| 师倩,宣一帆,杨燕飞.呼出气一氧化氮联合小气道功能鉴别儿童慢性咳嗽病因的价值研究[J].安徽医药,待发表. |
| 呼出气一氧化氮联合小气道功能鉴别儿童慢性咳嗽病因的价值研究 |
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| 投稿时间：2025-10-05 录用日期：2025-10-28 |
| DOI： |
| 中文关键词: 小气道功能 呼出气一氧化氮；慢性咳嗽；病因；儿童 |
| 英文关键词: |
| 基金项目:湖北陈孝平科技发展基金会(项目编号：CXPJJH123004-034) |
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| 中文摘要: |
| 目的 探讨呼出气一氧化氮(FeNO)测定联合小气道功能(SAF)指标检测在儿童慢性咳嗽中的价值分析。方法 回顾性分析2023年7月—2025年7月山西白求恩医院儿科治疗的230例儿童慢性咳嗽患儿的临床资料，根据病因分为3组，A组为咳嗽变异性哮喘（CVA），100例，B组为感染后咳嗽（PIC），63例，C组为上呼吸道咳嗽综合征（UACS），67例，进行FeNO浓度检测、肺功能及相关外周血检测，对比3组各项参数。结果 慢性咳嗽患儿230例中CVA 100例(43.5％),PIC 63例(27.4％),UACS 67例(29.1％)；FeNO值在CVA组中明显高于其他慢性咳嗽组，差异有统计学意义，PIC组与UACS组间比较差异无统计学意义［FeNO值分别为38.65(23.8,55.75)ppb、22.6(18.25,27.75)ppb、22.2(15.4,32.35)ppb］（H=37.899,P<0.01）；肺功能中反应大气道的指标，第一秒用力呼气容积（FEV1）［CVA 组为93.9(89.83,98.88)，PIC组为98.1(90.7,102.5)，UACS组为97.5(91.4,102)］、用力肺活量（FVC）［CVA 组为94.9(89.5,100.98)，PIC组为95.8(92.6,102.7)，UACS组为97.9(92.6,103.7)］三组间比较差异均无统计学意义(H=5.90、4.35,均P>0.05)；SAF指标：用力呼气75%肺活量时呼气流速MEF75(%)［CVA 组为80.7(76.9,84.75)，PIC组为84.8(81.6,91.6)，UACS组为87.3(84,89.5)］、用力呼气50%肺活量时呼气流速MEF50（%）［CVA 组为 81.85(76.5,86.55)，PIC为86.7(81.25,94.9)，UACS组为89.4(83.75,93.65)］、用力呼气25%肺活量时呼气流速MEF25(%)［CVA组为75.9(70.6,80.35)，PIC组为84.1(77.1,89.35)，UACS组为85.8(80.7,93.1)］在CVA组中均明显低于其他慢性咳嗽组,差异有统计学意义（H=46.55、37.094、59.339，均P<0.01），但PIC组以上三项SAF指标与UACS组比较，差异无统计学意义（P>0.05）。反应2型炎症指标的相关外周血检测：血清总IgE［CVA 组为207.75(105.92,489.85)，PIC组为97.4(44.05,170.38)，UACS组为399.2(85.95,647)］在PIC组明显偏低，与其余两组比较差异均有统计学意义（H=34.276，P<0.01），CVA组 、UACS组间比较差异无统计学意义（P>0.05）；外周血嗜酸性粒细胞（EOS）［CVA 组为0.36(0.235,0.585)，PIC组为0.23(0.125,0.325)，UACS组为0.24(0.09,0.52)］在CVA组高于其他慢性咳嗽组，差异有统计学意义（H=17.630 ，P<0.01），PIC组与UACS组间比较差异无统计学意义（P>0.05）。二元logistic 回归方程中，FeNO、MEF75、MEF25为鉴别CVA与非CVA（PIC组与UACS组合并）的重要指标（95%CI=0.95~0.986、1.038~1.182、1.061~1.17，P<0.01）。FeNO、MEF75及MEF25单独鉴别时，其最佳阈值分别为36.95ppb、79.75ppb、81.65ppb，曲线下面积分别为 0.737、0.758、0.789，敏感性分别为 87.7%、92.3%、64.6%，特异性分别为 55.0%、45.0%、82.0%。FeNO、MEF75及MEF25联合鉴别时曲线下面积为0.844，敏感性、特异性分别为89.2%、64.0%。结论 慢性咳嗽患儿常见的病因是CVA、PIC、UACS；FeNO与SAF指标具有高度的互补性，二者联合检测较单一检测效能高，结合过敏原、外周血EOS、血清总IgE等，提高了慢性咳嗽病因诊断的准确性，为实现儿童慢性咳嗽的精准诊断提供了强有力的理论依据。 |
| 英文摘要: |
| Objective To investigate the value of combining fractional exhaled nitric oxide measurement with small airway function indices in the etiological diagnosis of chronic cough in children.Methods A retrospective analysis was conducted on the clinical data of 230 children with chronic cough treated in the Pediatrics Department of Shanxi Bethune Hospital between July 2023 and July 2025. Patients were divided into three groups based on etiology: group A with cough-variant asthma(CVA, n=100), group B with post-infectious cough (PIC, n=63), and group C with upper airway cough syndrome (UACS, n=67). All patients underwent FeNO measurement, pulmonary function tests, and related peripheral blood tests. Parameters were compared among the three groups.Results Among the 230 children with chronic cough, the etiological distribution was as follows: CVA 100 cases (43.5%), PIC 63 cases (27.4%), and UACS 67 cases (29.1%). FeNO levels were significantly higher in the CVA group compared to the other groups [38.65 (23.8, 55.75) ppb vs. 22.6 (18.25, 27.75) ppb in PIC and 22.2 (15.4, 32.35) ppb in UACS; H=37.899, P<0.01], with no significant difference between the PIC and UACS groups. No significant differences were observed among the three groups in large airway function parameters, including forced expiratory volume in 1 second (FEV1) [CVA: 93.9 (89.83, 98.88), PIC: 98.1 (90.7, 102.5), UACS: 97.5 (91.4, 102)] and forced vital capacity (FVC) [CVA: 94.9 (89.5, 100.98), PIC: 95.8 (92.6, 102.7), UACS: 97.9 (92.6, 103.7)] (H=5.90 and 4.35, respectively; both P>0.05). In contrast, all small airway function (SAF) indices—MEF75% [CVA: 80.7 (76.9, 84.75), PIC: 84.8 (81.6, 91.6), UACS: 87.3 (84, 89.5)], MEF50% [CVA: 81.85 (76.5, 86.55), PIC: 86.7 (81.25, 94.9), UACS: 89.4 (83.75, 93.65)], and MEF25% [CVA: 75.9 (70.6, 80.35), PIC: 84.1 (77.1, 89.35), UACS: 85.8 (80.7, 93.1)]—were significantly lower in the CVA group compared to the other groups (H=46.55, 37.094, and 59.339, respectively; all P<0.01), while no significant differences were found between the PIC and UACS groups (P>0.05). Regarding type 2 inflammation markers, serum total IgE levels were significantly lower in the PIC group than in the CVA and UACS groups [97.4 (44.05, 170.38) vs. 207.75 (105.92, 489.85) and 399.2 (85.95, 647), respectively; H=34.276, P<0.01], with no significant difference between the CVA and UACS groups. Peripheral blood eosinophil (EOS) counts were significantly higher in the CVA group compared to the PIC and UACS groups [0.36 (0.235, 0.585) vs. 0.23 (0.125, 0.325) and 0.24 (0.09, 0.52), respectively; H=17.630, P<0.01], with no significant difference between the PIC and UACS groups. Binary logistic regression identified FeNO, MEF75%, and MEF25% as significant independent indicators for discriminating CVA from non-CVA (PIC and UACS combined) (P<0.01). The optimal cutoff values for FeNO, MEF75%, and MEF25% alone were 36.95 ppb, 79.75%, and 81.65%, with areas under the curve (AUC) of 0.737, 0.758, and 0.789, sensitivities of 87.7%, 92.3%, and 64.6%, and specificities of 55.0%, 45.0%, and 82.0%, respectively. The combination of FeNO, MEF75%, and MEF25% yielded an AUC of 0.844, with a sensitivity of 89.2% and specificity of 64.0%.Conclusions The common causes of chronic cough in children are CVA, PIC, and UACS. FeNO and SAF indices exhibit high complementarity. Their combined detection demonstrates superior diagnostic efficacy compared to single tests. Integrating these measurements with allergens, peripheral blood EOS, and total serum IgE improves the diagnostic accuracy for the etiology of chronic cough, providing a strong theoretical basis for the precise diagnosis of chronic cough in children. |
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