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      不同類型及分期兒童哮喘氣道功能及氣道炎癥指標(biāo)的分析

      2020-08-17 01:29:28張瑩艾濤張蕾羅榮華
      健康必讀·下旬刊 2020年8期
      關(guān)鍵詞:咳嗽變異性哮喘肺功能哮喘

      張瑩 艾濤 張蕾 羅榮華

      【摘 要】:目的:分析兒童咳嗽變異性哮喘(CVA)及典型支氣管哮喘(以下簡稱哮喘)的不同分期中氣道功能、氣道炎癥指標(biāo),探討其對(duì)哮喘管理的臨床意義。方法:回顧性分析2016年11月~2017年11月我院收治的CVA患兒56例、典型哮喘臨床緩解期患兒134例、典型哮喘急性發(fā)作期患兒89例、健康體檢兒童80例的用力通氣肺功能FVC、FEV 1、FEF25-75%、呼出氣一氧化氮(FeNO)檢測值。結(jié)果:1、急性期組與緩解期組、CVA組及對(duì)照組相比,F(xiàn)VC%、FEV1%及FEF25-75%明顯降低(P<0.01)。2、急性期組、緩解期組及CVA組與對(duì)照組相比,F(xiàn)eNO值升高(P<0.05)。3、急性期組、緩解期組及CVA組與對(duì)照組相比,F(xiàn)eNO值<20ppb的樣本率明顯降低(p<0.01);FeNO值>35ppb的樣本率明顯升高(p<0.01)。結(jié)論:對(duì)小氣道功能及高FeNO值(>35ppb)的監(jiān)測對(duì)于哮喘的診斷和管理更有臨床意義;CVA的氣道功能損傷及氣道功能炎癥均輕于典型哮喘。

      【關(guān)鍵詞】:兒童;哮喘;咳嗽變異性哮喘;肺功能;呼出氣一氧化氮

      Abstract:Objective: To find the difference of the index of airway function and inflammation between children cough variant asthma and typical asthma , and to investigate the clinic significance of the index for asthma management. Methods: We retrospectively analyzed the index of forced lung function, fractional exhaled nitric oxide(FeNO), and skin prick test in 359 children with cough variant asthma, asthma clinical remission, acute asthma attack, and healthy children in Chengdu womens and childrens central hospital during November 2016 to November 2017. Results: 1. There were significant differences in index of FVC%, FEV1%, and FEF25-75% between the exacerbation group and the other 3 groups (P<0.01). 2. There were differences in values of FeNO and the positive rates of skin prick between the asthma groups and the control group(P<0.05). 3.There were significant differences in the percentage of children with FeNO <20ppb and >35ppb between the asthma groups and the control group(P<0.01). Conclusion:Small airway function damage and the high FeNO (>35ppb) is more helpful for diagnose and management of asthma; The airway inflammation and impaired airway function of typical asthma are more serious than CVA.

      Keywords: Children; Asthma; Cough variant asthma(CVA); Lung function; Fractional exhaled nitric oxide

      【中圖分類號(hào)】R725.6【文獻(xiàn)標(biāo)識(shí)碼】A【文章編號(hào)】1672-3783(2020)08-24--01

      支氣管哮喘(以下簡稱哮喘)是兒童常見的呼吸道慢性疾病,近年我國兒童哮喘患病率呈明顯上升趨勢,哮喘嚴(yán)重影響患兒的身心健康,也給家庭和社會(huì)帶來沉重的精神及經(jīng)濟(jì)負(fù)擔(dān),早期診斷、干預(yù)和規(guī)范化管理有利于控制疾病、改善預(yù)后及減輕家庭和社會(huì)負(fù)擔(dān)。2018年GINA更強(qiáng)調(diào)了應(yīng)重視哮喘的管理而避免未來風(fēng)險(xiǎn)的發(fā)生[1]。典型哮喘表現(xiàn)為反復(fù)發(fā)作的喘息,咳嗽變異性哮喘(cough variant asthma,CVA)是一種以咳嗽為主要或單一癥狀的特殊類型的哮喘。目前兒童哮喘尚缺乏特異性的確診依據(jù),其診斷、分型及管理主要依據(jù)臨床表現(xiàn)、體征和肺功能指標(biāo)等[2]。用力通氣肺功能檢測是評(píng)價(jià)氣道功能的有力手段;呼出氣一氧化氮(fractional exhaled nitric oxide,F(xiàn)eNO)測定技術(shù)趨于成熟,可以無創(chuàng)的反映氣道嗜酸性粒細(xì)胞性炎癥,已被學(xué)術(shù)界認(rèn)可用于哮喘的診斷和指導(dǎo)治療[3]。本研究旨在分析不同類型及不同分期的兒童哮喘氣道功能及氣道炎癥的指標(biāo),進(jìn)一步探討其在兒童哮喘管理中的臨床意義。

      1 對(duì)象與方法

      1.1 研究對(duì)象

      選擇2016年11月至2017年11月于我院就診行用力通氣肺功能、FeNO的359例兒童,其中CVA56例(CVA組)、典型哮喘臨床緩解期患兒134例(以下簡稱緩解期組)、典型哮喘急性發(fā)作期患兒89例(以下簡稱發(fā)作期組)、健康體檢兒童80例(對(duì)照組)。納入標(biāo)準(zhǔn):依從性好,可完成用力通氣肺功能、FeNO;近2周無糖皮質(zhì)激素、白三烯受體拮抗劑應(yīng)用史及被動(dòng)吸煙病史。排除標(biāo)準(zhǔn):有心臟病、肺結(jié)核、支氣管異物、支氣管肺發(fā)育不良及其他先天性氣道畸形等疾病患兒?;純涸\斷和病情評(píng)估符合兒童哮喘診斷與防治指南(2016年版)[2]。本研究已經(jīng)過我院醫(yī)學(xué)倫理委員會(huì)審核批準(zhǔn)。

      中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)呼吸學(xué)組肺功能協(xié)作組,《中華實(shí)用兒科臨床雜志》編輯委員會(huì). 兒童肺功能系列指南(二):肺容積和通氣功能[J]. 中華實(shí)用兒科雜志,2016,31(10):744-50.

      American Thoracic Society, European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005[J]. Am J Respir Crit Care Med, 2005,171(8):912-30.

      Fujimura M. Pathophysiology, diagnosis and treatment of cough variant asthma[J]. Rinsho Byori, 2014,62(5):464-70.

      Usmani OS. Small airways dysfunction in asthma: evaluation and management to improve asthma control[J]. Allergy Asthma Immunol Res, 2014, 6(5):376-88.

      Liu X, Wang X, Yao X,et al. Value of Exhaled Nitric Oxide and FEF25–75 in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis[J]. Allergy Asthma Immunol Res, 2019,11(6):830-45.

      Feng-jia C, Xin-yan H, Geng Peng L, et al. Validity of fractional exhaled nitric oxide and small airway function indices in diagnosis of cough-variant asthma[J]. Journal of Asthma, 2018,7(55):750-55.

      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):602-15.

      Bjermer L, Alving K, Diamant Z, et al. Current evidence and future research needs for FeNO measurement in respiratory diseases[J]. Respir Med, 2014,108(6):830-41.

      Di Cara G, Marcucci F, Palomba A, et al. Exhaled nitric oxide in children with allergic rhinitis: a potential biomarker of asthma development[J]. Pediatr Allergy Immunol, 2015,26(1):85-7.

      Kim YH, Park HB, Kim MJ, et al. Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis[J]. Allergy Asthma Immunol Res, 2014, 6(1): 27-32.

      Ritz T, Kullowatz A, Bill MN, et al. Daily life negative mood and exhaled nitric oxide in asthma[J]. Biol Psychol, 2016,7(118):176-83.

      Lu M, Wu B, Che D, et al. FeNO and Asthma Treatment in Children: A Systematic Review and Meta-Analysis[J]. Medicine, 2015,4(94):1-8.

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