呼出气一氧化氮检测对儿童哮喘临床价值的研究

发布时间：2018-06-07 01:14

本文选题：呼出气一氧化氮 + 儿童　；参考：《山东大学》2013年硕士论文

【摘要】：目的：多方面评价呼出气一氧化氮(Exhaled Nitric Oxide, ENO)检测在儿童哮喘诊断和管理过程中的临床价值。方法：1.收集2012年3月至12月在山东省立医院儿科门诊就诊的7-13岁哮喘患儿共155例(观察组),包括首次就诊且既往6个月内未应用激素治疗者33例(非激素治疗组)和已在我院规范吸入激素(Inhaled corticosteroid, ICS)治疗1月以上者122例(激素治疗组)。155例哮喘患者根据控制水平不同,分为未控制组(30例)、部分控制组(67)例和完全控制组(58例),各组根据有无过敏相关性疾病家族史分别分为有家族史组和无家族史组。根据非激素治疗组患者是否在首次就诊后的15天、30天、90天按时复诊,共收集到21例哮喘患者复诊的完整资料,余12例哮喘患者因各种原因未能按时复诊。同时,我们在济南市某就近小学筛选出50名7-13岁健康儿童,作为对照组。所有入选儿童均进行呼出气一氧化氮、肺功能检测及外周血嗜酸性粒细胞计数检查。2.以中华医学会儿科分会呼吸学组2008年修订的儿童哮喘诊断标准为哮喘诊断的标准,并绘制受试者工作曲线(receiver operating characteristic,(ROC)curves),得出ENO检测诊断哮喘的界点值,评价ENO检测对支气管哮喘的诊断与鉴别诊断价值。结果：1.激素治疗组、非激素治疗组及对照组3组间ENO水平具有显著统计学差异,P均0.001,非激素治疗组ENO水平最高,激素治疗组次之,对照组最低； 2.对照组、未控制组、部分控制组、完全控制组各组间ENO水平均具有显著统计学差异,P均0.05,未控制组ENO水平最高,部分控制组和完全控制组次之,对照组最低。 3.未控制组有过敏相关性疾病家族史组ENO平均水平高于无过敏相关性疾病家族史组,t=2.221,P=0.035;部分控制组和完全控制组有过敏相关性疾病家族史组和无过敏相关性疾病家族史组间,ENO水平均无显著统计学差异,P均0.05。 4.ENO水平与患者的外周血EOS%、EOS#均成显著正相关关系(P均0.05),与肺功能各相关指标PEF%、FVC%、FEV1%、FEF25%、FEF50%、FEF75%均无相关性关系(P均0.05)； 5.规范治疗90天复诊ENO水平显著低于首次就诊、15天复诊及30天复诊时的ENO水平,P均0.05：患者15天复诊时ENO水平显盟著低于首次就诊时的ENO水平,P0.05：忠者15天复诊及30天复诊ENO水平间无显著差异,P均().()5： 6.对观察组及对照组儿童作受试者工作特征曲线,ROC曲线下面积为0.929,面积的标准误为0.018,选择ENO值为15.45ppb哮喘诊断界点时,灵敏度为81.9%,特异度为96.0%,ENO水平用于诊断哮喘有显著意义(P=0.000),ENO水平越高,诊断哮喘的可能性越大。结论： 1.ENO是反应气道炎症的良好指标,可作为哮喘筛选、早期诊断和鉴别诊断的工具,评估哮喘控制水平； 2.ENO可用于鉴别以嗜酸细胞气道炎症为主的哮喘； 3.有过敏相关性疾病家族史哮喘忠者较无过敏相关性疾病家族史者对支气管l哮喘规范治疗的反应好; 4.联合应用ENO和肺功能检测可更全面的反映哮喘疾病现状及控制水平； 5.哮喘规范治疗,可以降低气道炎症水平,能很好的监测哮喘的治疗效果,指导治疗；
[Abstract]:Objective: To evaluate the clinical value of Exhaled Nitric Oxide (ENO) in the diagnosis and management of childhood asthma.
Methods: 1. a total of 155 children aged 7-13 years of asthma (observation group) were collected from March 2012 to December in outpatient department of Pediatrics, Shangdong Province-owned Hospital, including 33 non hormone treatment group (non hormone treatment group) for the first time and 6 months of past 6 months (non hormone treatment group) and 122 cases (hormone, hormone, Inhaled, ICS) in our hospital over January (hormone therapy). According to the control level,.155 patients were divided into uncontrolled group (30 cases), partial control group (67) and complete control group (58 cases). Each group was divided into family history group and no family history group according to the family history of allergy related disease. The patients were treated with the non irritable treatment group for 15 days, 30 days, 90 days after the first visit. The complete data of 21 patients with asthma were collected in a total of 21 cases of asthma, and 12 cases of asthmatic patients failed to return on time for various reasons. At the same time, we selected 50 7-13 year old healthy children in a primary school in Ji'nan as the control group. All the selected children were performed exhaled oxygen nitrogen, lung function test and peripheral eosinophil. The diagnostic criteria of children asthma revised by the paediatric department of Pediatrics Department of the Chinese Medical Association in 2008 were the criteria for the diagnosis of asthma, and the working curve of the subjects (receiver operating characteristic, (ROC) curves) was plotted, and the boundary value of the diagnosis and diagnosis of asthma by ENO detection was obtained, and the diagnosis and differential diagnosis of bronchial asthma by ENO detection was evaluated by.2.. Value.
Results: in the 1. hormone treatment group, the level of ENO in the 3 groups of non hormone treatment group and control group had significant statistical difference, P was 0.001, the level of ENO in non hormone treatment group was the highest, and the hormone treatment group was the lowest, and the control group was the lowest.
2. control group, uncontrolled group, partial control group, complete control group ENO level has significant statistical difference, P 0.05, uncontrolled group ENO level is the highest, part control group and complete control group, the control group is the lowest.
3. in the uncontrolled group, the average level of ENO in the family history group was higher than that of the family history group without allergy related disease, t=2.221, P=0.035. There was no significant difference between the family history of allergic disease family history and the family history group without allergy related disease in the partial control group and the complete control group, and there was no significant difference in the level of ENO, P was 0.05..
The level of 4.ENO was significantly correlated with EOS% and EOS# in peripheral blood (P 0.05). There was no correlation with PEF%, FVC%, FEV1%, FEF25%, FEF50% and FEF75% (P 0.05) of all related indexes of lung function.
The level of ENO for 5. standard treatment for 90 days was significantly lower than that of the first visit, and the level of ENO in the 15 days and 30 days was 0.05. The ENO level of the patients was lower than the ENO level at the first visit at 15 days, and there was no significant difference between the faithful and the 30 days in the ENO level, P () 5:
6. to the observation group and the control group, the working characteristic curve of the subjects, the area under the ROC curve was 0.929, the standard of area was 0.018. The sensitivity was 81.9%, the specificity was 96% when ENO was selected as the diagnosis point of 15.45ppb asthma, and the level of ENO was significant (P=0.000). The higher the level of ENO, the greater the possibility of diagnosing asthma. Conclusion:
1.ENO is a good indicator of airway inflammation. It can be used as a tool for screening, early diagnosis and differential diagnosis of asthma, and to evaluate asthma control level.
2.ENO can be used to identify asthma with eosinophilic airway inflammation.
3. family history of allergy related diseases, and those with less family history of allergic diseases had better response to standard l bronchial asthma treatment.
4. combined application of ENO and lung function test can more comprehensively reflect the current situation and control level of asthma.
5. asthma standardized treatment can reduce airway inflammation level, and can monitor asthma treatment effect and guide treatment.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6

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