呼出气一氧化氮检测对支气管哮喘的诊断意义

Fractional exhaled nitric oxide in the diagnosis of bronchial asthma

目的:探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)对支气管哮喘的诊断意义。方法:纳入郑州大学人民医院呼吸与危重症医学科门诊与病房有喘息、气急、胸闷、咳嗽等疑似支气管哮喘患者97例,以支气管激发试验或舒张试验为诊断金标准,绘制受试者工作特征(ROC)曲线,结合ROC曲线评估FeNO对哮喘诊断的价值,并得出最佳界值。结果:97例患者中61例最终诊断为哮喘,36例为非哮喘。哮喘组FeNO高于非哮喘组[(42.2±25.0)ppb比(24.9±15.3)ppb,P<0.05]。FeNO与FEV1/FVC%(一秒率)无直线相关性(r=0.098,P=0.596)。ROC曲线下面积是0.810,FeNO最佳界值为27.5 ppb,以该点为界值,诊断哮喘的敏感度为83.6%,特异度为77.8%。结论:FeNO诊断哮喘有较高的敏感性与特异性,结合肺功能检测可以降低其漏诊率。

Objective： To explore the value of fractional exhaled nitric oxide（FeNO） in the diagno- sis of bronchial asthma. Methods： 97 patients with suspected bronchial asthma from department of respiratory medicine in People＇ s Hospital of Zhengzhou University were selected. Bronchial provocation or dilation tests were defined as golden standards for diagnosis of bronchial asthma. The diagnostic value of FeNO was assessed and the optimal critical value was determined by receiver operating characteristic（ROC） curves. Results： Among 97 patients,61 patients had final diagnosis as bronchial asthma. The remained 36 cases were diagnosed as non-asthma. The levels of FeNO in asthma group were higher than non-asthma group [ （42.2 ±25.0） ×10-9 mol/L VS （24.9 ± 15.3 ） × 10-9 mol/L,P 〈 0.05 ]. There was no significant correlation between FeNO and FEV1/FVC% in patients with asthma（r = 0. 098, P 〉 0.05 ）. Area under ROC curve was 0. 810. The optimal critical value of FeNO was 27.5 ppb. The diagnostic sensitivity of bronchial asthma was 83.6% and the specificity was 77.8% according to this critical value. Conclusion ： FeNO test have high sensitivity and specificity in the diagnosis of asthma, and the missed diagnosis rate may be decreased by combining with pulmonary function test.