Jerzyńska Joanna, Majak Paweł, Janas Anna, Stelmach Rafał, Stelmach Włodzimierz, Smejda Katarzyna, Stelmach Iwona
Department of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland.
Institute of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Lodz, Poland.
Nitric Oxide. 2014 Aug 31;40:87-91. doi: 10.1016/j.niox.2014.06.001. Epub 2014 Jun 11.
There are no studies investigating the benefit of using FeNO measurements in correlation with sensitization to perennial and seasonal allergens in children with asthma.
To define the group of children with respiratory symptoms in whose FeNO measurement has predictive value for asthma. We assessed the effect of age, allergy profile, atopy, lung function and the presence of allergic rhinitis on interpretation of FeNO levels for clinical applications.
It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 1767 children with symptoms of allergic diseases such as asthma and/or allergic rhinitis. We included in the analyses subjects who had the following tests done during diagnostic procedures (single measurement): FeNO, spirometry, specific IgE results. All subjects had undergone a minimum 3-years prospective clinical observation after the first FeNO measurement until the later assignment (or not) of an asthma/allergic rhinitis diagnosis.
We included 1767 children into the analysis; asthma diagnosis was confirm in 1054 (59.6%) children. We showed that only atopy (OR: 1.9; 95%CI: 1.5-2.4) and presence of allergic rhinitis (OR: 1.6; 95%CI: 1.4-1.9) were independently associated with increased FeNO level. Only among patients with atopy and allergic rhinitis FeNO level (above 23 ppb) was associated with asthma diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value of FeNO >23 ppb for asthma diagnosis were as follows: 0.9(95%CI: 0.68-0.98), 0.52(95%CI: 0.42-0.61), 0.25(95%CI: 0.16-0.37), 0.97(95%CI: 0.88-0.99).
We showed that in children with atopy and with allergic rhinitis a negative predictive value for asthma diagnosis was very high with the optimal cut-off point of FeNO 23 ppb. Therefore we showed the utility of FeNO measurements to exclude asthma in the subgroup of patients with atopy and allergic rhinitis.
尚无研究探讨在哮喘儿童中，将呼出一氧化氮（FeNO）测量结果与对常年性和季节性过敏原的致敏情况相关联的益处。
确定呼吸道症状儿童中，FeNO测量对哮喘具有预测价值的人群。我们评估了年龄、过敏谱、特应性、肺功能以及变应性鼻炎的存在对临床应用中FeNO水平解读的影响。
这是一项回顾性横断面研究。我们评估了1767例患有哮喘和/或变应性鼻炎等过敏性疾病症状儿童的医疗记录数据。我们将诊断过程中进行了以下检查（单次测量）的受试者纳入分析：FeNO、肺量计检查、特异性IgE结果。所有受试者在首次FeNO测量后至少进行了3年的前瞻性临床观察，直至后来确定（或未确定）哮喘/变应性鼻炎诊断。
我们将1767例儿童纳入分析；1054例（59.6%）儿童确诊为哮喘。我们发现只有特应性（比值比：1.9；95%置信区间：1.5 - 2.4）和变应性鼻炎的存在（比值比：1.6；95%置信区间：1.4 - 1.9）与FeNO水平升高独立相关。仅在患有特应性和变应性鼻炎的患者中，FeNO水平（高于23 ppb）与哮喘诊断相关。FeNO>23 ppb对哮喘诊断的敏感性、特异性、阳性预测值和阴性预测值如下：0.9（95%置信区间：0.68 - 0.98）、0.52（95%置信区间：0.42 - 0.61）、0.25（95%置信区间：0.16 - 0.37）、0.97（95%置信区间：0.88 - 0.99）。
我们发现，在患有特应性和变应性鼻炎的儿童中，FeNO的最佳截断点为23 ppb时，对哮喘诊断的阴性预测值非常高。因此，我们证明了FeNO测量在排除患有特应性和变应性鼻炎的患者亚组中的哮喘方面的效用。
