發(fā)布時(shí)間：2018-08-07 16:02

【摘要】：目的：探討肺常規(guī)通氣功能、外周血嗜酸性粒細(xì)胞計(jì)數(shù)以及皮膚點(diǎn)刺試驗(yàn)在兒童哮喘與咳嗽變異性哮喘中的臨床價(jià)值及意義。 方法：隨機(jī)選擇2010年5月至2010年11月就診于河北省兒童醫(yī)院呼吸科門診，年齡5～12歲，確診為哮喘或咳嗽變異性哮喘的患兒80例，分為①哮喘急性發(fā)作組（A組）33例，平均年齡（7.96±2.12）歲，男21例；②哮喘緩解組（B組）27例，平均年齡（7.97±1.91）歲，男17例；③咳嗽變異性哮喘組（C組）20例，平均年齡（8.03±2.18）歲，男13例；同時(shí)隨機(jī)選擇同時(shí)期兒童保健科正常健康體檢兒童30例，作為對(duì)照組（D組），平均年齡(8.58±2.11)歲，男16例。各組兒童年齡、性別、身高、體重等差異無(wú)統(tǒng)計(jì)學(xué)意義。 檢測(cè)項(xiàng)目四組均分別進(jìn)行下列檢查1肺常規(guī)通氣功能檢測(cè)，采用德國(guó)Jaeger公司生產(chǎn)的Master Screen肺功能儀測(cè)定用力肺活量(FVC)、一秒鐘用力呼氣容積(FEV1)、最大呼氣峰流速(PEF)、用力呼氣25%流速(FEF25)、用力呼氣50%流速(FEF50)、用力呼氣75%流速(FEF75)、最大呼氣中期流速(MMEF75/25)等7項(xiàng)指標(biāo)。2皮膚點(diǎn)刺試驗(yàn)，采用浙江我武生物科技有限公司提供的變應(yīng)原點(diǎn)刺液共23種（其中吸入組14種，食物組8種及組胺用于陽(yáng)性對(duì)照）進(jìn)行變應(yīng)原檢測(cè)；0.9%氯化鈉溶液用于陰性對(duì)照。由于哮喘急性發(fā)作時(shí)禁行皮膚點(diǎn)刺試驗(yàn)，故A組患兒未進(jìn)行該試驗(yàn)。試驗(yàn)前準(zhǔn)備搶救藥品，向患兒及家長(zhǎng)交代本試驗(yàn)的目的、方法及注意事項(xiàng)，并與家長(zhǎng)簽訂知情同意書(shū)，詳細(xì)記錄患兒的一般情況。試驗(yàn)期間密切觀察患兒反應(yīng)，發(fā)現(xiàn)異常及時(shí)處理。3外周血血常規(guī)檢查，采用指尖采血法取外周血經(jīng)美國(guó)貝克曼庫(kù)爾特ACT5diffAL血細(xì)胞分析儀檢測(cè)計(jì)Eos絕對(duì)值，認(rèn)為Eos絕對(duì)值超過(guò)0.5×10^9為升高。 數(shù)據(jù)分析應(yīng)用SPSS16.0軟件對(duì)研究數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析，正態(tài)分布資料以x±s表示，采用方差分析比較；頻數(shù)資料采用卡方檢驗(yàn)；相關(guān)分析采用雙變量相關(guān)分析；認(rèn)為p0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1、四組兒童肺常規(guī)通氣功能比較 1.1A、B、C三組患兒與D組兒童肺常規(guī)通氣功能比較 A組患兒各項(xiàng)肺常規(guī)通氣功能指標(biāo)均明顯低于D組兒童（p0.01）； B組患兒肺常規(guī)通氣功能指標(biāo)FVC、FEV1、FEF25、FEF50、MMEF75/25均低于D組兒童（p0.05），其中FVC、FEV1、FEF25明顯低于D組（p0.01）；而其他指標(biāo)PEF、FEF75均與D組差異無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）； C組患兒肺常規(guī)通氣功能指標(biāo)FVC、FEV1、FEF25、FEF75、MMEF75/25均低于D組兒童（p0.05），其中FVC、FEF75、MMEF75/25明顯低于D組（p0.01）；而其他指標(biāo)PEF、FEF50均與D組差異無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）。 1.2A、B、C三組患兒比較 A組患兒各項(xiàng)肺常規(guī)通氣功能指標(biāo)均分別明顯低于B組、C組（p0.01）； B、C組患兒各項(xiàng)肺常規(guī)通氣功能指標(biāo)差異均無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）。 可見(jiàn)A、B、C三組患兒各項(xiàng)肺常規(guī)通氣功能指標(biāo)均低于D組兒童，（B、C組除外PEF、FEF50、FEF75）；且A組各項(xiàng)肺功能指標(biāo)均明顯低于B和C組；但B、C兩組患兒差異無(wú)統(tǒng)計(jì)學(xué)意義。 2、各組患兒Eos計(jì)數(shù)比較 所有兒童進(jìn)行外周血血常規(guī)檢測(cè)，A組升高者30例（90.91%），B組升高者14例（51.85%），C組升高者13例（65%），D組無(wú)升高（0）。 2.1A、B、C三組患兒Eos計(jì)數(shù)絕對(duì)值均明顯高于D組（p0.01）。 2.2A、B、C三組患兒比較：A組明顯高于B組、C組（p0.01）；而B(niǎo)組與C組差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。 3、皮膚點(diǎn)刺試驗(yàn) B、C、D三組兒童共77人進(jìn)行本試驗(yàn)，陽(yáng)性率為B組70.4%（19/27），C組55%（11/20），，D組0，BC組總陽(yáng)性率63.83%（30/47）。 3.1B組與C組點(diǎn)刺結(jié)果分析：x2=1.18，p=0.28，兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)，認(rèn)為B、C組進(jìn)行皮膚點(diǎn)刺試驗(yàn)尋找變應(yīng)原結(jié)果是一致的。 3.2B、C組患兒變應(yīng)原均以吸入性為主，主要為粉塵螨、戶塵螨；而D組兒童未找到變應(yīng)原。 4、皮膚點(diǎn)刺試驗(yàn)陽(yáng)性與Eos計(jì)數(shù)絕對(duì)值存在相關(guān)性（p0.05），且二者呈正相關(guān)（r=0.22）。 結(jié)論： 1肺常規(guī)通氣功能檢測(cè)可以評(píng)價(jià)哮喘與咳嗽變異性哮喘患兒的氣道阻塞程度,對(duì)于診斷及病情評(píng)估有重要意義，可以指導(dǎo)臨床用藥； 2外周血Eos計(jì)數(shù)可以作為哮喘與咳嗽變異性哮喘診斷的初篩指標(biāo)； 3皮膚點(diǎn)刺試驗(yàn)操作簡(jiǎn)便，痛苦小，是尋找變應(yīng)原的可靠方法； 4本地區(qū)哮喘與咳嗽變異性哮喘患兒的變應(yīng)原均以吸入性為主，主要是粉塵螨、戶塵螨。 肺常規(guī)通氣功能檢測(cè)，對(duì)哮喘及咳嗽變異性哮喘的診斷、病情評(píng)估及療效判定有重要意義。外周血Eos計(jì)數(shù)可作為變態(tài)反應(yīng)性氣道炎癥的初篩指標(biāo)，尤其適于反復(fù)發(fā)作的難治性咳喘的病因分析。皮膚點(diǎn)刺試驗(yàn)?zāi)芊从硻C(jī)體特異性體質(zhì)，是尋找變應(yīng)原的可靠方法，二者在哮喘與咳嗽變異性哮喘的診斷中具有同等重要價(jià)值。
[Abstract]:Objective: To explore the clinical value and significance of pulmonary routine ventilation, peripheral eosinophil count and skin prick test in children with asthma and cough variant asthma.
Methods: in the Department of respiration of the Department of respiration, Hebei children's Hospital from May 2010 to November 2010, 80 children aged 5~12 years old were diagnosed with asthma or cough variant asthma. They were divided into 33 cases of asthma acute attack group (group A), average age (7.96 + 2.12) years, male 21 cases, and 27 cases of asthma remission group (group B), average age (7.97 + 1.91). 17 males and 20 cases of cough variant asthma group (group C), the average age (8.03 + 2.18) years and 13 males, and 30 cases of normal healthy children in the same period children's health care department were randomly selected as the control group (group D) with the average age of (8.58 + 2.11) years and 16 men. There was no statistical difference in the age, sex, height and weight of the children.
The four groups were tested for 1 lung ventilation functions, respectively, using the Master Screen lung function instrument produced by the German Jaeger company to determine the forced expiratory capacity (FVC), one second forced expiratory volume (FEV1), maximum expiratory flow rate (PEF), forced expiratory 25% flow rate (FEF25), forced expiratory flow rate (FEF50), and forced expiratory 75% flow rate (FEF75) 7 index.2 skin prick tests, such as maximum expiratory midbreath velocity (MMEF75/25), used by Zhejiang China Science and Technology Co., Ltd. to provide 23 kinds of allergen spines (including 14 inhalation groups, 8 food groups and histamine for positive control) and 0.9% Sodium Chloride Solution for negative control. During the attack, the skin prick test was forbidden, so the children in group A did not carry out the test. Before the test, the drug was prepared, the purpose, the method and the attention of the children and the parents were given, and the informed consent was signed with the parents, and the general situation of the children was recorded in detail. During the trial, the children's reaction was closely observed and the abnormal treatment of the peripheral blood of the.3 was found in time. Blood routine examination, using the fingertip blood sampling method to take the peripheral blood from the American Beckman Kurt ACT5diffAL blood cell analyzer to detect the absolute value of Eos, the absolute value of Eos is more than 0.5 x 10^9.
The data analysis was analyzed by SPSS16.0 software. The normal distribution data were expressed in X + s, and the variance analysis was compared. The frequency data were checked by chi square test, and the correlation analysis adopted the bivariate correlation analysis, and the P0.05 had statistical significance.
Result:
Comparison of pulmonary routine ventilation function in 1 and four groups of children
Comparison of pulmonary ventilation function between three groups of 1.1A, B and C children and D group
The pulmonary ventilation function indexes of children in group A were significantly lower than those in group D (P0.01).
FVC, FEV1, FEF25, FEF50 and MMEF75/25 in group B were lower than those in group D (P0.05), and FVC, FEV1, FEF25 were significantly lower than those in the D group.
FVC, FEV1, FEF25, FEF75 and MMEF75/25 in group C were lower than those in group D (P0.05), and FVC, FEF75, MMEF75/25 were significantly lower than those in the D group.
Comparison of three groups of children with 1.2A, B and C
The pulmonary ventilation function indexes of children in group A were significantly lower than those in group B, group C (P0.01).
There was no significant difference in pulmonary ventilation function between B group and C group (P0.05).
The lung function indexes of A, B and C three groups were lower than those in group D (B, group C except PEF, FEF50, FEF75), and the pulmonary function indexes of the A group were lower than B and C groups, but there was no statistical difference between the two groups.
2, Eos count comparison of children in each group
Routine peripheral blood test was performed in all the children. 30 cases (90.91%) in group A, 14 cases (51.85%) in group B, 13 cases (65%) in group C, and no increase (0) in group D.
The absolute values of Eos count in group 2.1A, B and C were significantly higher than those in group D (P0.01) in the three groups.
2.2A, B, C three groups of children: A group was significantly higher than that of group B, C group (P0.01), while B group and C group had no significant difference (P0.05).
3, skin pricking test
The positive rate was 70.4% (19/27) in group B, 55% (11/20) in group C, 0 in group D and 63.83% (30/47) in group BC.
Analysis of the results of prick in group 3.1B and group C: x2=1.18, p=0.28, there was no significant difference between the two groups (P0.05). The results of skin pricking test in group C were consistent with the results of skin pricking test in group C.
Allergens in group 3.2B and C were mainly inhaled, mainly Dermatophagoides Dermatophagoides and mites, while D group did not find allergens.
4, positive skin prick test was correlated with the absolute value of Eos count (P0.05), and the two were positively correlated (r=0.22).
Conclusion:
1 pulmonary routine ventilation function test can evaluate the degree of airway obstruction in children with asthma and cough variant asthma. It is of great significance for the diagnosis and evaluation of the disease, and can guide the clinical use of drugs.
2 peripheral blood Eos count can be used as a screening indicator for the diagnosis of asthma and cough variant asthma.
3 skin prick test is simple and painless. It is a reliable method for finding allergens.
4 the allergens of children with asthma and cough variant asthma are mainly inhaled, mainly Dermatophagoides Dermatophagoides and mites.
The detection of pulmonary routine ventilation is of great significance to the diagnosis of asthma and cough variant asthma. The Eos count in peripheral blood can be used as a preliminary screening index for allergic airway inflammation, especially for the cause analysis of refractory cough and asthma. Skin pricking test can reflect the body specific constitution, and it is a search for the body. Two reliable methods for finding allergens are equally important in the diagnosis of asthma and cough variant asthma.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.6

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