1.深圳市儿童医院;2.Shenzhen Children'3.'4.s Hospital
目的：探讨鼻呼出气一氧化氮（FnNO）动态变化对儿童慢性鼻窦炎（CRS）的疗效评估及潜在病因分析的临床意义。方法：回顾2018-2020年我院933例FnNO的检测结果，纳入其中随访FnNO变化的20例慢性鼻窦炎住院患儿，分为伴或不伴过敏组。应用Sunvou呼出气NO测定系统，采用鼻被动呼气+静音技术检测FnNO水平。结果：1.20例患儿病程均大于3月，20例有慢性咳嗽，16例有鼻塞，10例伴有过敏史。2.随访36月，20例慢性鼻窦炎患儿治疗前FnNO的平均值89ppb，治疗前后的FnNO差异有统计学意义（150±164）ppb VS（337±280）ppb，P＜0.05。CRS伴过敏组及不伴过敏组患儿的FnNO水平有显著性差异（544±251）ppb VS（264±191）ppb，P＜0.05。2.CRS伴过敏组治疗后较治疗前的FnNO明显升高，且统计具有显著差异性（136±116）ppb VS（519±280）ppb，P＜0.01；而CRS不伴过敏组治疗前后的FnNO差异无统计学意义（164±206）ppb VS（156±120）ppb，P＞0.05。3.10例CRS不伴过敏组患者中，4例FnNO水平持续降低，其中3例患儿确诊原发性纤毛运动障碍（PCD），多次复查FnNO均＜77ppb；1例确诊囊性纤维化（CF）。结论：儿童慢性鼻窦炎存在FnNO水平明显降低，可能与变态反应及鼻腔阻塞相关，而规律治疗后随访FnNO水平可逐渐趋于正常，少部分FnNO水平持续降低的患儿需警惕是否合并PCD、CF等基础疾病。
Objective: To investigate the clinical significance of dynamic changes of nasal exhaled nitric oxide (FnNO) in the treatment of chronic sinusitis (CRS) in children. Methods: 933 results of FnNO in our hospital from 2018 to 2020 were reviewed.20 hospitalized children with chronic sinusitis who were followed up for FnNO changes were included and divided into groups with or without allergy.The level of FnNO was measured by the Sunvou exhaled NO measuring system and the passive exhalation and silence technique. Results: 20 children had chronic cough longer than 3 months, 16 children had nasal congestion, and 10 children had a history of allergy.After 36 months of follow-up, the average FnNO of 20 children with chronic sinusitis was 89ppb.The difference of FnNO in 20 children before and after treatment was statistically significant (150±164) ppb VS (337±280) ppb, P<0.05.There was significant difference in FnNO level between CRS with allergy and without allergy group (544±251)ppb VS (264±191) ppb, P<0.05.FnNO in the group with allergy increased significantly after treatment compared with before(136±116) ppb VS (519±280)ppb, P<0.01.There was no significant difference in the group without allergy before and after treatment (164±206)ppb VS (156±120)ppb, P>0.05.The clinical data of 10 patients with CRS without allergy group were reviewed. FnNO level of 4 patients continued to decrease without significant improvement, 3 of them were diagnosed with PCD and FnNO<77ppb after repeated reexamination.Cystic fibrosis (CF) was confirmed in 1 case. Conclusion：The FnNO level is often significantly reduced in children chronic sinusitis which may be related to allergy or nasal obstruction.FnNO level gradually tended to normal after regular treatment in children chronic sinusitis.The FnNO level continuously decreased in children who with chronic sinusitis should be alert to whether they are complicated with basic diseases,such as PCD or CF.