呼出气一氧化氮联合白介素-17、白介素-27检测对儿童支气管哮喘的临床诊断价值

目的 检测呼出气一氧化氮(FeNO)、白介素-17(IL-17)、白介素-27(IL-27)与肺功能指标的相关性,及对儿童支气管哮喘的临床诊断价值。方法 选取2019年1月—2020年4月在南阳市中心医院诊断为支气管哮喘的84例儿童和同时期来本院就诊的56例健康儿童为研究对象。检测患者外周血中IL-17、IL-27水平和FeNO水平,记录肺功能相关指标,包括一秒用力呼气容积(FEV₁)、一秒用力呼气容积与肺活量比值(FEV₁/FVC)、峰值呼气流速(PEF)和残气量与肺总量比值(RV/TLC)。Pearson相关分析检测IL-17、IL-27和FeNO与肺功能指标的相关性。ROC工作曲线评估FeNO联合IL-17、IL-27检测对儿童哮喘的诊断价值。结果 对照组、稳定期和急性加重期患儿IL-17、IL-27、FeNO、FEV₁、FEV₁/FVC、PEF和RV/TLC之间差异均有统计学意义(F＝137.241、92.074、94.296、16.325、174.263、31.174、115.207,P<0.001)。哮喘患儿IL-17水平与FEV₁、FEV₁/FVC、PEF呈负相关(r=-0.690、-0.576、-0.613),与RV/TLC呈正相关(r=0.581)。IL-27水平与FEV₁、FEV₁/FVC、PEF呈负相关(r=-0.786、-0.818、-0.549),与RV/TLC呈正相关(r=0.513)。FeNO水平与FEV₁、FEV₁/FVC、PEF呈负相关(r=-0.667、-0.662、-0.637),与RV/TLC呈正相关(r=0.543)。IL-17诊断儿童哮喘的灵敏度为52.4%,特异度为76.2%,曲线下面积为0.684(95%CI:0.614～0.725);IL-27诊断儿童哮喘的灵敏度为68.5%,特异度为63.2%,曲线下面积为0.768(95%CI:0.710～0.805);FeNO诊断儿童哮喘的灵敏度为70.6%,特异度为65.3%,曲线下面积为0.792(95%CI:0.723～0.840);联合检测诊断儿童哮喘的灵敏度为86.9%,特异度为81.4%,曲线下面积为0.905(95%CI:0.802～0.941),与单独检测相比差异有统计学意义(P<0.05)。结论 IL-17、IL-27、FeNO水平与肺功能指标相关,联合检测可显著提高诊断儿童支气管哮喘灵敏度和特异度。

Clinical diagnostic value of interleukin-17,interleukin-27 and exhaled nitric oxide alone or combination in children with bronchial asthma

Objective To detect the correlation between fractional exhaled nitric oxide(FeNO),interleukin-17(IL-17),interleukin-27(IL-27)and lung function indexes,and to analyze the clinical diagnostic value for bronchial asthma in children. Methods A total of 84 children diagnosed with bronchial asthma in Nanyang Central Hospital were prospectively enrolled in this study from January 2019 to April 2020,meanwhile 56 healthy children were selected as control group.IL-17,IL-27 and FeNO levels of peripheral blood were tested,and pulmonary function-related indicators were recorded,including forced expiratory volume in one second(FEV1),forced expiratory volume in one second and vital capacity ratio(FEV1/FVC),peak expiratory flow rate(PEF),and ratio of residual volume to total lung volume(RV/TLC).Pearson correlation analysis was used to detect the correlation between IL-17,IL-27 and FeNO with lung function indexes.The ROC working curve was used to evaluate the diagnostic value of FeNO combined with IL-17 and IL-27 detection in childhood asthma. Results The differences of IL-17,IL-27,FeNO,FEV1,FEV1,FEV1/FVC,PEF and RV/TLC among the control group,stable phase and acute exacerbation phase groups were statistically significant(F=137.241,92.074,94.296,16.325,174.263,31.174,115.207,P<0.001).In children with asthma,IL-17 level was negatively correlated with FEV1,FEV1/FVC and PEF(r=-0.690,-0.576,-0.613),and positively correlated with RV/TLC(r=0.581).IL-27 level was negatively related to FEV1,FEV1/FVC and PEF(r=-0.786,-0.818,-0.549),and positively related to RV/TLC(r=0.513).FeNO level was negatively correlated with FEV1,FEV1/FVC and PEF(r=-0.667,-0.662,-0.637),and was positively correlated with RV/TLC(r=0.543).The sensitivity of IL-17,IL-27 and FeNO in the diagnosis of childhood asthma was 52.4%,68.5% and 70.6%,the specificity was 76.2%,63.2% and 65.3%,and the area under the curve was 0.684(95%CI:0.614—0.725),0.768(95%CI:0.710—0.805),0.792(95%CI:0.723—0.840),respectively.The sensitivity of the combined test for diagnosis of childhood asthma was 86.9%,the specificity was 81.4%,the area under the curve was 0.905(95%CI:0.802～0.941),and the difference was statistically significant compared with the single test(P<0.05). Conclusions The levels of IL-17,IL-27 and FeNO are correlated with lung function indexes.Joint detection can significantly improve the sensitivity and specificity of the diagnosis of bronchial asthma in children.