| Objective: This study aims to investigate the clinical significance of the standard asthma diagnostic model for children under 6 years old(the diagnostic model in short),and compares the difference in screening the risk of asthma between the diagnostic model and the modified asthma predictive index(m API).Methods: A total of 200 children under 6 years old who had symptoms of wheezing and at least 4 episodes of wheezing,and treated in the outpatient and impatient departments of The Second Hospital,University of South China from November 2018 to July 2019 were recruited.Their baseline characteristics,the fractional exhaled nitric oxide(Fe NO),and pulmonary function indexes of tidal respiratory: Time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),Volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)were recorded in detail.All recruited children with asthma were asked for filling in the questionnaire of the diagnostic model,and those under 3 years old were additionally filled in the questionnaire of m API.Recruited children were followed up for 1 year from the date of recruitment.Once they were diagnosed with asthma during the follow-up period,they would be intervened by a standard treatment for half a year,and Fe NO and pulmonary function indexes of tidal respiratory were reexamined.And statistical analysis of the data.Results: 1.Asthma screening for children under 3 years old using the diagnostic model showed that the Kappa coefficient was 0.751,which was highly consistent.The Kappa coefficient of m API was 0.457,which was only moderately consistent.The Youden index of the diagnostic model was higher than that of m API(0.771 vs.0.518),indicating that the authenticity of the diagnostic model in screening asthma was higher than that of m API.2.The Kappa coefficient,sensitivity(Sen),specificity(Spe),Youden index,positive likelihood ratio(PLR),and negative likelihood ratio(NLR)of the diagnostic model in screening asthma of children under 6 years old was 0.779,0.863,0.957,0.819,19.840,and 0.144,respectively.The Kappa coefficient of 0.779 suggested that the result was highly consistent.3.The diagnostic model was analyzed by the receiver operating characteristic(ROC)curve.The area under the curve(AUC)was 0.920,and the 95% confidence interval(CI)was 0.881-0.959,which was statistically significant(P<0.05).The optimal diagnostic cut-off value was 4 grades,and at this time,the sensitivity and specificity was 0.974 and 0.786,respectively.4.TPTEF/TE of children with positive m API were significantly lower than those with negative m API(17.73±5.3% vs.20.61±7.25%,P<0.05),and VPEF/VE were also significantly lower(20.37±4.65% vs.22.80±6.14%,P<0.05).Fe NO of children with positive m API were significantly higher than those with negative m API [15(7,23)ppb vs.8(6,14)ppb,P<0.05].5.TPTEF/TE of children under 6 years old with the diagnostic model≥ 4 grades were significantly lower than those < 4 grades(20.65±7.74%vs.23.56±8.28%,P<0.05),and VPEF/VE were also significantly lower(22.36±6.47% vs.25.44±6.89%,P<0.05).Fe NO of children under 6years with the diagnostic model ≥ 4 grades were significantly higher than those < 4 grades [13(7,25)ppb vs.8(6,12)ppb,P<0.05].6.TPTEF/TE of children with asthma who were confirmed by experts were significantly lower than those non-asthma children(20.64±7.72% vs.23.04±8.28%,P<0.05),and VPEF/VE were also significantly lower(22.35±6.49% vs.24.90±6.89%,P<0.05).Fe NO of children with asthma who were confirmed by childhood asthma experts were significantly higher than those non-asthma children [15(8,27)ppb vs.8(6,12)ppb,P<0.05].7.TPTEF/TE of children with asthma after treatment significantly increased than that before treatment(29.97±7.75% vs.20.64±7.72%,P<0.05),and VPEF/VE was also significantly elevated(30.79±6.64% vs.22.35±6.49%,P<0.05).Fe NO of children with asthma after treatment significantly decreased than that before treatment [13(8,24)ppb vs.15(8,27)ppb,P<0.05].Conclusions: 1.The standard asthma diagnostic model for children under 6 years old can be applied for kids under 6,and its screening precision may be superior to m API;2.Fe NO,TPTEF/TE,VPEF/VE can contribute to the diagnosis of asthma and they are consistent with the standard asthma diagnostic model for children under 6 years old. |
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