支气管激发试验、FeNO及诱导痰ECP在哮喘中的相关性及FeNO、诱导痰ECP诊断价值

Correlation analysis of bronchial provocation test,fractional exhaled nitric oxide,induced sputum ECP and and the diagnostic value of fractional exhaled nitric oxide,induced sputum ECP in asthma

目的 探讨哮喘患者中支气管激发试验、FeNO、诱导痰中的ECP相关性及FeNO、ECP诊断哮喘的临床价值。方法 收集2014年2月至2016年2月我院疑似支气管哮喘患者160例（最终诊断哮喘92例,非哮喘68例）,测定诱导痰嗜酸性粒细胞阳离子蛋白、呼出气一氧化氮水平,行肺通气功能、支气管激发试验检查。结果 FeNO水平与诱导痰ECP呈正相关（r=0.669,P=0.000）;FeNO水平与支气管激发定量试验呈负相关（r=-0.759,P=0.000）;诱导痰ECP与支气管激发定量试验呈负相关（r=-0.909,P=0.000）。通过ROC曲线分别评价FeNO、诱导痰ECP诊断支气管哮喘的价值,其约登指数的最大值分别为：59.1%、76.0%,最佳截断值分别为：42.2ppb、98.05μg/l,灵敏度分别为82.6%、84.8%,特异度分别为76.5%、91.2%,阳性预测值分别为82.6%（95%CI73.3%-89.7%）、92.9%（95%CI85.1%-97.3%）,阴性预测值分别为：76.5%（95%CI64.6%-85.9%）、81.6%（95%CI71.0%-89.5%）,曲线下面积分别为0.850、0.956（P〈0.05）。结论 哮喘患者中,支气管激发试验、FeNO、诱导痰ECP水平有显著相关性。支气管激发试验是公认的哮喘诊断的客观依据,FeNO、诱导痰ECP两者对哮喘的诊断均有较高价值,且诱导痰ECP诊断哮喘的价值优于FeNO,可作为哮喘诊断的重要辅助工具,但需要注意两者尚有临床局限性。

Objective To explore the correlation of bronchial provocation test, fractional exhaled nitric oxide （FeNO）, induced sputum ECP and the diagnostic value of FeNO and induced sputum ECP in asthma. Methods 160 patients with suspected asthma were selected from February, 2014 to February, 2016, and finally 92 patients were diagnosed with asthma and 68 patients were diagnosed without asthma. All the patients accepted the measure- ment of eosinophil cationic protein （ECP） , FeNO, pulmonary ventilation function, and bronchial provocation test （BPT）. Results FeNO value was positively correlated with induced sputum ECP （ r = 0. 669, P = 0. 000）, and negatively correlated with bronchial provocation quantitative test （ r = - 0. 759, P = 0. 000） Induced sputum ECP was negatively correlated with bronchial provocation quantitative test （ r = - 0. 909, P = 0. 000）. The value of diagnosis to asthma with FeNO or induced sputum ECP was determined by the receiver operating characteristic curves （ROC）. The maximum value of Youden＇s index was 59. 1% and 76. 0% respectively, and the optimal cut-off value was 42. 2ppb and 98. 05 μg/L separately. The sensitivity was 82. 6% and 84. 8%, and the specificity was 76. 5% and 91.2% separately. The positive predictive value （PPV） was 82. 6% （95% CI 73.3% - 89. 7% ） and 92. 9% （95% CI 85.1% - 97.3% ） respectively. The negative predictive value was 76. 5% （95% CI 64. 6% - 85.9% ） and81.6% （95% C171.0% -89.5%）. The areas under the ROC curve （AUC） were0.850 and0.956 （P〈 0. 05 ）. Conclusion In patients with asthma, there are significant correlations among BPT, FeNO and induced sputum ECP. Bronchial provocation test is generally recognized as an objective evidence, both of FeNO and induced sputum ECP have significant value to the diagnosis of asthma, but the value of the diagnosis of induced sputum ECP is better than that of FeNO. Both of them are used for assistant diagnosis tools of asthma, but we need pay attention to their clinical limitation.