本文選題：呼出氣一氧化氮 + 兒童��； 參考：《山東大學(xué)》2013年碩士論文

【摘要】：目的：多方面評價呼出氣一氧化氮(Exhaled Nitric Oxide, ENO)檢測在兒童哮喘診斷和管理過程中的臨床價值。 方法：1.收集2012年3月至12月在山東省立醫(yī)院兒科門診就診的7-13歲哮喘患兒共155例(觀察組),包括首次就診且既往6個月內(nèi)未應(yīng)用激素治療者33例(非激素治療組)和已在我院規(guī)范吸入激素(Inhaled corticosteroid, ICS)治療1月以上者122例(激素治療組)。155例哮喘患者根據(jù)控制水平不同,分為未控制組(30例)、部分控制組(67)例和完全控制組(58例),各組根據(jù)有無過敏相關(guān)性疾病家族史分別分為有家族史組和無家族史組。根據(jù)非激素治療組患者是否在首次就診后的15天、30天、90天按時復(fù)診,共收集到21例哮喘患者復(fù)診的完整資料,余12例哮喘患者因各種原因未能按時復(fù)診。同時,我們在濟南市某就近小學(xué)篩選出50名7-13歲健康兒童,作為對照組。所有入選兒童均進行呼出氣一氧化氮、肺功能檢測及外周血嗜酸性粒細胞計數(shù)檢查。2.以中華醫(yī)學(xué)會兒科分會呼吸學(xué)組2008年修訂的兒童哮喘診斷標(biāo)準(zhǔn)為哮喘診斷的標(biāo)準(zhǔn),并繪制受試者工作曲線(receiver operating characteristic,(ROC)curves),得出ENO檢測診斷哮喘的界點值,評價ENO檢測對支氣管哮喘的診斷與鑒別診斷價值。 結(jié)果：1.激素治療組、非激素治療組及對照組3組間ENO水平具有顯著統(tǒng)計學(xué)差異,P均0.001,非激素治療組ENO水平最高,激素治療組次之,對照組最低； 2.對照組、未控制組、部分控制組、完全控制組各組間ENO水平均具有顯著統(tǒng)計學(xué)差異,P均0.05,未控制組ENO水平最高,部分控制組和完全控制組次之,對照組最低。 3.未控制組有過敏相關(guān)性疾病家族史組ENO平均水平高于無過敏相關(guān)性疾病家族史組,t=2.221,P=0.035;部分控制組和完全控制組有過敏相關(guān)性疾病家族史組和無過敏相關(guān)性疾病家族史組間,ENO水平均無顯著統(tǒng)計學(xué)差異,P均0.05。 4.ENO水平與患者的外周血EOS%、EOS#均成顯著正相關(guān)關(guān)系(P均0.05),與肺功能各相關(guān)指標(biāo)PEF%、FVC%、FEV1%、FEF25%、FEF50%、FEF75%均無相關(guān)性關(guān)系(P均0.05)； 5.規(guī)范治療90天復(fù)診ENO水平顯著低于首次就診、15天復(fù)診及30天復(fù)診時的ENO水平,P均0.05：患者15天復(fù)診時ENO水平顯盟著低于首次就診時的ENO水平,P0.05：忠者15天復(fù)診及30天復(fù)診ENO水平間無顯著差異,P均().()5： 6.對觀察組及對照組兒童作受試者工作特征曲線,ROC曲線下面積為0.929,面積的標(biāo)準(zhǔn)誤為0.018,選擇ENO值為15.45ppb哮喘診斷界點時,靈敏度為81.9%,特異度為96.0%,ENO水平用于診斷哮喘有顯著意義(P=0.000),ENO水平越高,診斷哮喘的可能性越大。結(jié)論： 1.ENO是反應(yīng)氣道炎癥的良好指標(biāo),可作為哮喘篩選、早期診斷和鑒別診斷的工具,評估哮喘控制水平； 2.ENO可用于鑒別以嗜酸細胞氣道炎癥為主的哮喘； 3.有過敏相關(guān)性疾病家族史哮喘忠者較無過敏相關(guān)性疾病家族史者對支氣管l哮喘規(guī)范治療的反應(yīng)好; 4.聯(lián)合應(yīng)用ENO和肺功能檢測可更全面的反映哮喘疾病現(xiàn)狀及控制水平； 5.哮喘規(guī)范治療,可以降低氣道炎癥水平,能很好的監(jiān)測哮喘的治療效果,指導(dǎo)治療；
[Abstract]:Objective: To evaluate the clinical value of Exhaled Nitric Oxide (ENO) in the diagnosis and management of childhood asthma.
Methods: 1. a total of 155 children aged 7-13 years of asthma (observation group) were collected from March 2012 to December in outpatient department of Pediatrics, Shangdong Province-owned Hospital, including 33 non hormone treatment group (non hormone treatment group) for the first time and 6 months of past 6 months (non hormone treatment group) and 122 cases (hormone, hormone, Inhaled, ICS) in our hospital over January (hormone therapy). According to the control level,.155 patients were divided into uncontrolled group (30 cases), partial control group (67) and complete control group (58 cases). Each group was divided into family history group and no family history group according to the family history of allergy related disease. The patients were treated with the non irritable treatment group for 15 days, 30 days, 90 days after the first visit. The complete data of 21 patients with asthma were collected in a total of 21 cases of asthma, and 12 cases of asthmatic patients failed to return on time for various reasons. At the same time, we selected 50 7-13 year old healthy children in a primary school in Ji'nan as the control group. All the selected children were performed exhaled oxygen nitrogen, lung function test and peripheral eosinophil. The diagnostic criteria of children asthma revised by the paediatric department of Pediatrics Department of the Chinese Medical Association in 2008 were the criteria for the diagnosis of asthma, and the working curve of the subjects (receiver operating characteristic, (ROC) curves) was plotted, and the boundary value of the diagnosis and diagnosis of asthma by ENO detection was obtained, and the diagnosis and differential diagnosis of bronchial asthma by ENO detection was evaluated by.2.. Value.
Results: in the 1. hormone treatment group, the level of ENO in the 3 groups of non hormone treatment group and control group had significant statistical difference, P was 0.001, the level of ENO in non hormone treatment group was the highest, and the hormone treatment group was the lowest, and the control group was the lowest.
2. control group, uncontrolled group, partial control group, complete control group ENO level has significant statistical difference, P 0.05, uncontrolled group ENO level is the highest, part control group and complete control group, the control group is the lowest.
3. in the uncontrolled group, the average level of ENO in the family history group was higher than that of the family history group without allergy related disease, t=2.221, P=0.035. There was no significant difference between the family history of allergic disease family history and the family history group without allergy related disease in the partial control group and the complete control group, and there was no significant difference in the level of ENO, P was 0.05..
The level of 4.ENO was significantly correlated with EOS% and EOS# in peripheral blood (P 0.05). There was no correlation with PEF%, FVC%, FEV1%, FEF25%, FEF50% and FEF75% (P 0.05) of all related indexes of lung function.
The level of ENO for 5. standard treatment for 90 days was significantly lower than that of the first visit, and the level of ENO in the 15 days and 30 days was 0.05. The ENO level of the patients was lower than the ENO level at the first visit at 15 days, and there was no significant difference between the faithful and the 30 days in the ENO level, P () 5:
6. to the observation group and the control group, the working characteristic curve of the subjects, the area under the ROC curve was 0.929, the standard of area was 0.018. The sensitivity was 81.9%, the specificity was 96% when ENO was selected as the diagnosis point of 15.45ppb asthma, and the level of ENO was significant (P=0.000). The higher the level of ENO, the greater the possibility of diagnosing asthma. Conclusion:
1.ENO is a good indicator of airway inflammation. It can be used as a tool for screening, early diagnosis and differential diagnosis of asthma, and to evaluate asthma control level.
2.ENO can be used to identify asthma with eosinophilic airway inflammation.
3. family history of allergy related diseases, and those with less family history of allergic diseases had better response to standard l bronchial asthma treatment.
4. combined application of ENO and lung function test can more comprehensively reflect the current situation and control level of asthma.
5. asthma standardized treatment can reduce airway inflammation level, and can monitor asthma treatment effect and guide treatment.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R725.6

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