Zhang Hui-Qin, Zhang Hui-Qin, Zhang Jing-Jing, Liu Yu-Dong, Deng Yue-Lin, Luo Jian-Feng, Niu Huan-Hong, Sun Xin
Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China. sunxin6@ fmmu.edu.cn.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Apr;19(4):419-424. doi: 10.7499/j.issn.1008-8830.2017.04.012.
To investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children.
A total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups: asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once.
During one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P<0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P>0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P<0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P<0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P<0.05).
With the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.
探讨儿童支气管哮喘规范化治疗中肺功能及呼出一氧化氮分数（FeNO）的变化。
选取254例新诊断为支气管哮喘急性加重期的患儿作为哮喘组，再分为合并鼻炎哮喘亚组和不合并鼻炎哮喘亚组。所有患者均接受为期一年的规范化管理与治疗。肺功能参数包括一秒用力呼气容积（FEV1）、呼气峰值流速（PEF）、最大呼气中期流速（MMEF）以及肺活量25%、50%和75%时的呼气中期流速（MEF25、MEF50和MEF75）。在治疗前及治疗后3、6、9和12个月测量FeNO水平。另选取62例健康儿童作为对照组，仅测量一次肺功能和FeNO水平。
在一年的规范化治疗期间，FEV1、PEF、MMEF、MEF25、MEF50和MEF75逐渐升高，FeNO水平逐渐降低（P<0.05）。治疗6个月后，大气道功能指标如FEV1和PEF几乎恢复正常；治疗9个月后，小气道功能指标如MMEF、MEF25、MEF50和MEF75几乎恢复正常；治疗一年后，哮喘组与对照组上述指标无显著差异（P>0.05）。然而，治疗一年后哮喘组FeNO水平显著高于对照组（P<0.05）。合并鼻炎的哮喘患者在治疗前及治疗后3个月FeNO水平显著高于未合并鼻炎的患者（P<0.05）。治疗前，FeNO水平与肺功能参数之间存在显著负相关（P<0.05）。
随着儿童支气管哮喘的规范化治疗，肺功能参数逐渐升高，FeNO水平逐渐降低。大气道功能的恢复早于小气道功能的恢复。此外，应注意鼻炎对气道反应性的影响。
