肺功能检查及呼出气一氧化氮在儿童支气管哮喘规范化管理中的应用

Application of pulmonary function and fractional exhaled nitric oxide tests in the standardized management of bronchial asthma in children

摘要:

目的 探讨肺功能与呼出气一氧化氮（FeNO）在儿童支气管哮喘规范化治疗过程中的变化及意义。方法 选取254例初诊、急性发作期的支气管哮喘患儿作为研究对象，按照有无合并过敏性鼻炎分为合并鼻炎组与未合并鼻炎组，并以62例健康儿童作为对照组。哮喘患儿均给予规范化治疗，于治疗初始以及治疗3、6、9、12个月复查肺功能及FeNO水平；对照组测定一次肺功能和FeNO。结果 规范治疗1年中第1秒用力呼气容积（FEV1）、最高呼气流速（PEF）、最大呼气中段流量（MMEF），以及最大呼气25%、50%及75%肺活量的瞬间流速（MEF25、MEF50、MEF75）均逐渐升高，FeNO水平逐渐降低（P < 0.05）。治疗6个月后PEF、FEV1等大气道功能指标基本恢复；9个月后MMEF、MEF25、MEF50、MEF75等小气道功能指标基本恢复；1年后大小气道功能指标与对照组的差异均无统计学意义（P > 0.05），而FeNO水平仍高于对照组（P < 0.05）。治疗初始及3个月时，合并鼻炎组的哮喘患儿FeNO均高于未合并鼻炎组（P < 0.05）。治疗初始FeNO水平与肺功能各项指标均存在负相关（P < 0.05）。结论 哮喘儿童的规范化治疗过程中，肺功能参数逐渐升高，FeNO水平逐渐下降，大气道功能的恢复早于小气道功能，另外也要注意鼻炎对气道反应性的影响。

Abstract:

Objective To investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children. Methods A total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups:asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once. Results During one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P < 0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P > 0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P < 0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P < 0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P < 0.05). Conclusions With the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.