呼出气一氧化氮检测对支气管哮喘的诊断价值

Diagnostic value of fractional exhaled nitric oxide measurement in bronchial asthma

目的评价呼出气一氧化氮(FeNO)检测在支气管哮喘诊断中的意义。方法哮喘非特异症状患者118例,其中支气管哮喘患者71例为A组,首次诊断为支气管哮喘患者52例为Ⅰ组,规律应用吸入性糖皮质激素达4周以上的支气管哮喘患者19例为Ⅱ组,其余47例非哮喘患者为B组。采用NIOX NO测定仪测定FeNO水平,以2006年GINA标准为诊断支气管哮喘的金标准,绘制受试者工作曲线(ROC),评价FeNO对支气管哮喘鉴别诊断的价值,明确FeNO的诊断临界点。结果Ⅰ组FeNO高于Ⅱ组[(72.92±50.26)ppb比(35.74±27.53)ppb,P(0.05]和B组[(72.92±50.26)ppb比(17.62±9.77)ppb,P(0.05]。排除糖皮质激素对FeNO的影响,以Ⅰ组和B组患者为观察对象,ROC曲线下面积为0.90,最佳临界点为32.50ppb,以该点为阈值,诊断哮喘的敏感度为82.70%,特异度为87.90%。结论 FeNO对哮喘的诊断具有较高的敏感性和特异性。

Objective To explore the diagnostic value of fractional exhaled nitric oxide（FeNO）measurement in the diagnosis of bronchial asthma.Methods A total of 118 patients with nonspecific respiratory symptoms were enrolled.71 cases were diagnosed as bronchial asthma（group A）.52 cases did not received a treatment with glucocorticoids（groupⅠ） and 19 cases received it for more than 4 weeks（groupⅡ）.47 cases were diagnosed as non-asthma（group B）.FeNO was measured by a nitric oxide analyzer（NIOX;Aerocrine AB;Solna,Sweden）.GINA（2006） was defined as the gold standard in the diagnosis of bronchial asthma.The value of FeNO was assessed and the optimal operating point of the FeNO testing was determined by the means of the receiver operating characteristic（ROC） curves.Results Level of FeNO in groupⅠ was higher than that in groupⅡ[（72.92±50.26）ppb vs（35.74±27.53）ppb,P﹤0.05] and group B [（72.92±50.26）ppb vs（17.62±9.77）ppb,P﹤0.05].The area under the ROC curve was 0.90.The optimal diagnostic cutoff point was 32.50 ppb,which was capable of differentiating asthma and non-asthma with a sensitivity of 82.70% and a specificity of 87.90%.Conclusion The FeNO test may be helpful in the diagnosis of asthma with high sensitivity and specificity.