呼出气一氧化氮检测在哮喘儿童孟鲁司特治疗中的应用价值

目的探讨呼出气一氧化氮(FeNO)检测在哮喘儿童孟鲁司特治疗中的应用价值。 方法选择2013年5月至2014年5月于复旦大学附属上海市第五人民医院儿科门诊就诊的5～14岁哮喘儿童，共40例。给予入组患儿孟鲁司特常规治疗12周，随访6次并检测入组患儿FeNO水平，测定晨起呼气峰流速(PEF)，并计算PEF占预计值的百分比(PEF%pred)，记录儿童哮喘控制评分(C-ACT)。根据孟鲁司特治疗前及治疗12周时的哮喘控制水平分级变化，将入组患儿分为显效组和无效组，采用SPSS 17.0对不同分组的临床资料进行分析。最后有31例患儿完成为期12周的研究，其中显效组21例，无效组10例。 结果两组患儿在哮喘病史时间(2.36±2.03)年，(3.60±1.51)年]、病情分级(部分控制/未控制)(16/5，1/9)、起始C-ACT评分(20.71±0.85)分，(19.30±1.57)分]、起始FeNO水平(9.93±7.69)ppb，(32.52±22.70)ppb]方面比较，均差异具有统计学意义(t＝1.72，χ²＝11.98，t＝3.29，t＝4.15；均P<0.05)。显效组患儿起始FeNO水平为(9.93±7.69)ppb，孟鲁司特治疗12周，前后测量结果比较，差异无统计学意义(F＝0.51，P>0.05)；无效组患儿治疗前起始FeNO水平为(32.52±22.70)ppb，孟鲁司特治疗12周，前后测量结果之间差异无统计学意义(F＝0.56，P>0.05)。两组患儿孟鲁司特治疗后，PEF%pred、C-ACT评分均提高，6次测量结果之间均差异具有统计学意义(F＝4.63，6.06，50.67，6.09；均P<0.05)。两组患儿孟鲁司特治疗12周期间，除显效组患儿治疗2周时FeNO水平与PEF%pred呈正相关(r＝0.44，P<0.05)外，FeNO水平与PEF%pred、FeNO水平、C-ACT评分无相关性(P>0.05)。 结论FeNO与PEF%pred、C-ACT评分相比暂不具有明显的疗效监测价值，哮喘患儿的病史、病情分级、起始C-ACT评分、起始FeNO水平等因素可能会影响孟鲁司特的疗效。

The value of fractional exhaled nitric oxide detection in the treatment of asthma in children with montelukast

ObjectiveTo explore the possible value of fractional exhaled nitric oxide (FeNO)in the treatment of asthmatic children with montelukast. MethodsForty asthmatic children aged 5-14 were enrolled from May 2013 to May 2014 in the pediatrics department of the Shanghai Fifth People′s Hospital affiliated to Fudan University. Montelukast was administered to the enrolled patients for 12 weeks and each child was followed up for 6 times to detecte the levels of FeNO. The morning peak expiratory flow (PEF) was measured and the percentage of predicted PEF (PEF%pred) was calculated. The asthma control test of children (C-ACT) was recorded. According to the changes in the level of asthma control before and at the 12th week of treatment with montelukast, the enrolled patients were divided into the effective group and the noneffective group, and the clinical data were analyzed by SPSS 17.0. ResultsThirty-one children completed a 12 week study in the end, with 21 patients in the effective group and 10 in the noneffective group. The differences in asthma history(2.36±2.03, 3.60±1.51), disease grading(16/5, 1/9), initial C-ACT scores(20.71±0.85, 19.30±1.57), and initial FeNO level (9.93±7.69)ppb, (32.52±22.70)ppb] were statistically significant between the two groups (t=1.72, χ²=11.98, t=3.29, t=4.15, all P<0.05). The starting FeNO level in the effective group was (9.93±7.69)ppb and there were no significant differences between the 6 measurements (F=0.51, P>0.05). The starting FeNO level in the noneffective group was (32.52±22.70)ppb and there were no significant differences between the 6 measurements (F=0.56, P>0.05) as well. The PEF%pred and C-ACT scores of the two groups after treatment with montelukast were improved, and the differences among the 6 measurements were statistically significant (F=4.63, 6.06, 50.67, 6.09, all P<0.05). There were no correlations between FeNO and PEF%pred, FeNO and C-ACT scores during the 12 weeks treatment of montelukast between the two groups (P>0.05) except that the FeNO level was positively correlated with PEF%pred at the second week in the effective group (r=0.44, P<0.05). ConclusionsCompared with PEF%pred and C-ACT scores, FeNO level has no significant efficacy monitoring value. The history of asthmatic children, disease grading, initial C-ACT scores and initial FeNO level may affect the efficacy of montelukast.