Grzelewski Tomasz, Witkowski Konrad, Makandjou-Ola Eusebio, Grzelewska Aleksandra, Majak Paweł, Jerzyńska Joanna, Janas Anna, Stelmach Rafał, Stelmach Włodzimierz, Stelmach Iwona
Department of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland.
Pediatr Pulmonol. 2014 Jul;49(7):632-40. doi: 10.1002/ppul.22888. Epub 2013 Sep 9.
To establish a diagnostic value of fractional exhaled nitric oxide (FeNO), interrupter resistance measurement (Rint), specific resistance of the airways (sRaw), spirometric parameters in asthma diagnosis in schoolchildren.
It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 6,439 children (aged 6-18) with symptoms suggestive of asthma, who attended our Pediatric Allergic Outpatient Clinic. Medical documentation of the patients was analyzed with special attention to the first ever obtained results (before the introduction of controller medication) of: FeNO, Rint, sRaw, spirometry, diagnoses of allergic diseases, and allergen sensitization (specific IgE results).
We included 3,612 children in the analysis. Older age, male gender, the presence of allergic rhinitis, sensitization to perennial and seasonal allergens, higher FeNO and Rint, and FEV1 /FVC <80% were significantly associated with asthma. We observed a significant association between FeNO and Rint in the prediction of asthma diagnosis. Optimal cutoff points to differentiate asthmatics from non-asthmatics were established. Thus, Rint >175.4% was defined as asthma-predicting Rint, and FeNO >15.8 ppb was defined as asthma-predicting FeNO. In all study subgroups, sensitivity for asthma-predicting Rint was significantly higher than for asthma-predicting FeNO with an inverse trend in specificity value.
Our results suggest that asthma-predicting Rint and, to a lesser extent, asthma-predicting FeNO, defined in the present study, could serve as a reliable tool to exclude asthma in schoolchildren. However, our results also indicate a clinically important fact that all lung function parameters or FeNO should be interpreted in the context of age, gender, allergy profile, and the presence of co-morbidities in schoolchildren. Pediatr Pulmonol. 2014; 49:632-640. © 2013 Wiley Periodicals, Inc.
确立呼出一氧化氮分数（FeNO）、气道阻力测量值（Rint）、气道比电阻（sRaw）及肺量计参数在学龄儿童哮喘诊断中的诊断价值。
这是一项回顾性横断面研究。我们评估了6439名（年龄在6 - 18岁）有哮喘症状的儿童的医疗记录数据，这些儿童曾就诊于我们的儿科过敏门诊。对患者的医疗记录进行分析，特别关注首次获得的结果（在开始使用控制药物之前），包括：FeNO、Rint、sRaw、肺量计检查结果、过敏性疾病诊断以及过敏原致敏情况（特异性IgE结果）。
我们纳入了3612名儿童进行分析。年龄较大、男性、患有过敏性鼻炎、对常年性和季节性过敏原致敏、FeNO和Rint较高以及FEV1 /FVC <80%与哮喘显著相关。我们观察到FeNO与Rint在预测哮喘诊断方面存在显著关联。确定了区分哮喘患者与非哮喘患者的最佳截断点。因此，Rint >175.4%被定义为预测哮喘的Rint值，FeNO >15.8 ppb被定义为预测哮喘的FeNO值。在所有研究亚组中，预测哮喘的Rint的敏感性显著高于预测哮喘的FeNO，特异性值呈相反趋势。
我们的结果表明，本研究中定义的预测哮喘的Rint以及在较小程度上预测哮喘的FeNO，可作为排除学龄儿童哮喘的可靠工具。然而，我们的结果也表明了一个临床重要事实，即所有肺功能参数或FeNO都应结合学龄儿童的年龄、性别、过敏情况以及合并症情况进行解释。《儿科肺科杂志》。2014年；49:632 - 640。©2013威利期刊公司
