呼出气一氧化氮联合体外过敏原检测对识别反复喘息患儿中哮喘高危患儿的意义

Clinical significance of fractional exhaled nitric oxide combined with in vitro allergen test in identifying children at a high risk of asthma among those with recurrent wheezing

摘要:

目的 探讨体外过敏原、呼出气一氧化氮（FeNO）联合检测对识别反复喘息患儿中哮喘高危患儿的临床价值。方法 选取反复喘息患儿148例（0.5~6岁）为研究对象，80例门诊健康体检儿童为对照组。采用Pharmacia UniCAP免疫检测分析仪测定特异性免疫球蛋白（sIgE），纳库仑一氧化氮分析仪检测FeNO，并评估哮喘预测指数（API）。结果 148例反复喘息患儿中，sIgE阳性102例，阳性率为68.9%，明显高于对照组（11.3%，9/80）（P < 0.05）。喘息组患儿FeNO检测值及阳性率均明显高于对照组（P < 0.05）。喘息患儿的API总阳性率为32.4%，而API阳性患儿FeNO检测值为51±6 ppb，明显高于API阴性患儿（13±5 ppb）（P < 0.05）。sIgE阳性患儿中API阳性检出率为40.2%（41/102），FeNO阳性患儿中API阳性检出率为50.1%（38/73），二者阳性率比较差异无统计学意义。sIgE阳性+FeNO阳性组患儿中API阳性检出率为81.4%，明显高于sIgE、FeNO二者单独阳性组（P < 0.05）。结论 FeNO、体外过敏原联合检测对反复喘息患儿中哮喘高危患儿的检出率明显优于二者单独检测，二者联合检测为儿童哮喘的早期识别诊断、干预提供了良好的手段。

Abstract:

Objective To investigate the clinical value of combined determination of in vitro allergens and fractional exhaled nitric oxide (FeNO) in indentifying children at a high risk of asthma among those with recurrent wheezing. Methods A total of 148 children with recurrent wheezing (0.5-6 years old) were enrolled as study subjects, and 80 healthy children who underwent physical examination were enrolled as the control group. Pharmacia UniCAP immunoassay analyzer was used to measure specific immunoglobulin E (sIgE). Nano Coulomb Nitric Oxide Analyzer was used to measure FeNO. The asthma predictive index (API) was evaluated. Results The recurrent wheezing group had a significantly higher proportion of children with positive sIgE than the control group[68.9% (102/148) vs 11.3% (9/80); P < 0.05]. The recurrent wheezing group also had significantly higher levels and positive rate of FeNO than the control group (P < 0.05). The overall positive rate of API in children with wheezing was 32.4%, and the API-positive children had a significantly higher FeNO value than the API-negative children (51±6 ppb vs 13±5 ppb; P < 0.05). The detection rate of API was 40.2% (41/102) in positive-sIgE children and 50.1% (38/73) in FeNO-positive children, and there was no significant difference between these two groups. The children with positive sIgE and FeNO had a significantly higher detection rate of API (81.4%) than those with positive sIgE or FeNO (P < 0.05). Conclusions Combined determination of FeNO and in vitro allergens is more sensitive in detecting children at a high risk of asthma than FeNO or in vitro allergens determination alone and provides a good method for early identification, diagnosis, and intervention of asthma in children.