摘要
目的探究呼出气一氧化氮(FeNO)联合胸腺基质淋巴细胞生成素(TSLP)对儿童咳嗽变异性哮喘(CVA)与感染后咳嗽(PIC)的鉴别价值,并分析FeNO、TSLP与CVA病情、小气道功能的关系,为临床诊疗提供有利依据。方法选取2021年6月至2023年4月郑州大学第一附属医院儿科诊治收治的90例CVA患儿作为CVA组,另选取同期90例PIC患儿作为PIC组。比较两组患儿的临床资料和FeNO、TSLP水平,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析FeNO联合TSLP对CVA与PIC的鉴别价值;比较CVA不同病情严重程度和病情阶段患儿的小气道功能[FEF25(%)、FEF50(%)、FEF75(%)、FEF25~75(%)]和FeNO、TSLP水平,采用Spearman和Pearson相关系数法分析FeNO、TSLP与CVA小气道功能、病情阶段、病情严重程度的相关性。结果CVA组患儿的FeNO、TSLP水平明显高于PIC组,差异均有统计学意义(P<0.05);ROC分析结果显示,FeNO联合TSLP鉴别CVA与PIC的AUC最大(0.934),敏感度、特异度为87.78%、82.22%,明显高于各指标单独诊断(P<0.05);轻度组患儿的FEF25、FEF50、FEF75和FEF25~75>中度组>重度组,差异均有统计学意义(P<0.05);轻度组患儿的FeNO、TSLP水平<中度组<重度组,差异均有统计学意义(P<0.05);临床缓解期组患儿的FEF25、FEF50、FEF75、FEF25~75明显高于急性发作期组,FeNO、TSLP水平明显低于急性发作期组,差异均有统计学意义(P<0.05);Pearson相关系数法分析结果显示,FeNO、TSLP与FEF25、FEF50、FEF75、FEF25~75均呈负相关(P<0.05);Spearman相关系数法分析结果显示,FeNO、TSLP与病情阶段、病情严重程度均呈正相关(P<0.05)。结论与PIC患儿比较,CVA患儿FeNO、TSLP水平异常升高,其联合鉴别诊断CVA与PIC具有较高价值,且FeNO、TSLP水平与患儿病情、小气道功能密切相关。
Objective To explore the diagnostic value of exhaled nitric oxide(FeNO)combined with thymic stromal lymphopoietin(TSLP)in distinguishing childhood cough variant asthma(CVA)from post-infection cough(PIC),and to analyze the relationship between of FeNO and TSLP with CVA disease severity and small airway function,in order to provide beneficial evidence for clinical diagnosis and treatment.Methods A total of 90 children with CVA admitted to the Department of Pediatrics,the First Affiliated Hospital of Zhengzhou University from June 2021 to April 2023 were selected as the CVA group,and another 90 children with PIC were selected as the PIC group.The clinical data and FeNO and TSLP levels of the two groups of children were compared,and the receiver operating characteristic(ROC)curve and area under the curve(AUC)were plotted to analyze the differential value of FeNO combined with TSLP for CVA and PIC.The small airway function[FEF25(%),FEF50(%),FEF75(%),FEF25-75(%)]and FeNO,TSLP levels of children with different severity and stage of CVA were compared.Spearman and Pearson correlation coefficients were used to analyze the correlation between FeNO,TSLP and small airway function,disease stage,and severity of CVA.Results The levels of FeNO and TSLP in children with CVA were significantly higher than those in children with PIC(P<0.05).ROC analysis showed that the combination of FeNO and TSLP had the highest AUC for distinguishing CVA from PIC(0.934),with a sensitivity of 87.78%and a specificity of 82.22%,which were significantly higher than that of each indicator alone(P<0.05).The FEF25,FEF50,FEF75,and FEF25-75 reduced successively in children with mild CVA,moderate CVA,and severe CVA(P<0.05).The levels of FeNO and TSLP increased successively in children with mild CVA,moderate CVA,and severe CVA,with statistically significant differences(P<0.05).The FEF25,FEF50,and FEF75 in children with clinical remission were significantly higher than those in children with acute exacerbation,and the levels of FeNO and TSLP were significantly lower than those in children with acute exacerbation,with statistically significant differences(P<0.05).Pearson correlation coefficient analysis showed that FeNO and TSLP were negatively correlated with FEF25,FEF50,FEF75,and FEF25-75(P<0.05).Spearman correlation coefficient analysis showed that FeNO and TSLP were positively correlated with disease stage and severity(P<0.05).Conclusion Compared with children with PIC,children with CVA have abnormally elevated levels of FeNO and TSLP.The combined detection of the two indexes has high value in the differential diagnosis of CVA and PIC.The levels of FeNO and TSLP are closely related to the condition and small airway function of children.
作者
高艺伟
马莹莹
张曼
储卫红
彭韶
GAO Yi-wei;MA Ying-ying;ZHANG Man;CHU Wei-hong;PENG Shao(Department of Pediatric Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
CAS
2024年第13期1854-1858,共5页
Hainan Medical Journal
基金
2021年度河南省医学科技攻关计划(编号:LHGJ20212301)。
作者简介
第一作者:高艺伟(1986-),女,硕士,主治医师,主要研究方向为儿科呼吸及风湿免疫性疾病;通讯作者:彭韶(1963-),女,硕士,主任医师,主要研究方向为儿科呼吸及风湿免疫性疾病,E-mail:pengshaodh630@126.com。
