过敏性哮喘患儿中呼出气一氧化氮水平（FeNO）的决定因素：新生儿呼吸窘迫与低FeNO水平相关的证据
2010/09/14
摘要
背景：过敏性哮喘患儿呼出气一氧化氮水平(FeNO)与嗜酸性粒细胞性炎症相关。FeNO是否受到其他能影响生命早期哮喘自然史的因素的影响，目前尚不清楚。
目的：本试验评价能影响哮喘自然史的免疫应答因素的频率和采用多因素分析鉴别导致FeNO水平上升或下降的潜在决定因素。
方法：171名患轻至中度哮喘的患儿入选本研究，根据FeNO水平对其进行分层：低FeNO组（<20 ppb）、中FeNO组（20-40 ppb）、高FeNO组（>40 ppb）。对9个免疫应答因素的发生频率、致敏相关指标[总和过敏原特异性免疫球蛋白E (IgE)]、血液嗜酸性粒细胞计数）以及气流受限[第一秒用力呼气容积(FEV1)预测值]进行评价。
结果：与患者病史相关的因素中，新生儿呼吸窘迫仅出现于FeNO水平较低的患儿，而未出现于FeNO中至高水平的患儿（p = 0.008）。与低FeNO 组相比，中和高FeNO 组患儿嗜酸性粒细胞计数较高，其FEV1具有降低的趋势。多因素分析显示，4个因素[嗜酸性粒细胞>300/mm3、猫特异性IgE、屋尘螨(HDM)特异性IgE、FEV1≤86%预测值]与中至高FeNO水平显著相关，2个因素（嗜酸性粒细胞>600/mm3、总IgE>355 kU/L）与高FeNO水平相关。
结论：本研究除了确认血液嗜酸性粒细胞和/或致敏与FeNO之间存在紧密相关性，还显示，对于过敏性哮喘患儿，新生儿呼吸窘迫是一个与低FeNO相关的潜在因素。
（刘国梁 审校）
J Asthma. 2010 Jul 14. [Epub ahead of print]
Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels
Ricciardolo FL, Silvestri M, Pistorio A, Strozzi MM, Tosca MA, Bellodi SC, Battistini E, Gardella C, Rossi GA.
Pulmonary and Allergy Disease Paediatric Unit, G. Gaslini Institute, Genoa, Italy.
Abstract
Background. In allergic asthmatic children exhaled nitric oxide (FeNO) levels are related to eosinophilic inflammation by correlation analysis. Whether FeNO can be modified by factors potentially influencing the natural history of asthma in early life is not known.
Objective. To evaluate the frequency of anamnestic factors influencing the natural history of asthma and to identify potential determinants for elevated or low FeNO levels by multivariate analysis.
Methods. One hundred seventy-one children with mild-moderate asthma were stratified according to their FeNO levels into three groups: low (<20 ppb), mid (20-40 ppb), and high (>40 ppb). The frequency of nine anamnestic factors together with indices of allergic sensitization (total and allergen-specific immunoglobulin E [IgE], blood eosinophil counts) and of airflow limitation (forced expiratory volume in one second [FEV(1)]% predicted) were evaluated.
Results. Among factors related to the patient history, neonatal respiratory distress was reported only in children with low FeNO levels, whereas this factor was never reported in children with mid-to-high FeNO levels (p = .008). As compared with low FeNO group, mid and high FeNO groups showed higher eosinophil counts and a tendency to have lower FEV(1) values. By multivariate analysis, four factors (eosinophils >300 cells/mm(3), cat-specific IgE, house dust mites [HDM]-specific IgE, FEV(1) 600 cells/mm(3), total IgE >355 kU/L) with high FeNO levels.
Conclusions. Besides confirming the well-known tight association between blood eosinophilia and/or allergic sensitization and FeNO, these data provide new evidence for neonatal respiratory distress as potential factor associated with low FeNO levels in childhood atopic asthma.
J Asthma. 2010 Jul 14. [Epub ahead of print]
背景：过敏性哮喘患儿呼出气一氧化氮水平(FeNO)与嗜酸性粒细胞性炎症相关。FeNO是否受到其他能影响生命早期哮喘自然史的因素的影响，目前尚不清楚。
目的：本试验评价能影响哮喘自然史的免疫应答因素的频率和采用多因素分析鉴别导致FeNO水平上升或下降的潜在决定因素。
方法：171名患轻至中度哮喘的患儿入选本研究，根据FeNO水平对其进行分层：低FeNO组（<20 ppb）、中FeNO组（20-40 ppb）、高FeNO组（>40 ppb）。对9个免疫应答因素的发生频率、致敏相关指标[总和过敏原特异性免疫球蛋白E (IgE)]、血液嗜酸性粒细胞计数）以及气流受限[第一秒用力呼气容积(FEV1)预测值]进行评价。
结果：与患者病史相关的因素中，新生儿呼吸窘迫仅出现于FeNO水平较低的患儿，而未出现于FeNO中至高水平的患儿（p = 0.008）。与低FeNO 组相比，中和高FeNO 组患儿嗜酸性粒细胞计数较高，其FEV1具有降低的趋势。多因素分析显示，4个因素[嗜酸性粒细胞>300/mm3、猫特异性IgE、屋尘螨(HDM)特异性IgE、FEV1≤86%预测值]与中至高FeNO水平显著相关，2个因素（嗜酸性粒细胞>600/mm3、总IgE>355 kU/L）与高FeNO水平相关。
结论：本研究除了确认血液嗜酸性粒细胞和/或致敏与FeNO之间存在紧密相关性，还显示，对于过敏性哮喘患儿，新生儿呼吸窘迫是一个与低FeNO相关的潜在因素。
（刘国梁 审校）
J Asthma. 2010 Jul 14. [Epub ahead of print]
Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels
Ricciardolo FL, Silvestri M, Pistorio A, Strozzi MM, Tosca MA, Bellodi SC, Battistini E, Gardella C, Rossi GA.
Pulmonary and Allergy Disease Paediatric Unit, G. Gaslini Institute, Genoa, Italy.
Abstract
Background. In allergic asthmatic children exhaled nitric oxide (FeNO) levels are related to eosinophilic inflammation by correlation analysis. Whether FeNO can be modified by factors potentially influencing the natural history of asthma in early life is not known.
Objective. To evaluate the frequency of anamnestic factors influencing the natural history of asthma and to identify potential determinants for elevated or low FeNO levels by multivariate analysis.
Methods. One hundred seventy-one children with mild-moderate asthma were stratified according to their FeNO levels into three groups: low (<20 ppb), mid (20-40 ppb), and high (>40 ppb). The frequency of nine anamnestic factors together with indices of allergic sensitization (total and allergen-specific immunoglobulin E [IgE], blood eosinophil counts) and of airflow limitation (forced expiratory volume in one second [FEV(1)]% predicted) were evaluated.
Results. Among factors related to the patient history, neonatal respiratory distress was reported only in children with low FeNO levels, whereas this factor was never reported in children with mid-to-high FeNO levels (p = .008). As compared with low FeNO group, mid and high FeNO groups showed higher eosinophil counts and a tendency to have lower FEV(1) values. By multivariate analysis, four factors (eosinophils >300 cells/mm(3), cat-specific IgE, house dust mites [HDM]-specific IgE, FEV(1) 600 cells/mm(3), total IgE >355 kU/L) with high FeNO levels.
Conclusions. Besides confirming the well-known tight association between blood eosinophilia and/or allergic sensitization and FeNO, these data provide new evidence for neonatal respiratory distress as potential factor associated with low FeNO levels in childhood atopic asthma.
J Asthma. 2010 Jul 14. [Epub ahead of print]
