呼出气一氧化氮检测对儿童哮喘临床价值的研究

分类号：R7256密级：单位代码：10422学 号：201013241硕士学位论文论文题目：呼出气一氧化氮检测对儿童哮喘临床价值的研究The clinical value of exhaled nitric oxide test for asthma in children作者 姓名 姜壹垩学院 名 称 山峦太堂医堂院专业名称 k科堂指导 教 师 王金墓 教授合作 导 师201 3年4月1 9日愀愀本人郑重声明：所呈交的学位论文，是本人在导师的指导下，独立进行研究所取得的成果。除文中已经注明引用的内容外，本论文不包含任何其他个人或集体已经发表或撰写过的科研成果。对本文的研究作出重要贡献的个人和集体，均已在文中以明确方式标明。本声明的法律责任由本人承担。论文作者签名：羔蟑 日 期：二型幽关于学位论文使用授权的声明本人完全了解山东大学有关保留、使用学位论文的规定，同意学校保留或向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅；本人授权山东大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或其他复制手段保存论文和汇编本学位论文。(保密论文在解密后应遵守此规定)论文作者签名：蔓扭导师签名：论文作者签名：受盈半导师签名：目 录中文摘要l英文摘要3符号说明6调查方法10结 果13讨 论20结 论24附 图25参考文献30综j苤33致 谢45攻读学位期间发表论文46CoNTENTSAbstract in Chinese1Abstract in English3Symbol description6Introduction8Investigation methodResults13Discussion20Conclusion24Figures25References30Reviews33Acknowledgment45List of publications46山东大学硕士学位论文呼出气一氧化氮检测对儿童哮喘临床价值的研究硕士研究生：专 业：导 师：姜春平儿科学(呼吸)王金荣教授中文摘要目的：多方面评价呼出气一氧化氮(Exhaled Nitric Oxide，ENO)检测在儿童哮喘诊断和管理过程中的临床价值。方法：1收集2012年3月至12月在山东省立医院儿科门诊就诊的713岁哮喘患儿共155例(观察组)，包括首次就诊且既往6个月内未应用激素治疗者33例(非激素治疗组)和已在我院规范吸入激素(Inhaled corticosteroid，ICS)治疗1月以上者122例(激素治疗组)。155例哮喘患者根据控制水平不同，分为未控制组(30例)、部分控制组(67)例和完全控制组(58例)，各组根据有无过敏相关性疾病家族史分别分为有家族史组和无家族史组。根据非激素治疗组患者是否在首次就诊后的15天、30天、90天按时复诊，共收集到21例哮喘患者复诊的完整资料，余12例哮喘患者因各种原因未能按时复诊。同时，我们在济南市某就近小学筛选出50名7-13岁健康儿童，作为对照组。所有入选儿童均进行呼出气一氧化氮、肺功能检测及外周血嗜酸性粒细胞计数检查。2以中华医学会儿科分会呼吸学组2008年修订的儿童哮喘诊断标准为哮喘诊断的标准，并绘制受试者工作曲线(receiver operating characteristic，(ROC)curves)，得出ENO检测诊断哮喘的界点值，评价ENO检测对支气管哮喘的诊断与鉴别诊断价值。结果：1激素治疗组、非激素治疗组及对照组3组间ENO水平具有显著统计学差异，P均0001，非激素治疗组ENO水平最高，激素治疗组次之，对照组最低；2对照组、未控制组、部分控制组、完全控制组各组间ENO水平均具有显著统计学差异，P均005。4ENO水平与患者的外周血EOS、EOS#均成显著正相关关系(P均005)；5规范治疗90天复诊ENO水平显著低于首次就诊、15天复诊及30天复诊时的ENO水平，P均005；患者15天复诊时ENO水平显著低于首次就诊时的ENO水平，P005；6对观察组及对照组儿童作受试者工作特征曲线，ROC曲线下面积为0929，面积的标准误为0018，选择ENO值为1545ppb哮喘诊断界点时，灵敏度为819，特异度为96O，ENO水平用于诊断哮喘有显著意义(P=O000)，ENO水平越高，诊断哮喘的可能性越大。结论：1ENO是反应气道炎症的良好指标，可作为哮喘筛选、早期诊断和鉴别诊断的工具，评估哮喘控制水平；2ENO可用于鉴别以嗜酸细胞气道炎症为主的哮喘；3有过敏相关性疾病家族史哮喘患者较无过敏相关性疾病家族史者对支气管哮喘规范治疗的反应好；4联合应用ENO和肺功能检测可更全面的反映哮喘疾病现状及控制水平；5哮喘规范治疗，可以降低气道炎症水平，能很好的监测哮喘的治疗效果，指导治疗；关键词：呼出气一氧化氮；儿童；支气管哮喘；哮喘控制山东大学硕士学位论文THE CLINICAL VALUE OF EXHALED NITRIC OXIDETEST FoR ASTHMA IN CHILDRENPost Graduate：Specialty：Supervisor：Jiang ChunpingPediatricsProfWang JinrongABSTRACTObjective：TO explore the diagnostic and therapy values of the exhaled nitric Oxide test for asthma in childrenMethods：1A total number of 1 5 5 children who were diagnosed as asthmawere enrolled from March to December in 20 1 2(subject group)There were 33cases in the 1 5 5 cases who not received corticosteroid treatment in the pastsix months belonged to nonhormone therapy group and there were 1 22 caseswho have received inhaled corticosteroid treatment for more than one monthswere assigned to hormone therapy groupAlso all of 1 55 children was dividedinto there groups：uncontrolled group(3 0 cases)，partly controlled group(67cases)and controlled group(58 cases)Each group was divided into two groups：people who has asthmatic family history was selected as one group and therest cases as the other groupThere were 2 1 cases in the nonhormone therapygroup received standard therapy and we have collected the information on theirfrist time，the 1 5th day，the 30th day and the 90th dayS referral informationIn the same timewe screened out 50 healthy 7-1 3-year children as the contr-oiled groupEvery people in subj ect group ENO concentration，pulmonary function and eosinophilic granulocyte were detected too2We make the branchof the group of paediatric respiratory of the Chinese Medical Association revised the asthma diagnostic criteria in 2008 as the golden standard for asthma di-agnosis and we drew receiver operating characteristic curvesWith the curve wedrew we to evaluate the diagnostic and differential diagnostic value of exhalednitric oxide test山东大学硕士学位论文Results：1Compared the level of ENO in nonhormone therapy group and control group，there were statistical significant differences in the level of ENO in each group(POOO 1)In those three groups，non-hormone therapy group has the highestaverage level of ENO and hormone therapy group has higher average level ofENO than controlled group2There were significant differences between each two groups of controlled group，uncontrolled group，partly controlled group and controlled group of thelevel of ENO(P005)4The level of ENO has positive relationship、)、，ith EOSand EOS#(PO05)5Cases who reexamination on the 90th day has lower ENO level than thosewho reexamination on the frist day，the 1 5th day and the 30th day(PO05)Cases who reexamination on the 1 5th day has lower ENO level than that whoreexamination on the frist day；there is no significant difference between Csaeswho reexamination on the 1 5th day and on the 3 0th day6With the receiver operating characteristic curves we found area under ROCcurve was 0929 and the standard error was 001 8The optimal diagnostic cut-off point Was 1 545ppb which was capable of differentiating asthma and non-asthma with sensitivity of 8 19specificity of 960Conclusions：1The detection of ENO is a good indicator of airway inflammation reaction，which can be used as a tool to screen asthma，early diagnosis and differential4山东大学硕士学位论文diagnosis and also can used as the assessment of asthma control level；2The level of ENO can refect the eosinophilic granulocyte inflammation inairway and can be used as a tool to identify airway inflammation characteristicby eosinophilic granulocyte and steroid resistant asthma；3Cases have allergy related diseases family history of asthma have higher le-vel ENO and better reflect of treatment than those have no family history；4ENO test combining with pulmonary function may fully reflect the diseasestatus and the level of asthma control；5Specific