Department of General Pediatrics, The Affiliated First Hospital of Shaoyang University, No. 39, Tongheng Street, Shuangqing District, Shaoyang City, 422001, Hunan Province, China.
Health Management Centre, The Affiliated First Hospital of Shaoyang University, Shaoyang City, 422001, Hunan Province, China.
Sci Rep. 2024 Sep 10;14(1):21160. doi: 10.1038/s41598-024-72236-y.
Bronchiolitis is a significant factor contributing to bronchial asthma in infants and young children. After treatment, recurrent wheezing symptoms often occur, especially in children with atopic constitution, who tend to have more severe conditions and poorer prognosis. Therefore, exploring the prognostic value of total serum immunoglobulin E (tIgE) and fractional exhaled nitric oxide (FeNO) levels in children with atopic constitution who suffer from bronchiolitis is of great significance. A total of 260 children with bronchiolitis admitted to our hospital from October 2020 to June 2022 were regarded as the research subjects with prospective study, according to whether the children had atopic constitution, they were grouped into non atopic constitution group (n = 156) and atopic constitution group (n = 104); after 6 months of treatment, children with atopic constitution were grouped into a good prognosis group (n = 58) and a poor prognosis group (n = 46) based on their prognosis; in addition, 260 healthy children who underwent physical examination and had clinical data consistent with those of children with bronchiolitis were regarded as the reference group. The serum tIgE and FeNO levels of each group were compared; multivariate Logistic regression was applied to analyze the prognostic factors of children with atopic constitution bronchiolitis; ROC curve was applied to analyze the predictive value of tIgE and FeNO levels after treatment for the prognosis of children with atopic constitution bronchiolitis. The tIgE levels in the control group, non-atopic group, and atopic group [(123.54 ± 29.62) IU/mL, (245.71 ± 30.59) IU/mL, (316.46 ± 31.78) IU/mL, respectively] increased sequentially, with statistically significant differences (F = 1766.954, P = 0.000). The FeNO levels in the control group, non-atopic group, and atopic group [(8.36 ± 3.57) ppb, (15.28 ± 3.69) ppb, (19.84 ± 3.58) ppb, respectively] also increased sequentially, with statistically significant differences (F = 765.622, P = 0.000). The tIgE, FeNO, proportion of patients with asthma family history, and proportion of patients with allergic family history in the poor prognosis group were obviously higher than those in the good prognosis group (P < 0.05). Multivariate Logistic regression analysis showed that family history of asthma, family history of allergies, tIgE, and FeNO were influencing factors for the prognosis of children with atopic bronchiolitis (P < 0.05). The AUC of the combination of tIgE and FeNO in predicting the prognosis of children with atopic constitutional bronchiolitis was 0.910, with a sensitivity of 78.26% and a specificity of 93.10%, which was superior to the independent prediction of tIgE and FeNO (Z = 2.442, Z = 3.080, P = 0.015, 0.002). The levels of tIgE and FeNO in children with atopic constitution bronchiolitis are obviously increased, and the combination of the two has high predictive value for the prognosis of atopic constitution bronchiolitis.
毛细支气管炎是婴幼儿支气管哮喘的重要致病因素。经治疗后，常反复出现喘息症状，尤其是特应体质患儿，病情往往较重，预后较差。因此，探讨特应体质儿童毛细支气管炎总血清免疫球蛋白 E（tIgE）和呼出气一氧化氮分数（FeNO）水平的预后价值具有重要意义。选取 2020 年 10 月至 2022 年 6 月我院收治的 260 例毛细支气管炎患儿作为研究对象，前瞻性研究，根据患儿是否具有特应体质，分为非特应体质组（n=156）和特应体质组（n=104）；治疗 6 个月后，根据患儿预后情况，将特应体质患儿分为预后良好组（n=58）和预后不良组（n=46）；另外，选取同期体检且临床资料与毛细支气管炎患儿一致的 260 例健康儿童作为参考组。比较各组患儿血清 tIgE 和 FeNO 水平；采用多因素 Logistic 回归分析特应体质毛细支气管炎患儿的预后影响因素；采用 ROC 曲线分析治疗后 tIgE 和 FeNO 水平对特应体质毛细支气管炎患儿预后的预测价值。对照组、非特应体质组和特应体质组 tIgE 水平[（123.54±29.62）IU/ml、（245.71±30.59）IU/ml、（316.46±31.78）IU/ml]依次升高，差异有统计学意义（F=1766.954，P=0.000）。对照组、非特应体质组和特应体质组 FeNO 水平[（8.36±3.57）ppb、（15.28±3.69）ppb、（19.84±3.58）ppb]依次升高，差异有统计学意义（F=765.622，P=0.000）。预后不良组 tIgE、FeNO、哮喘家族史比例、过敏家族史比例明显高于预后良好组（P<0.05）。多因素 Logistic 回归分析显示，哮喘家族史、过敏家族史、tIgE、FeNO 是特应体质毛细支气管炎患儿预后的影响因素（P<0.05）。tIgE 和 FeNO 联合预测特应体质儿童毛细支气管炎预后的 AUC 为 0.910，灵敏度为 78.26%，特异度为 93.10%，优于 tIgE 和 FeNO 的独立预测（Z=2.442、Z=3.080，P=0.015、0.002）。特应体质毛细支气管炎患儿 tIgE 和 FeNO 水平明显升高，两者联合对特应体质毛细支气管炎的预后具有较高的预测价值。
