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--> 00:01.294\n咳嗽、变异型哮喘。\n\n00:05.024 --> 00:07.974\n精准分型中的临床价值研究。\n\n00:10.925 --> 00:11.026\n嗯，\n\n00:11.026 --> 00:15.175\n我们主要从下面六个方面进行分析讨论。\n\n00:15.425 --> 00:16.201\n第一个呢，\n\n00:16.201 --> 00:17.975\n是研究背景与意义。\n\n00:18.676 --> 00:19.250\n第二个呢，\n\n00:19.250 --> 00:21.725\n是研究方法与实验设计。\n\n00:22.225 --> 00:23.051\n第三个呢，\n\n00:23.051 --> 00:24.176\n是研究结果呢，\n\n00:24.176 --> 00:25.076\n跟数据分析。\n\n00:25.895 --> 00:28.895\n第四个是讨论与机制探讨，\n\n00:29.246 --> 00:32.346\n第五个是临床应用与价值转化前景。\n\n00:33.080 --> 00:33.630\n第六个呢，\n\n00:33.630 --> 00:34.979\n是结论跟展望。\n\n00:35.380 --> 00:36.229\n首先呢，\n\n00:36.229 --> 00:36.680\n我们。\n\n00:37.492 --> 00:37.742\n嗯。\n\n00:39.143 --> 00:41.443\n讨论一下研究背景跟意义。\n\n00:43.534 --> 00:43.909\n首先呢，\n\n00:43.909 --> 00:47.985\n咳嗽变异型哮喘的临床特点与诊断现状我们先看一下。\n\n00:48.951 --> 00:50.401\n咳嗽变异型哮喘呢，\n\n00:50.401 --> 00:53.651\n也就是CVA是一种特殊类型的哮喘，\n\n00:53.901 --> 00:56.901\n以慢性咳嗽为主要或者唯一的症状，\n\n00:57.101 --> 01:01.201\n缺乏一些典型的喘息或者气促的一些表现，\n\n01:01.401 --> 01:02.175\n通常呢，\n\n01:02.175 --> 01:04.000\n是夜间或者凌晨发作。\n\n01:04.655 --> 01:05.055\n可能呢，\n\n01:05.055 --> 01:09.555\n有冷空气、雾霾、刺激性的气味或者运动等因素诱发，\n\n01:09.655 --> 01:12.956\n多伴有个人或家族湿疹史、过敏史。\n\n01:14.061 --> 01:14.361\n嗯，\n\n01:15.061 --> 01:16.262\n近年来呢，\n\n01:16.262 --> 01:16.861\nCBA的发病呢，\n\n01:16.861 --> 01:18.111\n呈一个上升趋势，\n\n01:18.262 --> 01:19.686\n在亚洲地区呢，\n\n01:19.686 --> 01:21.699\n高达35.1%，\n\n01:21.699 --> 01:25.012\n是儿童慢性咳嗽的一个常见的病因之一，\n\n01:25.162 --> 01:25.887\n国内呢，\n\n01:25.887 --> 01:28.512\n约接近1/3的慢性咳嗽病因呢，\n\n01:28.512 --> 01:29.611\n是CVA。\n\n01:31.517 --> 01:36.968\n在传统确认方法如诱导痰细胞学检查和支气管激发试验。\n\n01:37.790 --> 01:39.540\n对专业技术要求比较高，\n\n01:39.690 --> 01:41.489\n需要患儿来主动配合。\n\n01:41.940 --> 01:43.165\n临床实践中呢，\n\n01:43.165 --> 01:44.540\n难以的广泛开展，\n\n01:44.889 --> 01:47.940\n容易导致CBA与其他的慢性咳嗽，\n\n01:47.989 --> 01:49.790\n比如感染后咳嗽混淆，\n\n01:49.989 --> 01:53.389\n造成抗生素滥用或者延误诊治。\n\n01:55.738 --> 01:57.363\n临床实践发现呢，\n\n01:57.363 --> 01:59.363\nCVA呢对哮喘治疗反应性呢，\n\n01:59.363 --> 02:00.638\n存在一个抑制性。\n\n02:02.349 --> 02:03.300\n部分患者呢，\n\n02:03.300 --> 02:04.250\n反应良好。\n\n02:21.393 --> 02:22.867\n也有少部分患者治疗后呢，\n\n02:22.867 --> 02:24.593\n反应较差或者容易复发，\n\n02:24.742 --> 02:27.417\n大概36.5%的CBA患者呢，\n\n02:27.417 --> 02:29.292\n经过6个月规范治疗后呢，\n\n02:29.292 --> 02:31.542\n咳嗽还是没有完全的能够缓解。\n\n02:32.225 --> 02:35.425\n我们看看传统诊断方法的一个局限性的一个分析，\n\n02:35.876 --> 02:36.626\n首先呢，\n\n02:36.626 --> 02:38.626\n是典型的症状依赖的不足，\n\n02:39.026 --> 02:40.550\n咳嗽变异型哮喘呢，\n\n02:40.550 --> 02:43.576\n是以慢性咳嗽作为唯一或者主要的症状，\n\n02:43.776 --> 02:46.925\n缺乏典型哮喘的喘息气促表现。\n\n02:47.660 --> 02:51.509\n容易与感染后咳嗽等其他的慢性咳嗽病因相混淆，\n\n02:51.759 --> 02:53.184\n仅依赖于症状呢，\n\n02:53.184 --> 02:54.410\n容易导致误诊。\n\n02:55.399 --> 02:57.375\n而诱导痰细胞学检查呢，\n\n02:57.375 --> 02:58.800\n存在一定的操作难题。\n\n02:59.576 --> 03:01.576\n作为评估气道炎症的方法呢，\n\n03:01.826 --> 03:03.876\n其获取标本过程复杂，\n\n03:04.076 --> 03:05.675\n患儿耐受性比较差，\n\n03:05.975 --> 03:08.876\n尤其对于年幼儿童实施难度比较大，\n\n03:09.026 --> 03:11.876\n限制了其在基层医院的常规应用。\n\n03:12.505 --> 03:14.930\n对于支气管激发试验的临床呢，\n\n03:14.930 --> 03:15.955\n有一定的限制。\n\n03:16.156 --> 03:17.955\n在传统确诊方法之一，\n\n03:18.055 --> 03:20.106\n对儿童要求比较高，\n\n03:20.255 --> 03:21.805\n需要患儿主动配合。\n\n03:22.106 --> 03:24.180\n在儿童临床实践中呢，\n\n03:24.180 --> 03:25.455\n难以的广泛开展。\n\n03:26.039 --> 03:29.690\n部分诱导剂过敏或者基础通气功能较差的患儿不适用。\n\n03:31.893 --> 03:32.919\n单一的指标呢，\n\n03:32.919 --> 03:33.944\n诊断效能不足，\n\n03:34.294 --> 03:37.593\n单独使用非或者某一项非功能指标，\n\n03:37.744 --> 03:45.643\n如MMEF或者MEF五零诊断CVA的曲线下面积AUC较低，\n\n03:45.944 --> 03:47.194\n如fino诊断。\n\n03:48.126 --> 03:51.626\n单独诊断AOC为0.726，\n\n03:51.626 --> 03:53.526\nMEF五零为0.709，\n\n03:53.776 --> 03:54.826\n难以满足。\n\n03:55.643 --> 03:57.744\n早期精确诊断的一个需求。\n\n04:00.029 --> 04:03.330\n我们看一看非老与肺功能检测的一个单独的应用价值。\n\n04:05.746 --> 04:06.445\n菲诺呢，\n\n04:06.445 --> 04:08.845\n是气道炎症的一个无创标志物。\n\n04:09.296 --> 04:10.095\n菲诺呢，\n\n04:10.095 --> 04:13.796\n作为气道嗜酸性粒细胞炎症的敏感指标，\n\n04:13.996 --> 04:16.846\n在CBA患儿中的显著升高。\n\n04:17.145 --> 04:19.170\n研究显示，\n\n04:19.170 --> 04:24.895\nCBA组的fino水平为49.10加减3.111 PBB。\n\n04:25.622 --> 04:28.571\n显著高于非CBA慢性咳嗽患儿，\n\n04:28.671 --> 04:32.022\n为19.98加减6.231 PPB。\n\n04:33.489 --> 04:35.989\n其诊断CBA的曲线下面积呢，\n\n04:35.989 --> 04:38.589\n可以达到0.726.0.901，\n\n04:38.790 --> 04:43.290\n最佳截断值是29.68.39.83。\n\n04:43.540 --> 04:45.989\n具有较好的鉴别诊断价值，\n\n04:46.140 --> 04:47.239\n且操作呢，\n\n04:47.239 --> 04:48.690\n简单方便无创，\n\n04:48.839 --> 04:50.190\n尤其适用于儿童。\n\n04:51.890 --> 04:52.816\nMMEF呢，\n\n04:52.816 --> 04:55.316\n是小气道功能障碍的一个关键指标。\n\n04:56.075 --> 04:57.901\n最大中期呼气流速呢，\n\n04:57.901 --> 04:59.226\n也就是MMEF，\n\n04:59.526 --> 05:02.376\n它是反映小气道功能的一个重要参数。\n\n05:03.523 --> 05:05.673\nCBA患儿的MMEF水平呢，\n\n05:05.673 --> 05:07.997\n是显著低于非CVA组的。\n\n05:08.623 --> 05:12.174\n其诊断CBA的AUC是0.638，\n\n05:12.424 --> 05:14.873\n所以单独应用时诊断效能较。\n\n05:16.001 --> 05:18.276\nFENO略低，\n\n05:18.626 --> 05:21.825\n但能有效量化小气道阻塞程度，\n\n05:22.126 --> 05:26.226\n是评估CVA患者肺功能损伤的重要补充指标，\n\n05:26.575 --> 05:28.376\n与气道炎症程度呢，\n\n05:28.376 --> 05:29.675\n存在一定相关性。\n\n05:31.804 --> 05:33.179\nMEF系列指标呢，\n\n05:33.179 --> 05:35.804\n是小肌的功能的一个分级评估。\n\n05:37.355 --> 05:40.955\n70%、50%以及25%的用力呼气流速。\n\n05:42.511 --> 05:48.036\n也就是MEF 75、MEF 50、MEF 25等指标呢，\n\n05:48.036 --> 05:50.962\n同样能反映小气道功能状态。\n\n05:50.962 --> 05:56.261\nCBA患儿的MEF 75跟MEF 50和MEF 25水平呢，\n\n05:56.261 --> 05:58.812\n显著的低于一个非CBA组。\n\n06:00.305 --> 06:02.580\n其诊断CBA的AUC呢，\n\n06:02.580 --> 06:07.605\n分别为0.611、0.709、0.734。\n\n06:07.855 --> 06:11.605\n其中MEF 25的诊断效能相对较高，\n\n06:11.855 --> 06:17.656\n提示小气道远端功能障碍在CVA病理整理过程中具有重要意义，\n\n06:17.756 --> 06:20.656\n可从不同层面的反映小气道受损。\n\n06:21.813 --> 06:25.039\n联合检测了在精准分型中的一个意义。\n\n06:25.039 --> 06:25.514\n研究。\n\n06:26.683 --> 06:27.359\n首先呢，\n\n06:27.359 --> 06:30.283\n我们可以破解单一指标诊断局限。\n\n06:31.209 --> 06:31.859\n菲诺呢，\n\n06:31.859 --> 06:33.859\n单独诊断CBA的AUC呢，\n\n06:33.859 --> 06:36.410\n是0.726.0.901，\n\n06:36.709 --> 06:38.209\n肺功能指标呢，\n\n06:38.209 --> 06:39.785\n如MMEF呢，\n\n06:39.785 --> 06:41.559\n单独诊断AUC的。\n\n06:42.276 --> 06:43.251\n诊断的AUC呢，\n\n06:43.251 --> 06:45.976\n是0.638.0.881，\n\n06:46.976 --> 06:51.675\n联合检测可将AUC提高至0.901.0.962，\n\n06:51.825 --> 06:53.675\n显著的优于单一指标。\n\n06:55.066 --> 06:58.666\n第二个是实现炎症与功能双维双维度评估。\n\n06:59.425 --> 07:00.175\n菲诺呢，\n\n07:00.175 --> 07:02.226\n它是可以反映嗜酸性粒细胞。\n\n07:03.019 --> 07:04.470\n气道炎症水平，\n\n07:04.619 --> 07:07.244\n肺功能指标，\n\n07:07.244 --> 07:10.970\nMMEFMM 255075量化小气道功能障碍，\n\n07:11.070 --> 07:15.970\n两者联合了可以全面捕捉CVA的炎症状态与结构损伤。\n\n07:16.850 --> 07:21.250\n基于肺、肺功能等参数的一个聚类分析，\n\n07:21.250 --> 07:23.100\n可将CVA分为不同。\n\n07:24.033 --> 07:24.484\n表型，\n\n07:24.783 --> 07:35.484\n如高T二型炎症表型、年轻、夜间咳嗽、飞楼高和非T二型炎症表型为个体化治疗了提供了一个依据。\n\n07:36.894 --> 07:37.618\n第四个呢，\n\n07:37.618 --> 07:40.743\n是提升复杂共病状态诊断效能。\n\n07:41.093 --> 07:45.394\n在合并胃食管反流病的CVA患者中呢，\n\n07:45.444 --> 07:50.394\n菲联合MMEF诊断AUC仍高达0.938，\n\n07:50.544 --> 07:52.694\n敏感性91.67，\n\n07:52.993 --> 07:56.243\n有效解决共病干扰诊断的一个难题。\n\n07:57.205 --> 07:57.480\n嗯，\n\n07:57.480 --> 07:58.031\n下面呢，\n\n07:58.031 --> 08:00.656\n我们探讨一下研究方向与实验设计。\n\n08:01.450 --> 08:04.299\n在研究对象的选取标准与分组情况，\n\n08:04.649 --> 08:05.325\n首先呢，\n\n08:05.325 --> 08:07.100\n是他看一下纳入标准，\n\n08:07.350 --> 08:12.399\n选取慢性咳嗽患儿符合咳嗽变异型哮喘诊断标准，\n\n08:12.549 --> 08:13.850\n纳入CBA组。\n\n08:14.049 --> 08:14.875\n同期呢，\n\n08:14.875 --> 08:19.899\n选取慢性咳嗽但是非CBA的患儿作为对照组。\n\n08:21.472 --> 08:22.423\n排除标准，\n\n08:22.572 --> 08:24.722\n排除合并支气管功能障碍，\n\n08:25.222 --> 08:26.872\n发育发育障碍，\n\n08:27.122 --> 08:28.273\n胸廓畸形，\n\n08:28.322 --> 08:32.122\n心血管疾病等可能影响肺功能检测的患儿，\n\n08:32.322 --> 08:38.622\n排除对检测诱导剂过敏或基础通气功能差无法配合检查者。\n\n08:39.257 --> 08:40.307\n分组情况，\n\n08:40.708 --> 08:42.857\n以某研究为例，\n\n08:42.857 --> 08:44.607\nCVA组是60例，\n\n08:44.757 --> 08:46.007\n男性36例，\n\n08:46.007 --> 08:47.007\n女性24例，\n\n08:47.107 --> 08:51.557\n平均年龄是4.97加减0.928岁。\n\n08:53.213 --> 08:54.314\nNCVA组呢，\n\n08:54.314 --> 08:55.314\n是60例。\n\n08:56.099 --> 08:57.125\n男性32例，\n\n08:57.125 --> 08:58.299\n女性28例，\n\n08:58.700 --> 09:02.599\n平均年龄是四点九零加减0.706岁，\n\n09:02.950 --> 09:03.750\n两组呢，\n\n09:03.750 --> 09:09.650\n在年龄、身高、体重、病程等一般资料上没有显著差异，\n\n09:09.650 --> 09:10.150\nP>0.05.\n\n09:12.002 --> 09:14.802\n肺功能检测指标的检测方法与参数说明，\n\n09:15.203 --> 09:23.153\n肺功能检测仪与校对要求采用了一个master screen肺功能仪进行检测，\n\n09:23.353 --> 09:25.552\n每日需进行仪器校准，\n\n09:25.552 --> 09:27.853\n以确保数据准确性。\n\n09:28.153 --> 09:29.002\n测试前呢，\n\n09:29.002 --> 09:33.353\n要记录患儿的身高、体重、性别、年龄等基本信息。\n\n09:33.853 --> 09:37.153\n要求患儿在进食后1.2小时进行检查，\n\n09:37.353 --> 09:39.103\n保持上呼吸道通畅。\n\n09:40.549 --> 09:42.650\n标准检测流程与规范操作，\n\n09:43.150 --> 09:44.500\n患儿的取坐位，\n\n09:44.500 --> 09:46.799\n通过口气平静呼吸。\n\n09:47.638 --> 09:48.989\n鼻夹夹闭鼻腔，\n\n09:49.189 --> 09:52.239\n操作者用手支撑其面颊，\n\n09:52.489 --> 09:54.789\n待机械稳定后采集数据。\n\n09:55.039 --> 09:56.989\n采样时间约30秒。\n\n09:57.189 --> 09:59.638\n所有非功能参数均检测两次，\n\n09:59.888 --> 10:02.088\n取平均值作为最终结果，\n\n10:02.189 --> 10:04.388\n以减少单次测量误差。\n\n10:06.403 --> 10:08.254\n主要小气道功能参数定义，\n\n10:08.604 --> 10:10.653\n最大中气呼气流速。\n\n10:11.650 --> 10:18.750\n反应用力呼气中期的一个平均流速是小气道功能的重要综合指标。\n\n10:18.750 --> 10:24.650\n75%用力呼气流速、50%用力呼气流速以及25%用力呼气流速，\n\n10:24.750 --> 10:31.700\n分别表示用力肺活量为75%、50%、25%的瞬间呼气流速，\n\n10:31.849 --> 10:35.700\n可敏感反应不同肺容积下的小气道阻塞程度。\n\n10:36.184 --> 10:38.883\n参数正常参考范围与临床意义。\n\n10:39.955 --> 10:43.405\n各参数通常以占预计值百分比表示，\n\n10:43.554 --> 10:48.330\n正常情况下应在80%.120%范围内。\n\n10:48.330 --> 10:48.955\nCBA患儿呢，\n\n10:48.955 --> 10:52.679\n由于小气道功能障碍，\n\n10:52.679 --> 10:56.530\nMMEFMEF 75、MEF 50、MEF 25等指标呢，\n\n10:56.530 --> 10:59.854\n显著低于非CVA慢性咳嗽患儿。\n\n11:00.427 --> 11:03.828\n可作为区分两者的重要功能学依据。\n\n11:06.070 --> 11:08.820\n统计学分析方法与诊断效能评价指标，\n\n11:09.221 --> 11:11.820\n计量资料与组间比较方法，\n\n11:12.070 --> 11:15.671\n计量资料以均数加减标准差表示，\n\n11:15.921 --> 11:19.070\n组间比较采用独立样本T检验或。\n\n11:20.176 --> 11:25.176\nMWU检验分类变量以频数和百分比比表示，\n\n11:25.325 --> 11:29.375\n采用卡方检验诊断价值的ROC曲线分析，\n\n11:29.625 --> 11:33.776\n使用ROC曲线分析各指标对CBA的诊断价值，\n\n11:34.026 --> 11:35.575\n通过Z检验比较，\n\n11:35.575 --> 11:41.625\n联合诊断与单一诊断的曲线下面积以P\u003C0.05为差异，\n\n11:41.726 --> 11:43.125\n有统计学意义。\n\n11:45.033 --> 11:47.184\n关键诊断效能评价指标，\n\n11:47.684 --> 11:53.033\n主要评价指标包括曲线下面积AUC敏感度和特异度。\n\n11:53.234 --> 11:57.783\n非流域肺功能指标联合检测的AUC值达到0.901，\n\n11:57.934 --> 11:59.684\n显著优于单一指标。\n\n11:59.934 --> 12:01.533\n敏感度和特异度呢，\n\n12:01.533 --> 12:05.684\n分别提高至92.2%和86%。\n\n12:08.377 --> 12:09.127\n第三个部分呢，\n\n12:09.127 --> 12:12.028\n是我们评估一下研究结果与数据分析。\n\n12:14.809 --> 12:17.359\n两组患儿基线资料的一个比较分析，\n\n12:17.859 --> 12:19.760\n一般人口学资料比较，\n\n12:20.010 --> 12:22.460\n病程及临床症状比较，\n\n12:22.609 --> 12:23.835\n非漏水平比较，\n\n12:23.835 --> 12:25.210\n肺功能指标比较。\n\n12:26.507 --> 12:27.007\n首先，\n\n12:27.007 --> 12:30.106\n第一个是一般人口学资料比较，\n\n12:30.106 --> 12:38.182\nCVA组与NCVA组在年龄、性别、构成、身高、体重等一般人口学资料方面比较差异，\n\n12:38.182 --> 12:40.932\n无统计学意义，\n\n12:40.932 --> 12:42.507\nP≥P>0.05具有可比性。\n\n12:43.138 --> 12:44.888\n病程及临床症状比较。\n\n12:47.481 --> 12:47.882\n是。\n\n12:50.559 --> 12:51.385\n两组患儿呢，\n\n12:51.385 --> 12:53.960\n在病程方面的差异也没有统计学意义。\n\n12:54.919 --> 12:55.393\n然后呢，\n\n12:55.393 --> 13:00.044\n我们看一下肺勒水平在CVA组与对照组的一个差异如下，\n\n13:00.393 --> 13:02.169\n在肺功能指标方面呢，\n\n13:02.169 --> 13:10.893\n是主要看一下MMEFMMMEF 25到七五之间的比较单一指标的一个ROC的分析曲线。\n\n13:10.893 --> 13:11.518\n结果呢，\n\n13:11.518 --> 13:14.244\n是下面这样的，\n\n13:14.643 --> 13:17.294\n非联合肺功能指标的诊断效能的一个评。\n\n13:19.992 --> 13:21.992\n是诊断的。\n\n13:23.439 --> 13:26.939\n显是讲好的一个稳定性不同的CVA表型，\n\n13:26.939 --> 13:29.088\n与临床分布与指标分析呢，\n\n13:29.239 --> 13:30.789\n有下面几种表型。\n\n13:31.607 --> 13:34.257\n各比各表型呢，\n\n13:34.257 --> 13:34.658\n嗯，\n\n13:34.958 --> 13:36.208\n有一些差异。\n\n13:38.942 --> 13:39.043\n嗯，\n\n13:39.043 --> 13:39.893\n第四个方面呢，\n\n13:39.893 --> 13:44.018\n我们与看一下讨论与机制探讨联合检测呢，\n\n13:44.018 --> 13:46.492\n可以提升诊断效能的一个机制分析，\n\n13:46.692 --> 13:50.043\n预计既往的研究结果的一个对比与验证。\n\n13:50.981 --> 13:51.281\n嗯。\n\n13:52.392 --> 13:55.341\n小气道功能障碍与气道炎症的一个关联性的研究，\n\n13:55.642 --> 14:00.541\n精准分型对治疗策略选择的一个指导价值研究。\n\n14:01.492 --> 14:01.867\n嗯，\n\n14:01.867 --> 14:05.767\n研究的局限性与未来方向的一个改进啊。\n\n14:05.767 --> 14:06.892\n第五个方面呢。\n\n14:11.260 --> 14:11.935\n第五个方面呢，\n\n14:11.935 --> 14:14.710\n我们看一下临床应用价值与转化前景。\n\n14:15.890 --> 14:17.140\n在基层医院呢，\n\n14:17.440 --> 14:19.940\n一般是阶梯式的诊断流程的一个建立。\n\n14:20.239 --> 14:20.914\n首先呢，\n\n14:20.914 --> 14:22.065\n阶梯式诊断流程呢，\n\n14:22.065 --> 14:23.239\n要有一个核心设计，\n\n14:23.739 --> 14:27.590\n主要是以非no检测和非功能检测为核心。\n\n14:28.956 --> 14:31.182\n然后研究关键指标的一个截断值。\n\n14:32.336 --> 14:35.937\n比如说非诺最佳截断值是39.83。\n\n14:37.685 --> 14:38.385\n临床实施的，\n\n14:38.385 --> 14:40.335\n我要看一下它可行性与优势。\n\n14:41.346 --> 14:45.245\n然后与现有的指南指南进行一个衔接和优化。\n\n14:47.900 --> 14:49.125\n无创检测技术呢，\n\n14:49.125 --> 14:51.049\n在患儿儿童患者中呢，\n\n14:51.099 --> 14:54.049\n依从性的方面是有比较好的优势，\n\n14:54.349 --> 14:55.650\n因为操作简便呢，\n\n14:55.650 --> 14:56.750\n儿童配合度高，\n\n14:56.900 --> 14:57.849\n安全性高，\n\n14:57.849 --> 14:58.799\n也没有创伤，\n\n14:59.049 --> 15:00.025\n重复性好，\n\n15:00.025 --> 15:01.500\n便于动态的一个监测，\n\n15:01.900 --> 15:03.700\n家长的接受度也比较高，\n\n15:03.700 --> 15:05.799\n临床普及性也比较长强。\n\n15:06.500 --> 15:10.950\n对于伴有勾的的CBA患者的鉴别诊断方案优化。\n\n15:11.606 --> 15:11.830\n嗯，\n\n15:11.830 --> 15:13.306\nGold与CBA共病呢，\n\n15:13.306 --> 15:16.005\n它是增加了一个临床的诊断难度。\n\n15:16.763 --> 15:17.013\n嗯，\n\n15:17.314 --> 15:19.614\n飞篓与MM联合检测呢？\n\n15:22.590 --> 15:27.090\n即使在疙瘩的患者的他的肺肉水平也是更高的，\n\n15:27.239 --> 15:30.640\n没有影响MMEF作为结构性标志物的诊断贡献。\n\n15:30.940 --> 15:34.789\n无创联合方案的一个临床转化呢，\n\n15:34.789 --> 15:35.090\n是。\n\n15:38.179 --> 15:39.953\n大幅度提高患者的应从性，\n\n15:40.354 --> 15:43.554\n为基层医院建立阶梯式诊断提供了依据。\n\n15:43.854 --> 15:49.104\n可以将CBA确诊时间从数天、数周、数展缩短为数天。\n\n15:51.007 --> 15:54.706\n我们要看一下动态监测与治疗响应评估的一个临床实践。\n\n15:55.424 --> 15:56.723\n菲勒动态监测呢，\n\n15:56.723 --> 15:58.723\n可以指导糖皮质激素的一个治疗，\n\n15:59.023 --> 16:02.073\n联合动态变化预测治疗呢。\n\n16:02.952 --> 16:05.302\n能够更全面的评估治疗效果。\n\n16:07.187 --> 16:08.387\n两型炎症呢，\n\n16:08.387 --> 16:11.286\n是CVA患者咳嗽完全缓解的预测因素。\n\n16:12.161 --> 16:13.711\n治疗响应的更佳。\n\n16:14.906 --> 16:15.681\n长期呢，\n\n16:15.681 --> 16:18.205\n预随访与预后的评估方面呢，\n\n16:18.205 --> 16:20.931\n是有助于及时调整治疗方案，\n\n16:20.931 --> 16:21.755\n改善预后。\n\n16:22.205 --> 16:22.830\n最后呢，\n\n16:22.830 --> 16:24.306\n我们看一下结论与展望。\n\n16:25.664 --> 16:26.289\n首先呢，\n\n16:26.289 --> 16:26.914\n第一点呢，\n\n16:26.914 --> 16:30.513\n非流与小气道功能指标的一个诊断价值呢，\n\n16:30.564 --> 16:33.564\n两两者发与CBA的发生呢，\n\n16:33.564 --> 16:34.664\n是密切相关的。\n\n16:36.390 --> 16:37.315\n联合诊断呢，\n\n16:37.315 --> 16:39.340\n是提高了一个诊断的效能，\n\n16:39.590 --> 16:42.789\n为早期的一个无创诊断提供了重要依据。\n\n16:44.374 --> 16:47.223\n对支气管哮喘防治指南的修订呢，\n\n16:47.223 --> 16:48.249\n有一些启示。\n\n16:53.169 --> 16:53.744\n首先呢，\n\n16:53.744 --> 16:56.568\n第一个是提高了一个肺漏检测的临床地位。\n\n16:56.919 --> 16:57.568\n菲呢，\n\n16:57.568 --> 17:00.919\n它作为一种无创敏感的气道炎症生物标志物，\n\n17:01.218 --> 17:03.494\n在儿童的CVA诊断中的价值呢，\n\n17:03.494 --> 17:05.269\n已经得到多项研究证实。\n\n17:06.076 --> 17:07.326\n像CVA诊断，\n\n17:07.375 --> 17:10.225\n像非罗诊断CVA的AUC值呢？\n\n17:11.020 --> 17:14.069\n可以达到7.0.726.0.901。\n\n17:14.170 --> 17:19.670\n建议在指南中明确其作为CVA早期筛查及诊断的重要辅助指标。\n\n17:20.355 --> 17:23.755\n可以纳入一个小气道功能指标评估体系，\n\n17:24.255 --> 17:31.456\n像MMEFMMMEF 25、MEF 50m EF七五等小气道功能指标呢，\n\n17:31.505 --> 17:35.255\n能有效的反应CBA患儿的一个气道功能障碍，\n\n17:35.355 --> 17:38.755\n且与菲洛联合检测可显著提高诊断效能。\n\n17:39.605 --> 17:40.755\n指南修订时呢，\n\n17:40.755 --> 17:42.855\n应将将这些小气道参数呢，\n\n17:42.855 --> 17:45.306\n纳入一个常规的评估指标。\n\n17:47.206 --> 17:49.505\n肺与肺功能指标联合呢，\n\n17:49.755 --> 17:55.956\n检测能从炎症和功能两个维度全面提升CBA诊断准确性，\n\n17:56.156 --> 17:57.806\n其敏感度和特异度呢，\n\n17:57.806 --> 18:00.906\n分别可达92.2和86.8。\n\n18:01.255 --> 18:06.956\n指南应推荐将该联合检测策略作为CBA诊断的重要手段，\n\n18:07.056 --> 18:08.456\n尤其适用于其。\n\n18:09.671 --> 18:11.270\n其他慢性咳嗽的鉴别。\n\n18:12.683 --> 18:14.734\n关注特殊人群与合并症的情况，\n\n18:14.884 --> 18:17.734\n在合并有胃食管反流病等情况下，\n\n18:17.933 --> 18:22.833\nFilo与MMEF联合检测仍具有稳定的诊断性能。\n\n18:23.083 --> 18:24.308\n指南修订时呢，\n\n18:24.308 --> 18:28.134\n需要考虑特殊人群及合并症对CBA诊断的影响，\n\n18:28.333 --> 18:30.433\n细化相应的一个诊断流程。\n\n18:31.682 --> 18:35.381\n对于未来多中心大样本研究的方向及建议。\n\n18:37.157 --> 18:40.807\n一个是扩大样本来源与人权多样性。\n\n18:41.008 --> 18:43.858\n应纳入不同地区、不同年龄段，\n\n18:44.008 --> 18:47.907\n如幼儿及青少年、不同种族的儿童C、B患者，\n\n18:48.008 --> 18:52.608\n以验证非龙联合肺功能指标在更广泛人群中的适用性，\n\n18:52.758 --> 18:57.907\n弥补现有样本来自亚洲儿童年龄范围较窄的局限性。\n\n18:58.540 --> 19:01.189\n可以整合多维度生物标志物检测，\n\n19:01.489 --> 19:02.540\n未来研究呢，\n\n19:02.540 --> 19:04.640\n可以结合过敏参数，\n\n19:04.739 --> 19:12.089\n如IGE水平、嗜酸性粒细胞技术诱导痰细胞学检查、血液炎症因子等，\n\n19:12.140 --> 19:16.540\n从多个维度更全面的评估CVA的一个病理生理特征。\n\n19:17.156 --> 19:22.255\n探索联合多种生物标志物提高精准分析效能的可能性。\n\n19:23.118 --> 19:26.468\n可以开展一个动态监测与长期随访研究，\n\n19:26.718 --> 19:29.468\n进行非漏与肺功能指标的动态监测，\n\n19:29.718 --> 19:33.767\n观察其在CBA患儿治疗过程中的一个变化趋势，\n\n19:34.218 --> 19:38.718\n分析这些指标与治疗反应、病情复发及预后的关系，\n\n19:38.817 --> 19:42.767\n为优化治疗方案和评估疾病转归提供了一个依据。\n\n19:45.328 --> 19:46.427\n结合AI技术呢，\n\n19:46.427 --> 19:48.277\n可以优化诊断与分型模型，\n\n19:48.527 --> 19:50.177\n利用人工智能技术，\n\n19:50.328 --> 19:53.578\n基于非非功能指标及临床数据呢。\n\n19:54.208 --> 19:58.358\n构建CBA精准分型与诊和诊断的预测模型，\n\n19:58.508 --> 20:01.758\n可以提高诊断的自动化和智能化水平，\n\n20:01.907 --> 20:08.108\n同时探索AI辅助下不同表型CBA的个体化治疗策略。\n\n20:09.467 --> 20:09.666\n嗯，\n\n20:10.416 --> 20:11.442\n今天的分享呢，\n\n20:11.442 --> 20:12.116\n就到这里，\n\n20:12.116 --> 20:12.516\n嗯，\n\n20:13.116 --> 20:13.766\n谢谢。\n\n","v0d47cg10004d714sniljht781gfj5v0",1218,506,"2026-01-26 11:42:48"," 呼出一氧化碳（FENO）联合肺功能检测在儿童咳嗽变异性哮喘精准分型中的临床价值研究  \n"," 呼出一氧化碳检测, FENO, 肺功能检测, 儿童哮喘, 咳嗽变异性哮喘, 哮喘精准分型, 临床研究, 呼吸疾病诊断  \n"," 本研究探讨呼出一氧化碳（FENO）联合肺功能检测在儿童咳嗽变异性哮喘精准分型中的临床应用价值，为儿童哮喘的早期诊断和个性化治疗提供科学依据。","2026-04-27 10:30:00",[34],{"menuId":35,"menuName":36,"parentId":17,"orderNum":37,"path":38,"component":39,"isFrame":40,"isCache":41,"menuType":42,"visible":23,"status":17,"createDept":6,"remark":15,"createTime":43,"children":44,"columnImage":45,"columnLogo":46,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":47,"seoKeywords":48,"seoDescription":49,"contentNum":6,"promotionalPoster":50,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":51,"routerPath":38,"componentInfo":39},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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