呼出气一氧化氮诊断支气管哮喘的临床价值

Clinical value of fractional exhaled nitric oxide in the diagnosis of bronchial asthma

目的评估呼出气一氧化氮(Fe NO)浓度对支气管哮喘的诊断价值方法选取我院呼吸内科患者87例,严格使用NO测定仪(瑞典尼尔斯NIOX)检测其Fe NO水平,以临床症状和支气管舒张试验为哮喘诊断金标准。绘制受试者工作特征曲线(ROC曲线),测定Fe NO诊断哮喘的最佳临界值及准确度。结果87例患者中,48例被最终确诊为哮喘,39例最终被诊断为非哮喘。哮喘组患者Fe NO值明显较非哮喘组高:48ppb>18ppb,P<0.05。ROC曲线下面积为0.884,最佳临界点为29ppb,以该点作为阈值,诊断哮喘的敏感度为79.1%,特异度为84.6%,阳性预测值为86.4%,阴性预测值为76.7%,准确度为80.5%。结论 Fe NO对支气管哮喘的诊断和鉴别诊断具有可观的敏感性和特异度,可以作为哮喘的辅助诊断工具。

Objective To assess the value of fractional exhaled nitric oxide in the diagnosis of bronchial asthma. Methods 87 patients were selected from respiratory department, and their FeNO was strictly detected by nitric oxide analyzer （NIOX MINO）. Taking symptoms of asthma and bronchial dilation test as diagnostic gold standard, the accuracy and cutoff value of FeNO was determined by ROC curves. Results 48 cases were finally diagnosed as asthma, and 39 cases were diagnosed as non-asthma. The level of FeNO was obviously higher in the asthma group than in the non-asthma group （48ppb vs 18ppb, P 〈0. 05）. The area under the ROC curve was 0. 884 （95% CI ： O. 812 to O. 956, P 〈 0. 001 ）, and the optimal FeNO cutoff value was 29ppb with the sensitivity of 79.1%, specificity of 84. 6%, positive predictive value of 86.4%, negative predictive value of 76.7% and accuracy of 80. 5%. Conclusion FeNO can be used as an additional diagnostic tool for the screening of patients with a considerable diag- nosis of asthma.