurement in children 4 years of age and older[J]. Ann Allergy Asthma Immunol, 2013, 111(5):358-363.
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组、小儿学组, 中华儿科杂志编辑委员会. 儿童变应性鼻炎诊断和治疗指南(2010年, 重庆)[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(1):7-8.
[8] Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline:interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5):602-615.
[9] 广州呼吸疾病研究所, 首都医科大学附属北京儿童医院, 卫生部中日友好医院, 等. 中国人呼出气一氧化氮(FeNO)正常值全国多中心研究[J]. 中华全科医学, 2013, 11(3):341-345.
[10] Jang WN, Park IS, Choi CH, et al. Relationships between exhaled nitric oxide and atopy profiles in children with asthma[J]. Allergy Asthma Immunol Res, 2013, 5(3):155-161.
[11] Pavord ID, Beasley R, Agusti A, et al. After asthma:redefining airways diseases[J]. Lancet, 2018, 391(10118):350-400.
[12] Lluncor M, Barranco P, Amaya ED, et al. Relationship between upper airway diseases, exhaled nitric oxide, and bronchial hyperresponsiveness to methacholine[J]. J Asthma, 2018. doi:10.1080/02770903.2018.1429465.[Epub ahead of print]
[13] Visitsunthorn N, Mahawichit N, Maneechotesuwan K. Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children[J]. Respirology, 2017, 22(1):71-77.
[14] Price D, Ryan D, Burden A, et al. Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care[J]. Clin Transl Allergy, 2013, 3(1):37.
[15] Palm JP, Alving K, Lundberg JO. Characterization of airway nitric oxide in allergic rhinitis:the effect of intranasal administration of L-NAME[J]. Allergy, 2015, 58(9):885-892.
[16] Alsaadi MM, Habib SS, Al Muqhem BA, et al. Significance of fractional exhaled nitric oxide measurements in detecting primary ciliary dyskinesia in Saudi children[J]. Saudi Med J, 2013, 34(1):24-28.
[17] Kambara R, Minami T, Akazawa H, et al. Lower airway inflammation in eosinophilic chronic rhinosinusitis as determined by exhaled nitric oxide[J]. Int Arch Allergy Immunol, 2017, 173(4):225-232.
[18] Nakano H, Ide H, Imada M, et al. Reduced nasal nitric oxide in diffuse panbronchiolitis[J]. Am J Respir Crit Care Med, 2000, 162(6):2218-2220.
[19] Oka A, Hirano T, Yamaji Y, et al. Determinants of incomplete asthma control in patients with allergic rhinitis and asthma[J]. J Allergy Clin Immunol Pract, 2017, 5(1):160-164.
[20] Oka A, Matsunaga K, Kamei T, et al. Ongoing allergic rhinitis impairs asthma control by enhancing the lower airway inflammation[J]. J Allergy Clin Immunol Pract, 2014, 2(2):172-178.
[21] Agache I, Akdis CA. Endotypes of allergic diseases and asthma:an important step in building blocks for the future of precision medicine[J]. Allergol Int, 2016, 65(3):243-252.
[22] Kou W, Li X, Yao H, et al. Meta-analysis of the comorbidity rate of allergic rhinitis and asthma in Chinese children[J]. Int J Pediatr Otorhinolaryngol, 2018, 107:131-134.
[23] Bousquet J, Schünemann HJ, Samolinski B, et al. Allergic Rhinitis and its Impact on Asthma (ARIA):achievements in 10 years and future needs[J]. J Allergy Clin Immunol, 2012, 130(5):1049-1062.