呼出气一氧化氮对咳嗽变异性哮喘的诊断价值

Diagnostic value of fractional exhaled nitric oxide in the diagnosis of cough variant asthma

目的探讨CVA患者FeNO与支气管激发试验中PD20-FEV1.0的相关性,比较两者的诊断价值。方法收集在华山医院呼吸科同时进行支气管激发试验和FeNO测定的53例慢性咳嗽患者,其中CVA组40例,BPT(+)为33例;非CVA组13例,无BPT(+)患者。分析两组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CVA的诊断价值。结果 CVA组FeNO结果显著高于非CVA组(P=0.0078)。咳嗽变异性患者的FeNO与BPT-PD20-FEV1.0值呈明显的负相关(r=-0.35,P=0.049)。ROC示FeNO的曲线下面积(AUC)为0.725,95%CI为0.59-0.84,明显小于BPT的AUC(0.91,95%CI,0.80-0.97)。结论 FeNO检测虽然能反映CVA患者气道炎症水平,但诊断价值低于BPT,不能依靠其确诊CVA。

Objective To explore the association between fractional exhaled nitric oxide （ FeNO） and PD20-FEV1. 0 in bronchial provocation test （ BPT-PD20-FEV1. 0 ） and to compare the value of them in the diagnosis of cough variant asthma. Methods 53 patients with chronic cough, who were measured by both bronchial provocation test and＆amp;nbsp;fractional exhaled nitric oxide test in Respiratory Department, Huashan Hospital during Jan 2013 and Oct 2013, were finally included. 40 patients were diagnosed as cough variant asthma, 33 of which had positive results in BPT. 13 pa-tients were diagnosed as non cough variant asthma, without positive results in BPT. We compared the results of FeNO between the two groups, and explored the association between FeNO and BPT-PD20-FEV1. 0 , and evaluated the diag-nostic value of FeNO and BPT through receiver operating characteristic curve （ ROC） . Results The level of FeNO in CVA patients was significantly higher than that in patients without CVA （P=0. 0078）. FeNO was negatively relat-ed to BPT-PD20-FEV1.0 in CVA patients （r= -0. 35, P=0. 049）. Area under curve （AUC） of FeNO （0. 73, 95% CI, 0. 59-0. 84） was statistically less than AUC of BPT （0. 91, 95%CI, 0. 59-0. 84）. Conclusion Al-though FeNO could reflect the level of bronchial inflammation, the diagnostic value of FeNO is less than that of BPT. Therefore, the diagnosis of CVA could not be confirmed only by FeNO measurement.