支气管激发试验与舒张试验对支气管哮喘患者呼出气一氧化氮测定值的影响和意义

Effects and significance of methacholine bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide in patients with asthma

目的 研究支气管哮喘（哮喘）患者行乙酰甲胆碱（Mch）支气管激发试验或沙丁胺醇支气管舒张试验对呼出气一氧化氮（FeNO）测定值的影响及意义.方法 采用前瞻性研究方法,选择2014年11月至2015年8月南方医科大学珠江医院呼吸科门诊临床诊断的哮喘患者135例,根据患者肺功能情况及配合程度分别采用Astograph Jupiter-21气道反应仪（Astograph组）、APS-Pro气道反应测定仪完成Mch支气管激发试验（APS组）或沙丁胺醇支气管舒张试验（舒张组）,比较检查前基础FeNO值（Pre-FeNO）与检查完成后5 min复测FeNO值（Post-FeNO）的差异.结果 Astograh组患者Pre-FeNO几何均数为28.07 ppb,检查后下降至24.08 ppb,差异有统计学意义（Z=-3.093,P=0.002）,其中Astograh组激发阳性患者检查后FeNO值下降,差异有统计学意义（Z=-2.787,P=0.005）,阴性者检查前后FeNO值差异无统计学意义（Z=-1.355,P=0.176）;APS组患者Pre-FeNO几何均数为27.95 ppb,检查后下降至23.15 ppb,差异有统计学意义（Z=-5.170,P=0.000）,不管是生理盐水激发阳性、Mch激发阳性还是激发阴性患者检查后FeNO值均下降,差异有统计学意义（均P＜0.05）;Astograh组及APS组FeNO值下降程度（AFeNO）比较差异无统计学意义（U＜918.000,P =0.117）;舒张组患者Pre-FeNO几何均数为36.74 ppb,Post-FeNO为34.79 ppb,差异无统计学意义（Z=-1.281,P=0.200）.结论 沙丁胺醇支气管舒张试验对哮喘患者FeNO测定值影响很小,Mch支气管激发试验可引起哮喘患者FeNO测定值下降,Mch支气管激发试验后测定的FeNO值需谨慎临床解读.

Objective To study the effects and significance of methacholine （Mch） bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide （FeNO） in patients with asthma.Methods This was a prospective study conducted between November 2014 and August 2015.A total of 135 patients with asthma visiting the respiratory clinic of Zhujiang Hospital were enrolled.The patients received either Mch bronchial provocation test or salbutamol bronchial dilation test based on their FEV1/FVC values and cooperative degree.Mch bronchial provocation test was performed by using Astograph Jupiter-21 （Astograh group）or APS-Pro airway reaction testing apparatus （APS group）,and salbutamol bronchial dilation test was performed by using Jaeger spirometer （Dilation group）.We compared the differences between FeNO values measured before examinations （Pre-FeNO） and 5 min after completion of these examinations（Post-FeNO）.Results The geometric mean of Pre-FeNO and Post-FeNO was 28.07 ppb and 24.08 ppb respectively in the Astograh group,with a significant decrease of the FeNO value after the examination（Z =-3.093,P =0.002）.A significant difference between Pre-FeNO and PostFeNO was found in patients who had positive provocation results in the Astograh group（Z =-2.787,P =0.005）,but not in the patients with negative results （Z =-1.355,P =0.176）.The geometric mean of FeNO in the APS group decreased significantly from 27.95 ppb to 23.15 ppb after the examination was completed（Z =-5.170,P =0.000）;both in patients with positive saline or Mch provocation results and in patients with negative provocation results,the differences between Pre-FeNO and Post-FeNO in the APS group being significant（Z =-2.705,-3.709,-2.371,P =0.002,0.000,0.018）.No difference of FeNO change（AFeNO） was observed between the 2 Mch bronchial provocation test groups （U 〈 918.000,P =0.117）.The geometric mean of Pre-FeNO was 36.74 ppb and that of Post-FeNO was 34.79 ppb in the Dilation group;the difference being not significant （Z =-1.281,P =0.200）.Conclusions Our results confirm that salbutamol bronchial dilation test has minor effect on the measurement of FeNO,but Mch bronchial provocation tests can significantly decrease measured FeNO value in patients with asthma,and therefore Post-FeNO values should be interpreted with caution.