标题：FeNO联合TSLP对儿童咳嗽变异性哮喘与感染后咳嗽的鉴别价值及与小气道功能的关系

      作者：高艺伟，马莹莹，张曼，储卫红，彭韶    郑州大学第一附属医院小儿内科，河南 郑州 450000

      卷次： 2024年35卷13期

      【摘要】 目的 探究呼出气一氧化氮(FeNO)联合胸腺基质淋巴细胞生成素(TSLP)对儿童咳嗽变异性哮喘(CVA)与感染后咳嗽(PIC)的鉴别价值，并分析FeNO、TSLP与CVA病情、小气道功能的关系，为临床诊疗提供有利依据。方法 选取2021年6月至2023年4月郑州大学第一附属医院儿科诊治收治的90例CVA患儿作为CVA组，另选取同期90例PIC患儿作为PIC组。比较两组患儿的临床资料和FeNO、TSLP水平，绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析FeNO联合TSLP对CVA与PIC的鉴别价值；比较CVA不同病情严重程度和病情阶段患儿的小气道功能[FEF25 (%)、FEF50 (%)、FEF75 (%)、FEF25~75 (%)]和 FeNO、TSLP水平，采用 Spearman和Pearson相关系数法分析FeNO、TSLP与CVA小气道功能、病情阶段、病情严重程度的相关性。结果 CVA组患儿的 FeNO、TSLP水平明显高于 PIC组，差异均有统计学意义(P<0.05)；ROC分析结果显示，FeNO联合 TSLP鉴别CVA与PIC的AUC最大(0.934)，敏感度、特异度为87.78%、82.22%，明显高于各指标单独诊断(P<0.05)；轻度组患儿的FEF25、FEF50、FEF75和FEF25~75>中度组>重度组，差异均有统计学意义(P<0.05)；轻度组患儿的FeNO、TSLP水平<中度组<重度组，差异均有统计学意义(P<0.05)；临床缓解期组患儿的FEF25、FEF50、FEF75、FEF25~75明显高于急性发作期组，FeNO、TSLP水平明显低于急性发作期组，差异均有统计学意义(P<0.05)；Pearson相关系数法分析结果显示，FeNO、TSLP与FEF25、FEF50、FEF75、FEF25~75均呈负相关(P<0.05)；Spearman相关系数法分析结果显示，FeNO、TSLP与病情阶段、病情严重程度均呈正相关(P<0.05)。结论 与 PIC患儿比较，CVA患儿FeNO、TSLP水平异常升高，其联合鉴别诊断CVA与PIC具有较高价值，且FeNO、TSLP水平与患儿病情、小气道功能密切相关。
      【关键词】 呼出气一氧化氮；胸腺基质淋巴细胞生成素；咳嗽变异性哮喘；感染后咳嗽；小气道功能
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2024）13—1854—05

Value of FeNO combined with thymic stromal lymphopoietin in distinguishing between cough variant asthma andpost-infection cough in children and its relationship with small airway function.
GAO Yi-wei, MA Ying-ying,ZHANG Man, CHU Wei-hong, PENG Shao. Department of Pediatric Medicine, the First Affiliated Hospital of ZhengzhouUniversity, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To explore the diagnostic value of exhaled nitric oxide (FeNO) combined with thymicstromal lymphopoietin (TSLP) in distinguishing childhood cough variant asthma (CVA) from post-infection cough(PIC), and to analyze the relationship between of FeNO and TSLP with CVA disease severity and small airway function,in order to provide beneficial evidence for clinical diagnosis and treatment. Methods A total of 90 children with CVAadmitted to the Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from June 2021 to April2023 were selected as the CVA group, and another 90 children with PIC were selected as the PIC group. The clinical dataand FeNO and TSLP levels of the two groups of children were compared, and the receiver operating characteristic (ROC)curve and area under the curve (AUC) were plotted to analyze the differential value of FeNO combined with TSLPfor CVA and PIC. The small airway function [FEF25 (%), FEF50 (%), FEF75 (%), FEF25-75 (%)] and FeNO,TSLP levels of children with different severity and stage of CVA were compared. Spearman and Pearson correla-tion coefficients were used to analyze the correlation between FeNO, TSLP and small airway function, diseasestage, and severity of CVA. Results The levels of FeNO and TSLP in children with CVA were significantly higherthan those in children with PIC (P<0.05). ROC analysis showed that the combination of FeNO and TSLP had the highestAUC for distinguishing CVA from PIC (0.934), with a sensitivity of 87.78% and a specificity of 82.22%, which were sig-nificantly higher than that of each indicator alone (P<0.05). The FEF25, FEF50, FEF75, and FEF25-75 reduced succes-sively in children with mild CVA, moderate CVA, and severe CVA (P<0.05). The levels of FeNO and TSLP increasedsuccessively in children with mild CVA, moderate CVA, and severe CVA, with statistically significant differences (P<0.05). The FEF25, FEF50, and FEF75 in children with clinical remission were significantly higher than those in childrenwith acute exacerbation, and the levels of FeNO and TSLP were significantly lower than those in children with acute ex-acerbation, with statistically significant differences (P<0.05). Pearson correlation coefficient analysis showed that FeNOand TSLP were negatively correlated with FEF25, FEF50, FEF75, and FEF25-75 (P<0.05). Spearman correlation coef-ficient analysis showed that FeNO and TSLP were positively correlated with disease stage and severity (P<0.05).Conclusion Compared with children with PIC, children with CVA have abnormally elevated levels of FeNO andTSLP. The combined detection of the two indexes has high value in the differential diagnosis of CVA and PIC. The lev-els of FeNO and TSLP are closely related to the condition and small airway function of children.
      【Key words】 Exhaled nitric oxide; Thymic stromal lymphopoietin; Cough variant asthma; Post-infection cough;Small airway function