作者：张钰，张丽珍，申永旺，田君平，梁海联，陈欣

单位：

073000 河北省定州市人民医院普儿一科；通信作者：张钰，E-mail：cenken00067@163.com

Units：

The First Department of General Pediatrics，the People's Hospital of Dingzhou，Dingzhou 073000，China；Corresponding author：ZHANG Yu，E-mail：cenken00067@163.com

关键词：

咳嗽；儿童；咳嗽变异性哮喘；感染后咳嗽；呼出气一氧化氮；诱导痰嗜酸粒细胞；鉴别诊断

Keywords：

Cough；Child；Cough variant asthma；Post-infectious cough；Fractional exhaled nitric oxide；Induced sputum eosinophils；Differential diagnosis

CLC：

R 256.11

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y11

Funds：

2019 年度河北省医学科学研究课题（20191752）

摘要：

目的　分析呼出气一氧化氮（FeNO）浓度、诱导痰嗜酸粒细胞分数及二者联合对咳嗽变异性哮喘（CVA）与感染后咳嗽（PIC）所致儿童慢性咳嗽的鉴别诊断价值。方法　选取 2018 年 1 月—2019 年 1 月定州市人民医院儿科收治的慢性咳嗽患儿 84 例，根据病因分为 CVA 组 32 例和 PIC 组 52 例。比较两组患儿 FeNO 浓度、日间咳嗽症状积分、夜间咳嗽症状积分、视觉模拟评分法（VAS）评分、肺功能指标〔包括用力肺活量（FVC）、第 1 秒用力呼气容积（FEV 1 ）、第 1 秒用力呼气容积与用力肺活量比值（FEV 1 /FVC）及最大呼气流量（PEF）〕及诱导痰细胞检查结果，绘制 ROC 曲线以评价 FeNO 浓度、诱导痰嗜酸粒细胞分数及二者联合对 CVA、PIC 所致儿童慢性咳嗽的鉴别诊断价值。结果　CVA 组患儿 FeNO 浓度、诱导痰嗜酸粒细胞分数高于 PIC 组（P<0.05）；两组患儿日间咳嗽症状积分、夜间咳嗽症状积分、VAS 评分、FVC、FEV 1 、FEV 1 /FVC、PEF 及诱导痰淋巴细胞分数、中性粒细胞分数、巨噬细胞分数比较，差异无统计学意义（P>0.05）。ROC 曲线显示，FeNO 浓度、诱导痰嗜酸粒细胞分数及二者联合鉴别诊断 CVA 与 PIC所致儿童慢性咳嗽的曲线下面积（AUC）分别为 0.725〔95%CI（0.623，0.827）〕、0.718〔95%CI（0.599，0.836）〕及 0.757〔95%CI（0.661，0.853）〕；二者联合鉴别诊断 CVA、PIC 所致儿童慢性咳嗽的 AUC 大于 FeNO 浓度、诱导痰嗜酸粒细胞分数（P<0.05）。结论　FeNO 浓度、诱导痰嗜酸粒细胞分数对 CVA 与 PIC 所致儿童慢性咳嗽具有一定鉴别诊断价值，且二者联合的鉴别诊断价值更高。

Abstract：

Objective　To analyze the differential diagnostic value of FeNO concentration，induced sputumeosinophils ratio and combination of the above two on chronic cough caused by cough variant asthma（CVA）and by post-infectious cough（PIC）in children. Methods　From January 2018 to January 2019，a total of 84 children with chronic coughwere selected in the Department of Pediatrics，the People's Hospital of Dingzhou，and they were divided into CVA group（n=32）and PIC group（n=52）according to the etiological factors. FeNO concentration，daytime and nighttime coughsymptom score，VAS score，index of pulmonary function（including FVC，FEV 1 ，FEV 1 /FVC and PEF）and induced sputumcytoscopy results were compared between the two groups，moreover ROC curve was drawn to evaluate the differential diagnosticvalue of FeNO concentration，induced sputum eosinophils ratio and combination of the above two on chronic cough caused byCVA and by PIC in children. Results　FeNO concentration and induced sputum eosinophils ratio in CVA group were statisticallysignificantly higher than those in PIC group（P<0.05）；there was no statistically significant difference in daytime or nighttimecough symptom score，VAS score，FVC，FEV 1 ，FEV 1 /FVC，PEF，lymphocyte ratio，neutrophils ratio or macrophageratio in induced sputum between the two groups（P>0.05）. ROC curve showed that，AUC of FeNO concentration，inducedsputum eosinophils ratio and combination of the above two in differential diagnosis of chronic cough caused by CVA and by PIC inchildren was 0.725〔95%CI（0.623，0.827）〕，0.718〔95%CI（0.599，0.836）〕and 0.757〔95%CI（0.661，0.853）〕，respectively，moreover AUC of combination of FeNO concentration and induced sputum eosinophils ratio was statisticallysignificantly larger than that of each single in differential diagnosis of chronic cough caused by CVA and by PIC in children，respectively（P<0.05）. Conclusion　FeNO concentration and induced sputum eosinophils ratio have differential diagnosticvalue on chronic cough caused by CVA and by PIC in children，and combination of the above two has higher differentialdiagnostic value.

ReferenceList：