Short-term efficacy evaluation of nasal nitric oxide on immunotherapy in children with allergic rhinitis
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摘要: 目的 初步探讨鼻呼出气NO(nNO)对特异性变应原皮下免疫治疗儿童变应性鼻炎(AR)的短期疗效评估价值。方法 选择2018年1月—2019年1月在广州市妇女儿童医疗中心耳鼻咽喉科治疗的AR患儿87例(病例组)以及同期在医院接受体检的健康儿童80例(对照组)的资料进行回顾性分析。病例组采用特异性变应原皮下免疫治疗方法。对比对照组和病例组不同治疗时间点的nNO及鼻部症状评分(TNSS)变化情况。观察病例组患儿在治疗1年后的治疗效果，分析不同治疗效果的病例组患儿在治疗过程中的nNO与TNSS变化情况(nNO△、TNSS△)，测算nNO△、TNSS△对患儿治疗效果的评估价值。结果 病例组的nNO、TNSS均随着治疗时间延长而明显降低(均P < 0.05)，病例组在不同治疗时间点的nNO、TNSS均高于对照组(P < 0.05)。对照组和病例组在全部信息采集时间点的nNO与TNSS呈正相关(r=0.870，P < 0.05)。治疗1年后，病例组患儿的治疗有效率为78.16%(68/87)。病例组不同治疗效果患儿的nNO△、TNSS△对比，差异有统计学意义(P < 0.05)。利用nNO△、TNSS△对于患儿的治疗效果推断，最佳截断值为457.78 μg/L、3.95分，约登指数为0.821、0.639。结论 特异性变应原皮下免疫治疗对AR患儿具有良好的治疗效果，利用患儿治疗前后的nNO数值变化对治疗效果进行评估具有良好的价值。Abstract: Objective To evaluate the short-term efficacy of nasal nitric oxide(nNO) on specific allergen subcutaneous immunotherapy in children with allergic rhinitis.Methods The data of 87 children with allergic rhinitis treated in the otolaryngology clinic of Guangzhou Women and Children's Medical Center from January 2018 to January 2019(case group) and 80 healthy children who received physical examination in the hospital during the same time period(control group) were retrospectively analyzed. The case group was treated with specific allergen subcutaneous immunotherapy. Compare the nNO and symptom score changes of the control group and the case group at different time points. Describe the treatment effect of children in the case group after 1 years of treatment. Analyze the changes of nNO and TNSS(nNO△, TNSS△) in the case group of patients with different treatment effects during treatment, and calculate the evaluation value of nNO△and TNSS△on the treatment effect of children.Results The nNO and TNSS in the case group decreased significantly with the prolonged treatment time(both P < 0.05). The nNO and TNSS of the case group at different treatment time points were higher than those of the control group(all P < 0.05). There was a positive correlation between nNO and TNSS in the control group and case group at all information collection time points(r=0.870, P < 0.05). After 1 year of treatment, the effective rate of treatment in the case group was 78.16%(68/87). There was a statistically significant difference in nNO△ and TNSS△ of children with different treatment effects in the case group(P < 0.05). Using the nNO△ and TNSS△ to infer the therapeutic effect of children, the best cut-off values were 457.78 μg/L and 3.95(points). The Youden Index was 0.821, 0.639.Conclusion Specific allergen subcutaneous immunotherapy has a good therapeutic effect on children with allergic rhinitis, and it is of good value to evaluate the therapeutic effect by using the changes of nNO values before and after treatment in children.
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Key words:
- nasal nitric oxide /
- rhinitis, allergic /
- child /
- subcutaneous immunotherapy
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表 1 对照组和病例组的一般临床资料比较
x±s 组别 例数 性别/例 年龄/岁 身高/cm 体重/kg 病程/月 男 女 对照组 80 41 39 6.87±3.25 117.68±8.14 24.68±5.14 - 病例组 87 42 45 7.25±3.16 120.01±10.37 25.01±6.35 5.25±2.14 统计值 χ2=0.101 t=0.745 t=1.573 t=0.359 - P 0.750 0.457 0.118 0.720 - 
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表 2 对照组和病例组不同时间点的nNO以及TNSS
x±s 组别 nNO/(μg·L-1 ) TNSS/分 对照组 147.25±61.251)2)3)4) 0.53±0.201)2)3)4) 病例组 治疗前1 d 876.87±76.273)4)5) 11.75±2.723)4)5) 治疗1个月 810.23±62.152)3)4)5) 10.61±2.583)4)5) 治疗6个月 457.25±51.481)2)4)5) 5.28±2.751)2)4)5) 治疗1年 307.66±42.091)2)3)5) 3.65±1.331)2)3)5) F 87.682 69.361 P < 0.001 < 0.001 与病例组治疗前1 d比较，1)P < 0.05；与病例组治疗1个月比较，2)P < 0.05；与病例组治疗6个月比较，3)P < 0.05；与病例组治疗1年比较，4)P < 0.05；与对照组比较，5)P < 0.05。
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表 3 病例组不同治疗效果患儿的nNO△、TNSS△对比
x±s 疗效 例数 nNO△/(μg·L-1) TNSS△/分 显效 43 651.72±49.47 9.11±1.15 有效 25 508.25±50.68 6.13±0.87 无效 19 417.25±53.75 3.05±0.76 F - 78.325 59.663 P - < 0.001 < 0.001
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表 4 nNO△、TNSS△对患儿治疗效果的评估价值
项目 最佳截断值 ROC曲线下面积 诊断灵敏度/% 诊断特异度/% 约登指数 nNO△ 457.78 0.940 92.65 89.47 82.12 TNSS△ 3.95 0.856 69.12 94.74 63.85
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