文章摘要

呼出气一氧化氮浓度评估糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘的临床疗效

作者: 1张喜, 1陈艳萍
1 湖南省儿童医院呼吸二科,长沙 410007
通讯: 陈艳萍 Email: hnchengyanping@163.com
DOI: 10.3978/j.issn.2095-6959.2020.08.020

摘要

目的:评价呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)浓度对糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘疗效的应用价值。方法:收集156例确诊的咳嗽变异性哮喘患儿,随机分为实验组和对照组各78例,实验组采用糖皮质激素和白三烯受体拮抗剂联合治疗的方法,而对照组只使用糖皮质激素治疗,观察两组患者的临床疗效、肺功能改善情况、炎症因子表达水平、不良反应,分析FeNO浓度与FEV1%pred的关系。结果:实验组和对照组的在临床疗效、临床症状缓解时间、肺功能情况、炎症因子表达方面差异有统计学意义(P<0.05),在不良反应方面两组差异无统计学意义(P>0.05)。FeNO浓度与FEV1%pred存在显著的负相关(r=−0.9491,95%CI=−0.9627~−0.9307,P<0.001),FeNO浓度与PAQLQ量表评分也存在显著的负相关(r=−0.9313,95%CI=−0.9495~−0.9069,P<0.001)。FeNO评估FEV1%pred(%) ROC曲线:AUC=0.807,95%CI=0.735~0.878,P<0.001。约登指数=0.633,FeNO诊断CVA的最佳截断值为40.5 μg/L,敏感度90%,特异度73.3%,阳性预测值93.6%,阴性预测值62.9%。结论:糖皮质激素联合白三烯受体拮抗剂治疗儿童咳嗽变异性哮喘的效果显著,监测治疗前后的FeNO浓度可以评估肺功能的改善情况。
关键词: 糖皮质激素;白三烯受体拮抗剂;咳嗽变异型哮喘;呼出气一氧化氮;第1秒用力呼气量

Exhaled nitric oxide concentration to evaluate the clinical efficacy of glucocorticoids combined with leukotriene receptor antagonists treating children with cough variant asthma

Authors: 1ZHANG Xi, 1CHEN Yanping
1 Second Department of Respiratory Disease, Hunan Provincial Children’s Hospital, Changsha 410007, China

CorrespondingAuthor: CHEN Yanping Email: hnchengyanping@163.com

DOI: 10.3978/j.issn.2095-6959.2020.08.020

Abstract

Objective: To evaluate the value of exhaled nitric oxide concentration in the treatment of cough variant asthma in children, treated with glucocorticoids combined with leukotriene receptor antagonists. Methods: A total of 156 children diagnosed definitely cough variant asthma were randomly divided into the experimental group and the control group (n=78 for each group). The experimental group was treated with a combination of glucocorticoids and leukotriene receptor antagonists, while the control group was treated with glucocorticoids alone. The aim was to observe the clinical efficacy, pulmonary function, inflammatory factor expression level, and adverse reactions between the two groups, analyzing the relationship between FeNO concentration and FEV1%pred. Results: There were statistically significant differences in clinical efficacy, clinical symptom relief time, pulmonary function, and expression of inflammatory factors between the experimental group and the control group (P<0.05). However, there was no significant difference in adverse reactions between the two groups (P>0.05). There was a significant negative correlation between FeNO concentration and FEV1%pred (r=−0.9491, 95%CI: −0.9627 to −0.9307, P<0.001), and there was also a significant negative correlation between FeNO concentration and PAQLQ score (r=−0.9313, 95%CI: −0.9495 to −0.9069, P<0.001). The ROC curve of FeNO to FEV1%pred illustrated that: AUC=0.807, 95%CI: 0.735 to 0.878, P<0.001. Youden index=0.633. The best cutoff value for FeNO diagnosing CVA is at 40.5 μg/L, with 90% sensitivity, 73.3% specificity, 93.6% positive predictive value, and 62.9% negative predictive value. Conclusion: Glucocorticoids combined with leukotriene receptor antagonists have a significant effect on the treatment of cough variant asthma in children. Monitoring FeNO concentration, before and after treatment, can evaluate properly the improvement of lung function.
Keywords: glucocorticoids; leukotriene receptor antagonists; cough variant asthma; fractional exhaled nitric oxide; forced expiratory volume in the first second