背景:呼出气一氧化氮(FeNO)部分用于诊断和监测儿童哮喘,但过敏性致敏的影响仍然知之甚少。这里,我们研究了哮喘和过敏性致敏对儿童期FeNO水平的影响.
方法:我们调查了哮喘,空气过敏原致敏,在COPSAC2000出生队列的411名儿童中,使用重复测量混合模型校正胎龄,从5-18岁测量FeNO,性别,并发气道感染,吸入皮质类固醇,烟草暴露。在类似设计的700名儿童的COPSAC2010队列中寻求复制。
结果:在COPSAC2000队列中,133人在5到18岁之间有哮喘,在COPSAC2010队列中,112名患者在5至10岁之间患有哮喘。在COPSAC2000队列中,哮喘和空气过敏原致敏都与5至18岁的较高FeNO相关:校正几何平均比(aGMR),1.22(1.08-1.35),p<.01,和1.41(1.21-1.65),p分别<0.001。然而,哮喘与空气过敏原致敏儿童的FeNO增加相关:1.44(1.23-1.69),p<0.0001,而哮喘与非致敏儿童的FeNO降低相关:0.80(0.65-0.99),p=.05(哮喘x致敏的p相互作用<.0001)。COPSAC2010队列中的复制显示出相似的结果(p-交互作用<.01)。Further,血嗜酸性粒细胞计数,总IgE,支气管扩张剂反应,和支气管高反应性均与对空气过敏原敏感的儿童中FeNO增加有关,但不是在非敏感儿童中。
结论:哮喘儿童的呼出一氧化氮分数在儿童期升高,并与哮喘相关性状相关,这取决于空气过敏原致敏的存在。这些发现表明,FeNO仅是并发空气过敏原致敏儿童的有效哮喘生物标志物,这对于FeNO临床使用的指南建议很重要。
BACKGROUND: Fraction of exhaled nitric oxide (FeNO) is used for diagnosing and monitoring asthma in children, but the influence of allergic sensitization is still poorly understood. Here, we investigate how asthma and allergic sensitization influence FeNO levels during childhood.
METHODS: We investigated the associations between asthma, aeroallergen sensitization, and FeNO measured from age 5-18 years in the COPSAC2000 birth cohort of 411 children using repeated measurement mixed models adjusted for gestational age, sex, concurrent airway infection, inhaled corticosteroids, and tobacco exposure. Replication was sought in the similarly designed COPSAC2010 cohort of 700 children.
RESULTS: In the COPSAC2000 cohort, 133 had asthma between age 5 and 18 years, and in the COPSAC2010 cohort, 112 had asthma between age 5 and 10 years. In the COPSAC2000 cohort, asthma and aeroallergen sensitization were both associated with higher FeNO from age 5 to 18 years: adjusted geometric mean ratio (aGMR), 1.22 (1.08-1.35), p < .01, and 1.41 (1.21-1.65), p < 0.001, respectively. However, asthma was associated with increased FeNO among children with aeroallergen sensitization: 1.44 (1.23-1.69), p < .0001, whereas asthma was associated with decreased FeNO among nonsensitized children: 0.80 (0.65-0.99), p = .05 (p-interaction<.0001 for asthma x sensitization). Replication in the COPSAC2010 cohort showed similar results (p-interaction <.01). Further, blood eosinophil count, total-IgE, bronchodilator response, and bronchial hyperreactivity were all associated with increased FeNO among children sensitized to aeroallergens, but not among nonsensitized children.
CONCLUSIONS: Fraction of exhaled nitric oxide is elevated through childhood in children with asthma and is correlated with asthma-associated traits depending on the presence of aeroallergen sensitization. These findings indicate that FeNO is only a valid asthma biomarker in children with concurrent aeroallergen sensitization, which is important for guideline recommendations on the clinical use of FeNO.