FeNO、EOS与喘息性支气管炎患儿肺功能的相关性及对哮喘的预测价值

Correlation of FeNO and EOS with pulmonary function in children with asthmatic bronchitis and its predictive value for asthma

摘要:

目的 探究呼出气一氧化氮（FeNO）、外周血嗜酸性粒细胞（EOS）与喘息性支气管炎患儿肺功能的相关性及对哮喘的预测价值。方法 回顾性分析2020年6月—2022年6月武汉市第一医院儿科收治的132例喘息性支气管炎患儿的病历资料。参考改良哮喘预测指数（mAPI）将患儿分为哮喘发作组26例和喘息性支气管炎组106例。收集患儿入院时FeNO、EOS及肺功能指标的水平；Pearson法分析FeNO、EOS与喘息性支气管炎患儿肺功能指标的相关性，绘制受试者工作特征（ROC）曲线评估FeNO、EOS对喘息性支气管炎患儿发生哮喘的预测效能。结果 哮喘发作组的FeNO、EOS高于喘息性支气管炎组（P <0.05）。哮喘发作组的呼吸道总阻力、中心呼吸道阻力、周边弹性阻力及响应频率均高于喘息性支气管炎组（P <0.05）；喘息性支气管炎患儿的FeNO与呼吸道总阻力（r =0.801，P =0.001）、中心呼吸道阻力（r =0.648，P =0.001）、周边弹性阻力（r =0.723，P =0.001）及响应频率（r =0.651，P =0.001）均呈正相关；喘息性支气管炎患儿的EOS与呼吸道总阻力（r =0.736，P =0.001）、中心呼吸道阻力（r =0.612，P =0.001）、周边弹性阻力（r =0.694，P =0.001）及响应频率（r =0.617，P =0.001）均呈正相关。FeNO、EOS单一及联合预测喘息性支气管炎患儿发生哮喘的敏感性分别为65.4%（95% CI：0.443，0.821）、69.2%（95% CI：0.481，0.849）、78.9%（95% CI：0.579，0.914）；特异性分别为71.7%（95% CI：0.619，0.798）、79.8%（95% CI：0.652，0.856）、73.6%（95% CI：0.639，0.814）；曲线下面积分别为0.718（95% CI：0.603，0.858）、0.729（95% CI：0.615，0.864）、0.816（95% CI：0.728，0.913）。结论 FeNO、EOS与喘息性支气管炎患儿的呼吸道总阻力、中心呼吸道阻力、周边弹性阻力及响应频率呈正相关，且可用于预测哮喘的发生。

Abstract:

Objective To explores the correlation between fractional exhaled nitric oxide (FeNO), peripheral blood eosinophils (EOS), and pulmonary function in children with wheezing bronchitis (WB) and their predictive value for asthma.Methods A retrospective analysis of medical records from 132 cases of wheezing bronchitis in children admitted to Wuhan First Hospital from June 2020 to June 2022 was conducted. Using the modified Asthma Predictive Index (mAPI) as a reference, the children were categorized into an asthma attack group (26 cases) and a wheezing bronchitis group (106 cases). Levels of FeNO, EOS, and pulmonary function indicators at admission were collected. Pearson's correlation analysis was employed to assess the correlation between FeNO, EOS, and pulmonary function in children with wheezing bronchitis. Receiver Operating Characteristic (ROC) curves were constructed to evaluate the predictive efficacy of FeNO and EOS for the development of asthma in children with wheezing bronchitis.Results FeNO and EOS levels were higher in the asthma attack group than in the wheezing bronchitis group (P < 0.05). Respiratory total resistance, central airway resistance, peripheral elastic resistance, and response frequency were all higher in the asthma attack group than in the wheezing bronchitis group (P < 0.05). In children with wheezing bronchitis, FeNO showed a positive correlation with respiratory total resistance (r = 0.801, P = 0.001), central airway resistance (r = 0.648, P = 0.001), peripheral elastic resistance (r = 0.723, P = 0.001), and response frequency (r = 0.651, P = 0.001). Similarly, EOS in children with wheezing bronchitis exhibited a positive correlation with respiratory total resistance (r = 0.736, P = 0.001), central airway resistance (r = 0.612, P = 0.001), peripheral elastic resistance (r = 0.694, P = 0.001), and response frequency (r = 0.617, P = 0.001). FeNO and EOS, both individually and in combination, demonstrated sensitivity of 65.4% (95% CI: 0.443, 0.821), 69.2% (95% CI: 0.481, 0.849) and 78.9% (95% CI: 0.579, 0.914), and specificity of 71.7% (95% CI: 0.619, 0.798), 79.8% (95% CI: 0.652, 0.856) and 73.6% (95% CI: 0.639, 0.814), respectively, for predicting the occurrence of asthma in children with wheezing bronchitis. The area under the ROC curve was 0.718 (95% CI: 0.603, 0.858) for FeNO, 0.729 (95% CI: 0.615, 0.864) for EOS, and 0.816 (95% CI: 0.728, 0.913) for their combination.Conclusion FeNO and EOS are positively correlated with respiratory total resistance, central airway resistance, peripheral elastic resistance, and response frequency in children with wheezing bronchitis, and they can be used to predict the occurrence of asthma.