| Objective: To analyze the changes of viral pathogen,allergen,lung function and respiratory tract inflammatory indices in asthma high-risk infants,such as sputum eosinophils,Creola bodies and Fe NO,and to explore its value in early diagnosis of asthma.Methods:From April 2016 to August 2017,135 cases in asthmatic bronchitis and asthmatic bronchial pneumonia in our hospital which with the high risk of asthma as the observation group,there were 37 cases(27.41%)for the first wheezing and 98 cases(72.59%)for the second wheezing,at the same period in our hospital outpatient department of cardiac ultrasound follow-up with 200 cases as control group,who are non asthmatic and non allergic children.The real time fluorescence PCR method was used to detect seven strains of Flu-A,RSV,ADV,Pin F,HRV,h MPV and HBo V of the nasopharyngeal aspiration specimens of children with wheezing;A test of lung function and bronchodilation test with a German JAEGER MASTER SCREEN PAED tester for infants and young children;Sputum specimen smear,ethanol fixation and HE staining microscopy in eosinophil and Creola bodies;Detected by the Swedish Pharmacia company Immuno CAP inhalation allergen of dermatophagoides pteronyssinus(D1)and dermatophagoides farinae(D2),and cat dander(E1),dog fur chip(E5),green,branched,Aspergillus(MX2),Alternaria(M6),spring and summer pollen(TX4),autumn and spring pollen(wx5);food allergic fowl protein F1,milk F2,and total Ig E concentration;determination of tidal breathing respiratory exhalation nitric oxide with Swiss ECO PHYSICS analyzer photochemical method.Results:First.A research on the etiology of virus among infants with high risk of asthma when wheezing(1)Virus detection situation: 135 cases of nasopharynx secretions in high risk infants with asthma,a total of 61 cases were detected at least one virus,the total virus detection rate was 45.19%,the positive rate of each virus from high to the bottom followed by HRV25.19%,HBo V9.63%,RSV8.12%,Pin F5.93%,Flu-A3.7%,ADV1.48%,h MPV0.74%.T here were 7 cases of virus and other virus mixed infection,of which HRV mixed with other viruses accounted for 71.43%,HBo V mixed with other viruses accounted for 71.43%,followed by Pin F and other viruses mixed infection accounted for 28.57%.(2)Age and sex distribution: The detection rate of HRV in children aged <1 year old was 16.13%,followed by RSV(9.68%)and Pin F(9.68%).The highest detection rate of HRV was 32.88% among 1 to 3 years old children,followed by HBo V and RSV;the detection rate of HRV aged 1 to 3 years old was higher than that in children aged <1 year old,the difference was statistically significant(P<0.05).There was no significant difference in the gender of each virus(P>0.05).(3)Research on the number of wheezing and pathogen: There were no significant differences in the detection rates of seven viruses(RSV,HRV,HBo V,Flu-A,Pin F,h MPV,ADV)between the first wheezing children and second wheezing children(P>0.05);the detection rate of rhinovirus was the highest in both was 18.92% and 27.55%.Second:Detection of allergen in infants with high risk of asthma(1)Among 135 infants with high risk of asthma,80 cases were positive for Phadiatop and Fx5 test,the positive rate was 59.26%,the positive rate of inhaled allergens was 43.75%,the positive rate of food allergens was 88.75%,both of them were positive,accounting for 32.50%,and the positive rate of food allergens was significantly higher than that of inhaled allergens;the positive rate of inhalation allergens from high to low was dust mites 33.75%,mould 16.25%,pollen 11.25% and animal dandruff 3.75%.(2)the positive rate of inhaled allergens in <1 year old group was greater than that in the age group of 1-3 years old group(P<0.05).The positive rate of food allergens between the two groups was not statistically significant(P>0.05);the positive rate of food allergens in 1-3 year old age group was higher than that of inhalation allergens,the difference was statistically significant(P<0.05);the difference of T-Ig E in children aged 1-3 years was significantly higher than that of <1 years old(P<0.05);there was no significant difference in age between two groups of inhalation allergens,such as dust mites,animal dandruff,mould and pollen(P>0.05).(3)The positive rate of inhaled allergens and the positive rate of food allergens in children with second wheezing were significantly higher than those in the first wheezing children,the difference was statistically significant(P<0.001);the positive rate of inhalational allergen dust mites and fungi in second children with wheezing was higher than that of the first wheezing children,and the difference was statistically significant(P<0.05).Inhaled allergens and food allergens positive rate in RSV,HRV,HBo V,Pin F,ADV,Flu-A,h MPV,virus mixed infection in children have no statistically significant differences(P>0.05);virus detection group inhaled allergens positive rate was greater than that detected the virus group,the difference was statistically significant(P<0.05),no statistically significant differences in food allergen positive rate between the two groups(P>0.05).(4)T-Ig E was not related to the number of wheezing,virus infection and different pathogenic species(P>0.05).Third: Change of tidal breathing lung function among infants with high risk of asthma(1)Changes of respiratory function parameters: The TPTEF/Te,VPEF/Ve,Vt and 1/PTEFas%TEF25 in the observation group were significantly lower than those in the control group.The RR,PTEF and PTEF/VT in the observation group were significantly higher than those in the control group,with statistically significant difference(P<0.05);The TPTEF/Te of children with wheezing was significantly lower than that of VPEF/Ve,and the difference was statistically significant(P<0.05).(2)Comparison of pulmonary function parameters after different virus infection:There was no significant difference in lung function parameters among HRV,HBo V,RSV,Flu-A,Pin F,ADV,h MPV and virus mixed infection(P>0.05).There was no significant difference in the parameters between virus detection group and virus undetection group(P>0.05).(3)Comparison of pulmonary function of different wheezing times: Among the 135 subjects,there were 37 cases(27.41%)with the first wheezing,and 98 cases(72.59%)with the second wheezing.The PTEF,TEF50%-r and TEF25%-r in second wheezing group were higher than those in the first wheezing group,the difference was statistically significant(P<0.05).(4)Comparison of pulmonary function parameters before and after diastolic test: PTEF and TEF50%-r increased significantly after the diastolic test,and the difference was statistically significant(P<0.05).TPTEF/TE = 23% group bronchodilation test positive rate of 20%,15 TPTEF/TE<23% group of bronchodilation test positive rate of 26.56%,TPTEF/TE<15% group of bronchodilation test positive rate of 41.03%,the more serious the degree of obstruction,the higher diagnostic value of positive diagnostic test.(5)The consistency of TPTEF/Te diastolic test positive with other pulmonary function parameters:The positive consistency of VPEF/Ve,1/PTEFas%TEF25 and TPTEF/Te diastolic test was statistically significant(P<0.001),and the consistency level of VPEF/Ve and TPTEF/Te was higher than that of 1/PTEFas%TEF25 and TPTEF/Te.(6)Correlation analysis between pulmonary function parameters:TEF50%-r was positively correlated with TEF25%-r(P<0.001);there was a positive correlation between PTEF and TEF50%-r and TEF25%-r(P<0.001).There is a positive correlation between 1/PTEFas%TEF25 and TEF50%-r and TEF25%-r(P<0.05);there is also a positive correlation with TPTEF/Te and VPEF/Ve(P<0.001).Fourth:Change of exhaled nitric oxide in high risk infants with asthma(1)Fe NO was significantly lower than the control group in 4-6 months,10-12 months,1-2 years old and 2-3 years old group and the difference was statistically significant(P<0.05).The Fe NO of children with homosexual wheezing was significantly lower than that of non wheezing children in the control group,and the difference was statistically significant(P<0.05).(2)There was a significant difference in Fe NO between RSV,HRV,HBo V,Pin F,Flu-A,ADV,h MPV and virus mixed infection among children(P<0.05).Among them,children with HBo V infection were significantly higher than those of other children.(3)There was no significant difference in Fe NO between four groups,including single inhalation allergens,single food allergens,inhalation + food positive,inhalation + food negative(P>0.05).(4)There was no significant difference in Fe NO between different wheezing times and male and female sex(P>0.05).Fifth: Changes in sputum eosinophils,Creola bodies(1)Comparison of Creola bodies in children with different pathogenic wheezing: 135 infants with high risk of asthma in Creola detection rate 41.48%,the Creola body score was significantly different in children with RSV,HRV,HBo V,Pin F,Flu-A,ADV,h MPV,and virus mixed infection(P<0.05),Creola bodies in virus mixed infection were significantly higher than that of single virus infection(P<0.05);Creola body score between virus detection group and virus undetected group had no significant differences(P>0.05).(2)Comparison of sputum EOS and Creola bodies between different wheezing times: Sputum eosinophils and creola body score in the first wheezing children and second wheezing children had no significant difference(P>0.05).(3)Changes of sputum EOS,Creola bodies in different allergic state: the sputum eosinophils in single inhaled allergen positive,single food allergens positive and inhalation + food were positive,inhalation + food were negative difference between the four groups was not statistically significant(P>0.05);the Creola body score in the single inhalation allergens were significantly higher than that of the single food allergens positive(P<0.05);significant differences in single food allergen and inhaled + food-negative group negative(P<0.05).Sixth:Correlation analysis of inflammation indices of respiratory tract(1)Sputum eosinophils have positive correlation with blood eosinophils and Creola bodies(P<0.05),no significant correlation with Fe NO(P>0.05);blood eosinophils and Creola bodies and Fe NO were not significantly correlated(P>0.05);Creola bodies and Fe NO have no significant correlation(P>0.05).(2)Tidal breathing pulmonary function RR,Vt,Ti/Te,PTEF,TPTEF/Te,VPEF/Ve,TEF50%-r,TEF25%-r,PTEF/VT,1/PTEFas%TEF25 and blood EOS,sputum EOS,Creola bodies,Fe NO were not correlated(P>0.05).(3)There was no correlation between blood EOS,sputum EOS,Creola body score,Fe NO and T-Ig E(P>0.05).Conclusion: Rhinovirus is the most common viral pathogen of asthma attack in high risk infants,followed by Boka virus and respiratory syncytial virus;allergy is a risk factor for wheezing or even repeated wheezing,the positive rate of inhalation allergen at the age of <1 year old group was high,and the positive rate of food allergens at the age of 1-3 years old group was high,patients with positive inhalation allergens are more likely to have a virus infection;TPTEF / Te,VPEF / Ve decreased significantly during the onset of wheezing,1/PTEFas%TEF25 can be used as a sensitive index for the bronchodilation test;during the onset of wheezing,the value of nitric oxide in the tidal breath is not descending,and whether Fe NO can be used as an effective indicator of airway inflammation during wheezing attack remains to be further explored;creola body score is higher than single virus infection in people with mixed virus infection,positive allergen and positive group in single inhalation allergen is higher than that of food allergens positive group;positive correlation between putum EOS and Creola bodies. |
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