儿童胸闷变异性哮喘的临床特征及外周血EOS计数、总IgE、肺功能的诊断价值

郭浩然; 宋梦瑶; 孙晨; 夏群; 王磊; 彭紫雨; 马莉娟; 周瑞

doi:10.16766/j.cnki.issn.1674-4152.004521

儿童胸闷变异性哮喘的临床特征及外周血EOS计数、总IgE、肺功能的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.004521

郭浩然¹,
宋梦瑶¹,
孙晨¹,
夏群¹,
王磊¹,
彭紫雨²,
马莉娟¹,
周瑞^1, ,

1.
蚌埠医科大学第一附属医院儿科, 安徽蚌埠 233004
2.
蚌埠医科大学公共卫生学院，安徽蚌埠 233030

基金项目:

安徽省重点实验室开放课题 AHIAI2023K02

安徽省高校自然科学研究项目 KJ2019A0342

蚌埠医科大学研究生科研创新计划项目 Byycx23041

详细信息

通讯作者:
周瑞，E-mail：1176034941@qq.com

中图分类号: R562.25
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- 文章访问数: 9
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出版历程
- 收稿日期: 2025-01-19
- 网络出版日期: 2026-11-10

Clinical features of children with chest tightness variant asthma and diagnostic value of EOS count, total IgE and pulmonary function in peripheral blood

1.
Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨儿童胸闷变异性哮喘(CTVA)的临床特征及外周血嗜酸性粒细胞(EOS)计数、总IgE、肺功能的诊断价值，为儿童CTVA的早期识别提供依据。方法以2023年1月—2024年12月在蚌埠医科大学第一附属医院就诊的51例CTVA患儿为研究对象，选取同期58例非急性发作期典型哮喘患儿为CA组，及40例健康儿童为对照组。收集3组临床资料，使用Spearman相关分析法研究外周血EOS计数、总IgE与肺功能的相关性，并绘制ROC曲线分析其对儿童CTVA的诊断价值。结果 CTVA组发病年龄[10.3(8.8，11.6)岁]高于CA组[7.7(6.4，10.5)岁，Z=-3.811，P < 0.05]；2组发病时间、发病季节、合并过敏性鼻炎史、BMI以及各项肺功能指标差异均无统计学意义。CTVA组外周血EOS计数、总IgE低于CA组，但高于对照组(P < 0.05)。CTVA组外周血EOS计数、总IgE均与小气道[最大呼气中期流速(MMEF)、用力呼气50%(FEF₅₀)、75%(FEF₇₅)肺活量的呼气峰流速]呈负相关关系(r < 0，P < 0.05)。ROC曲线显示，CTVA组MMEF、FEF₅₀、FEF₇₅的最佳截断值分别为76.4%、68.3%、67.1%，外周血EOS计数、总IgE最佳截断值为0.12×10⁹/L、62.6 IU/mL；外周血EOS计数+总IgE+三项小气道指标的AUC为0.832(95% CI: 0.731~0.907，P < 0.05)，均大于单一指标的诊断效能。结论 CTVA患儿的发病年龄高于CA患儿；外周血EOS计数、总IgE联合小气道可协助CTVA患儿的临床诊断。
- 胸闷变异性哮喘 /
- 儿童 /
- 肺功能 /
- 免疫球蛋白E /
- 嗜酸性粒细胞
Abstract: Objective To investigate the clinical characteristics of childhood chest tightness variant asthma (CTVA) and the diagnostic value of peripheral blood eosinophil (EOS) count, total IgE, and pulmonary function, so as to provide evidence for early identification of CTVA in children. Methods A total of 51 children with CTVA admitted to the First Affiliated Hospital of Bengbu Medical University from January 2023 to December 2024 were enrolled as the study subjects. In addition, 58 children with non-acute exacerbation typical asthma during the same period were selected as the CA group, and 40 healthy children served as the control group. Clinical data from the three groups were collected. Spearman correlation analysis was used to examine the correlations of peripheral blood EOS count and total IgE with pulmonary function parameters. Receiver operating characteristic (ROC) curves were plotted to analyze their diagnostic value for childhood CTVA. Results The age of onset in the CTVA group was 10.3 (8.8, 11.6) years, which was higher than that in the CA group [7.7 (6.4, 10.5) years, Z=-3.811, P < 0.05]. There were no statistically significant differences between the two groups in terms of disease duration, season of onset, history of comorbid allergic rhinitis, BMI, and various pulmonary function indices. The peripheral blood EOS count and total IgE in the CTVA group were lower than those in the CA group, but higher than those in the control group (P < 0.05). In the CTVA group, both peripheral blood EOS count and total IgE showed negative correlations with small airway parameters [maximal mid-expiratory flow (MMEF), forced expiratory flow at 50% of vital capacity (FEF₅₀), forced expiratory flow at 75% of vital capacity (FEF₇₅), r < 0, P < 0.05]. ROC curve analysis indicated that the optimal cutoff values for MMEF, FEF₅₀, and FEF₇₅ in the CTVA group were 76.4%, 68.3%, and 67.1%, respectively, while the optimal cutoff values for peripheral blood EOS count and total IgE were 0.12×10⁹/L and 62.6 IU/mL, respectively. The area under the curve (AUC) for the combination of peripheral blood EOS count, total IgE, and the three small airway indices was 0.832 (95% CI: 0.731-0.907, P < 0.05), which was greater than the diagnostic efficacy of any single indicator. Conclusion The age of onset in children with CTVA is higher than that in children with CA. The combination of peripheral blood EOS count, total IgE, and small airway parameters can assist in the clinical diagnosis of CTVA in children.
- Chest tightness variant asthma /
- Children /
- Pulmonary function /
- Immunoglobulin E /
- Eosinophils

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图 1 外周血EOS计数、总IgE预测儿童CTVA的ROC曲线

Figure 1. ROC curve of peripheral blood EOS count and total IgE in the prediction of CTVA in children

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图 2 MMEF、FEF₅₀、FEF₇₅预测儿童CTVA的ROC曲线

Figure 2. ROC curves of MMEF, FEF50, and FEF75 in the prediction of CTVA in children

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图 3 外周血EOS计数+总IgE+小气道指标预测儿童CTVA的ROC曲线

Figure 3. ROC curves for peripheral blood EOS counts combined with small airway indices and total IgE in the prediction of CTVA in children

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表 1 CTVA组与CA组患儿临床资料比较

Table 1. Comparison of clinical features between the CTVA and CA groups

组别	例数	发病年龄 [M(P₂₅，P₇₅)，岁]	BMI [M(P₂₅，P₇₅)]	鼻炎史[例(%)]
组别	例数	发病年龄 [M(P₂₅，P₇₅)，岁]	BMI [M(P₂₅，P₇₅)]	有		无
CTVA组	51	10.3(8.8，11.6)	19.12(15.62，21.55)	33(64.7)		18(35.3)
CA组	58	7.7(6.4，10.5)	16.92(14.69，21.12)	43(74.1)		15(25.9)
统计量		-3.811^a	-1.561^a	1.144^b
P值		＜0.001	0.119	0.285

组别	例数	发病时间[例(%)]			发病季节[例(%)]
组别	例数	白天	夜间	无规律	春	夏	秋	冬
CTVA组	51	18(35.3)	23(45.1)	10(19.6)	10(19.6)	20(39.2)	11(21.6)	10(19.6)
CA组	58	13(22.4)	25(43.1)	20(34.5)	11(19.0)	19(32.8)	21(36.2)	7(12.1)
统计量		3.789^b			3.292^b
P值		0.150			0.349
注：^a为Z值，^b为χ²值。

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表 2 3组研究对象外周血EOS计数、总IgE比较

Table 2. Comparison of peripheral blood EOS counts and total IgE among the three groups

组别	例数	EOS计数 [M(P₂₅, P₇₅)，×10⁹/L]	例数	总IgE [M(P₂₅, P₇₅)，IU/mL]
CTVA组	45	0.170(0.095，0.275)^a	38	72.70(30.48，183.00)^a
CA组	46	0.320(0.133，0.475)^ab	31	264.00(82.00，544.00)^ab
对照组	40	0.115(0.043，0.188)	40	36.95(14.83，71.70)
H值		23.168		23.759
P值		＜0.001		＜0.001
注：与对照组比较，^aP＜0.05；与CTVA组比较，^bP＜0.05。

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表 3 3组研究对象肺功能参数比较

Table 3. Comparison of pulmonary function parameters among the three groups of research subjects

组别	例数	FEV₁ [M(P₂₅, P₇₅)，%]	FVC [M(P₂₅, P₇₅)，%]	FEV₁/FVC [M(P₂₅, P₇₅)]	PEF [M(P₂₅, P₇₅)，%]	MMEF(x±s，%)	FEF₂₅ [M(P₂₅, P₇₅)，%]	FEF₅₀(x±s，%)	FEF₇₅ [M(P₂₅, P₇₅)，%]
CTVA组	51	88.30(81.10，94.80)^a	91.30(81.70，102.70)	96.80(89.00，103.60)^a	74.00(68.10，82.50)	64.77±17.16^a	70.60(64.60，80.20)^a	65.72±21.77^a	61.90(38.60，71.00)^a
CA组	56	87.20(80.28，98.90)^a	91.70(84.35，104.00)	94.55(86.08，100.78)^a	71.55(59.98，88.05)	61.39±21.53^a	68.65(56.25，82.10)^a	62.72±21.38^a	53.25(36.18，66.03)^a
对照组	40	98.80(91.50，105.60)	100.80(83.15，107.60)	102.80(97.48，108.00)	81.00(72.13，87.48)	83.26±15.78	84.70(75.93，93.90)	83.98±14.52	76.05(67.53，91.48)
统计量		23.851^b	2.811^b	20.698^b	3.112^b	17.730^c	17.217^b	14.830^c	33.552^b
P值		< 0.001	0.245	< 0.001	0.211	< 0.001	< 0.001	< 0.001	< 0.001
注：与对照组比较，^aP＜0.05；^b为H值，^c为F值。

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表 4 CTVA组外周血EOS计数、总IgE与肺功能指标的相关性

Table 4. Correlations between peripheral blood EOS count, total IgE, and pulmonary function indicators in the CTVA group

项目	外周血EOS计数		总IgE
项目	r_s值	P值	r_s值	P值
FEV₁	-0.206	0.215	-0.146	0.381
FVC	-0.075	0.653	-0.006	0.972
FEV₁/FVC	-0.127	0.446	-0.069	0.680
PEF	-0.019	0.909	-0.127	0.446
MMEF	-0.344	0.034	-0.834	< 0.001
FEF₂₅	-0.163	0.327	-0.038	0.823
FEF₅₀	-0.333	0.041	-0.793	< 0.001
FEF₇₅	-0.368	0.023	-0.822	< 0.001

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表 5 外周血EOS计数、总IgE、小气道指标及联合诊断CTVA的ROC曲线分析

Table 5. ROC curve for peripheral blood EOS, total IgE, small airway indices, and their combination in the diagnosis of CTVA

项目	截断值	灵敏度(%)	特异度(%)	AUC	95% CI	P值
MMEF	76.4	71.00	70.00	0.782	0.674~0.867	< 0.001
FEF₅₀	68.3	63.16	90.00	0.780	0.672~0.866	< 0.001
FEF₇₅	67.1	63.16	82.50	0.777	0.668~0.863	< 0.001
EOSa	0.12	65.79	60.00	0.674	0.559~0.776	0.004
总IgE	62.6	63.16	67.50	0.670	0.554~0.772	0.006
EOS+总IgE+小气道^a		81.58	70.00	0.832	0.731~0.907	< 0.001
注：^a小气道为MMEF+FEF₅₀+FEF₇₅。

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