呼出气一氧化氮浓度测定与白三烯D4支气管激发试验对支气管哮喘的诊断和评估价值

Value of Fractional Exhaled Nitric Oxide Measurement and Leukotriene D4 Bronchial Provocation Test in Diagnosis and Evaluation of Asthma

目的比较呼出气一氧化氮浓度(FENO)测定与白三烯D4(LTD4)支气管激发试验结果对支气管哮喘的诊断和评估价值。方法对83例受试者(20例未控制、22例部分控制、20例完全控制的哮喘患者及21例正常受试者)分别进行FENO测定(瑞典Aerocrine NIOX MINO)和LTD4支气管激发试验,分析两者结果的分布特点及相关性,并通过受试者工作特征曲线(ROC)比较两者对支气管哮喘的诊断价值。结果 80.7%哮喘受试者FENO>25.0 ppb。未控制组与部分控制组落在26.0～49.0 ppb区间的比例高于完全控制组。未控制组与部分控制组PD20FEV1-LTD4中位数及四分位间距均小于完全控制组。PD20FEV1-LTD4的ROC曲线下面积[AUC:0.914,95%CI:(0.855,0.974)]大于FENO测定[AUC:0.820,95%CI:(0.718,0.921)]。PD20FEV1-LTD4≤4.800 nmol的灵敏度(0.8710比0.8065)及特异度(0.9048比0.7619)均高于FENO≥26.0 ppb作为阳性阈值。结论与FENO测定相比,LTD4支气管激发试验的灵敏度和特异度更高,对哮喘的诊断价值更大。

Objective To compare the value of fractional exhaled nitric oxide （FENO） measurement and leukotriene D4 bronchial provocation test （LTIM-BPT） in diagnosis and evaluation of asthma. Methods 20 uncontrolled,22 partially controlled,20 controlled asthmatics, and 21 normal subjects were enrolled in the study. Measurement of FENO was performed followed by LTD4-BPT. The distribution characteristics and relationship of both results were analyzed, and the diagnostic value was compared using receiver operation characteristic （ROC） curve. Results FENO was above 25.0ppb in 80.7% of the asthmatics. The proportion of asthmatics with FENO between 26. Oppb and 49. 0ppb was larger in the uncontrolled and partially controlled subjects than that in the controlled subjects. Both the median and interquartile range of cumulative dosage （ PD20 FEV1 -LTD4） were much higher in the controlled asthmatics as compared with the uncontrolled and partially controlled asthmatics. The area under the ROC curve （AUC） for PD20FEV1-LTIM [AUC：O. 914,95% CI： （0. 855,0. 974） ] was larger than that of FENO [AUC：0. 820, 95% CI： （0.718,0. 921 ） ]. Higher sensitivity （0. 8570 vs. 0. 8065 ） and specificity （0. 9048 vs. 0. 7619） were in favor of PD20 FEV1-LTD4〈 4. 800 nmol as compared with FENO ≥ 26.0ppb being the positive threshold. Conclusion Compared with FENO measurement, LTD4-BPT has higher sensitivity and specificity and is of higher diagnostic value for asthma.