肺常规通气功能、嗜酸性粒细胞计数及皮肤点刺试验在儿童哮喘和咳嗽变异性哮喘中的临床价值分析

发布时间：2018-08-07 16:02

【摘要】：目的：探讨肺常规通气功能、外周血嗜酸性粒细胞计数以及皮肤点刺试验在儿童哮喘与咳嗽变异性哮喘中的临床价值及意义。方法：随机选择2010年5月至2010年11月就诊于河北省儿童医院呼吸科门诊，年龄5～12岁，确诊为哮喘或咳嗽变异性哮喘的患儿80例，分为①哮喘急性发作组（A组）33例，平均年龄（7.96±2.12）岁，男21例；②哮喘缓解组（B组）27例，平均年龄（7.97±1.91）岁，男17例；③咳嗽变异性哮喘组（C组）20例，平均年龄（8.03±2.18）岁，男13例；同时随机选择同时期儿童保健科正常健康体检儿童30例，作为对照组（D组），平均年龄(8.58±2.11)岁，男16例。各组儿童年龄、性别、身高、体重等差异无统计学意义。检测项目四组均分别进行下列检查1肺常规通气功能检测，采用德国Jaeger公司生产的Master Screen肺功能仪测定用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)、用力呼气75%流速(FEF75)、最大呼气中期流速(MMEF75/25)等7项指标。2皮肤点刺试验，采用浙江我武生物科技有限公司提供的变应原点刺液共23种（其中吸入组14种，食物组8种及组胺用于阳性对照）进行变应原检测；0.9%氯化钠溶液用于阴性对照。由于哮喘急性发作时禁行皮肤点刺试验，故A组患儿未进行该试验。试验前准备抢救药品，向患儿及家长交代本试验的目的、方法及注意事项，并与家长签订知情同意书，详细记录患儿的一般情况。试验期间密切观察患儿反应，发现异常及时处理。3外周血血常规检查，采用指尖采血法取外周血经美国贝克曼库尔特ACT5diffAL血细胞分析仪检测计Eos绝对值，认为Eos绝对值超过0.5×10^9为升高。数据分析应用SPSS16.0软件对研究数据进行统计分析，正态分布资料以x±s表示，采用方差分析比较；频数资料采用卡方检验；相关分析采用双变量相关分析；认为p0.05有统计学意义。结果： 1、四组儿童肺常规通气功能比较 1.1A、B、C三组患儿与D组儿童肺常规通气功能比较 A组患儿各项肺常规通气功能指标均明显低于D组儿童（p0.01）； B组患儿肺常规通气功能指标FVC、FEV1、FEF25、FEF50、MMEF75/25均低于D组儿童（p0.05），其中FVC、FEV1、FEF25明显低于D组（p0.01）；而其他指标PEF、FEF75均与D组差异无统计学意义（p0.05）； C组患儿肺常规通气功能指标FVC、FEV1、FEF25、FEF75、MMEF75/25均低于D组儿童（p0.05），其中FVC、FEF75、MMEF75/25明显低于D组（p0.01）；而其他指标PEF、FEF50均与D组差异无统计学意义（p0.05）。 1.2A、B、C三组患儿比较 A组患儿各项肺常规通气功能指标均分别明显低于B组、C组（p0.01）； B、C组患儿各项肺常规通气功能指标差异均无统计学意义（p0.05）。可见A、B、C三组患儿各项肺常规通气功能指标均低于D组儿童，（B、C组除外PEF、FEF50、FEF75）；且A组各项肺功能指标均明显低于B和C组；但B、C两组患儿差异无统计学意义。 2、各组患儿Eos计数比较所有儿童进行外周血血常规检测，A组升高者30例（90.91%），B组升高者14例（51.85%），C组升高者13例（65%），D组无升高（0）。 2.1A、B、C三组患儿Eos计数绝对值均明显高于D组（p0.01）。 2.2A、B、C三组患儿比较：A组明显高于B组、C组（p0.01）；而B组与C组差异无统计学意义(p0.05)。 3、皮肤点刺试验 B、C、D三组儿童共77人进行本试验，阳性率为B组70.4%（19/27），C组55%（11/20），，D组0，BC组总阳性率63.83%（30/47）。 3.1B组与C组点刺结果分析：x2=1.18，p=0.28，两组差异无统计学意义(p0.05)，认为B、C组进行皮肤点刺试验寻找变应原结果是一致的。 3.2B、C组患儿变应原均以吸入性为主，主要为粉尘螨、户尘螨；而D组儿童未找到变应原。 4、皮肤点刺试验阳性与Eos计数绝对值存在相关性（p0.05），且二者呈正相关（r=0.22）。结论： 1肺常规通气功能检测可以评价哮喘与咳嗽变异性哮喘患儿的气道阻塞程度,对于诊断及病情评估有重要意义，可以指导临床用药； 2外周血Eos计数可以作为哮喘与咳嗽变异性哮喘诊断的初筛指标； 3皮肤点刺试验操作简便，痛苦小，是寻找变应原的可靠方法； 4本地区哮喘与咳嗽变异性哮喘患儿的变应原均以吸入性为主，主要是粉尘螨、户尘螨。肺常规通气功能检测，对哮喘及咳嗽变异性哮喘的诊断、病情评估及疗效判定有重要意义。外周血Eos计数可作为变态反应性气道炎症的初筛指标，尤其适于反复发作的难治性咳喘的病因分析。皮肤点刺试验能反映机体特异性体质，是寻找变应原的可靠方法，二者在哮喘与咳嗽变异性哮喘的诊断中具有同等重要价值。
[Abstract]:Objective: To explore the clinical value and significance of pulmonary routine ventilation, peripheral eosinophil count and skin prick test in children with asthma and cough variant asthma.
Methods: in the Department of respiration of the Department of respiration, Hebei children's Hospital from May 2010 to November 2010, 80 children aged 5~12 years old were diagnosed with asthma or cough variant asthma. They were divided into 33 cases of asthma acute attack group (group A), average age (7.96 + 2.12) years, male 21 cases, and 27 cases of asthma remission group (group B), average age (7.97 + 1.91). 17 males and 20 cases of cough variant asthma group (group C), the average age (8.03 + 2.18) years and 13 males, and 30 cases of normal healthy children in the same period children's health care department were randomly selected as the control group (group D) with the average age of (8.58 + 2.11) years and 16 men. There was no statistical difference in the age, sex, height and weight of the children.
The four groups were tested for 1 lung ventilation functions, respectively, using the Master Screen lung function instrument produced by the German Jaeger company to determine the forced expiratory capacity (FVC), one second forced expiratory volume (FEV1), maximum expiratory flow rate (PEF), forced expiratory 25% flow rate (FEF25), forced expiratory flow rate (FEF50), and forced expiratory 75% flow rate (FEF75) 7 index.2 skin prick tests, such as maximum expiratory midbreath velocity (MMEF75/25), used by Zhejiang China Science and Technology Co., Ltd. to provide 23 kinds of allergen spines (including 14 inhalation groups, 8 food groups and histamine for positive control) and 0.9% Sodium Chloride Solution for negative control. During the attack, the skin prick test was forbidden, so the children in group A did not carry out the test. Before the test, the drug was prepared, the purpose, the method and the attention of the children and the parents were given, and the informed consent was signed with the parents, and the general situation of the children was recorded in detail. During the trial, the children's reaction was closely observed and the abnormal treatment of the peripheral blood of the.3 was found in time. Blood routine examination, using the fingertip blood sampling method to take the peripheral blood from the American Beckman Kurt ACT5diffAL blood cell analyzer to detect the absolute value of Eos, the absolute value of Eos is more than 0.5 x 10^9.
The data analysis was analyzed by SPSS16.0 software. The normal distribution data were expressed in X + s, and the variance analysis was compared. The frequency data were checked by chi square test, and the correlation analysis adopted the bivariate correlation analysis, and the P0.05 had statistical significance.
Result:
Comparison of pulmonary routine ventilation function in 1 and four groups of children
Comparison of pulmonary ventilation function between three groups of 1.1A, B and C children and D group
The pulmonary ventilation function indexes of children in group A were significantly lower than those in group D (P0.01).
FVC, FEV1, FEF25, FEF50 and MMEF75/25 in group B were lower than those in group D (P0.05), and FVC, FEV1, FEF25 were significantly lower than those in the D group.
FVC, FEV1, FEF25, FEF75 and MMEF75/25 in group C were lower than those in group D (P0.05), and FVC, FEF75, MMEF75/25 were significantly lower than those in the D group.
Comparison of three groups of children with 1.2A, B and C
The pulmonary ventilation function indexes of children in group A were significantly lower than those in group B, group C (P0.01).
There was no significant difference in pulmonary ventilation function between B group and C group (P0.05).
The lung function indexes of A, B and C three groups were lower than those in group D (B, group C except PEF, FEF50, FEF75), and the pulmonary function indexes of the A group were lower than B and C groups, but there was no statistical difference between the two groups.
2, Eos count comparison of children in each group
Routine peripheral blood test was performed in all the children. 30 cases (90.91%) in group A, 14 cases (51.85%) in group B, 13 cases (65%) in group C, and no increase (0) in group D.
The absolute values of Eos count in group 2.1A, B and C were significantly higher than those in group D (P0.01) in the three groups.
2.2A, B, C three groups of children: A group was significantly higher than that of group B, C group (P0.01), while B group and C group had no significant difference (P0.05).
3, skin pricking test
The positive rate was 70.4% (19/27) in group B, 55% (11/20) in group C, 0 in group D and 63.83% (30/47) in group BC.
Analysis of the results of prick in group 3.1B and group C: x2=1.18, p=0.28, there was no significant difference between the two groups (P0.05). The results of skin pricking test in group C were consistent with the results of skin pricking test in group C.
Allergens in group 3.2B and C were mainly inhaled, mainly Dermatophagoides Dermatophagoides and mites, while D group did not find allergens.
4, positive skin prick test was correlated with the absolute value of Eos count (P0.05), and the two were positively correlated (r=0.22).
Conclusion:
1 pulmonary routine ventilation function test can evaluate the degree of airway obstruction in children with asthma and cough variant asthma. It is of great significance for the diagnosis and evaluation of the disease, and can guide the clinical use of drugs.
2 peripheral blood Eos count can be used as a screening indicator for the diagnosis of asthma and cough variant asthma.
3 skin prick test is simple and painless. It is a reliable method for finding allergens.
4 the allergens of children with asthma and cough variant asthma are mainly inhaled, mainly Dermatophagoides Dermatophagoides and mites.
The detection of pulmonary routine ventilation is of great significance to the diagnosis of asthma and cough variant asthma. The Eos count in peripheral blood can be used as a preliminary screening index for allergic airway inflammation, especially for the cause analysis of refractory cough and asthma. Skin pricking test can reflect the body specific constitution, and it is a search for the body. Two reliable methods for finding allergens are equally important in the diagnosis of asthma and cough variant asthma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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