呼出气一氧化氮测定指导老年慢性阻塞性肺疾病急性发作期的用药选择

Therapy guide of fractional exhaled nitric oxide in elderly patients with acute exacerbations of chronic obstructive pulmonary disease

目的探讨呼出气一氧化氮(Fe NO)测定对老年慢性阻塞性肺疾病急性发作期(AECOPD)用药选择中的指导作用。方法对我院在2013年3月至2014年3月收治的76例老年AECOPD患者进行Fe NO检测及症状评估,以27 ppb为Fe NO"切点"值,将76例患者分为低Fe NO组和高Fe NO组;高Fe NO组在低Fe NO组治疗基础上,加用糖皮质激素治疗,并分析不同治疗组的疗效。结果低Fe NO组患者31例(40.8%),平均Fe NO为(23.7±7.4)ppb;高Fe NO组患者45例(59.2%),平均Fe NO为(38.5±10.2)ppb。症状评估:低Fe NO组中3级12例,4级19例;高Fe NO组中3级14例,4级31例。两组之间症状轻重比较,差异无统计学意义(P>0.05)。两组疗效比较,差异无统计学意义(P>0.05)。高Fe NO组治疗后Fe NO检测值显著低于治疗前(P<0.01)。结论 Fe NO的高低不能作为老年AECOPD症状轻重的指标,但可指导治疗方案的选择,部分低Fe NO者可不加用糖皮质激素治疗,但还需进一步研究。

Objective To investigate the value of therapy guide of fractional exhaled nitric oxide （ FeNO） in elderly patients with a-cute exacerbations of chronic obstructive pulmonary disease （AECOPD）. Methods Totally 76 elderly patients with AECOPD were measured with FeNO testing,and symptom assessment was conducted. A total of 76 AECOPD patients were allocated either into the low （ 〈27 ppb） or the high （≥27 ppb） FeNO group depending on their FeNO level at exacerbation. The cases in high FeNO group were treated with glucocorticoids,on basis of the low FeNO group. The therapeutic effect was analyzed between the two subgroups. Results In all 76 AECOPD patients,31 cases （40. 8%） were in low FeNO group with an mean FeNO of （23. 7 ± 7. 4） ppb,and 45 cases （59. 2%） were in high FeNO group with an mean FeNO of （38. 5 ± 10. 2） ppb. There was no significant difference of symptom as-sessment between the two subgroups （P〉0. 05）. Also,there was no significant difference of therapeutic effect between them （P〉0. 05）. In high FeNO group,its FeNO after treatment was significantly lower than that of pre-treatment （P〈0. 01）. Conclusion Fe-NO level can not be used as indicators of symptomatic severity in elderly patients with AECOPD,but it can guide the treatment op-tions. Some cases in low FeNO group can be treated without glucocorticoid,while,it still needs further study.