应用呼出气一氧化氮联合脉冲振荡肺功能评估哮喘患者的小气道功能

Estimation on small airway function in asthmatic patients with fractional exhaled nitric oxide and impulse oscillometry

目的探讨呼出气一氧化氮(Fe NO)及脉冲振荡肺功能(IOS)与哮喘患者小气道功能的关系。方法选取2014年7月至2015年7月于山东大学齐鲁医院呼吸科门诊就诊的哮喘患者140例,其中小气道功能正常组69例,小气道功能异常组71例,分别测定Fe NO值、外周血嗜酸性粒细胞(EOS)及总免疫球蛋白E(Ig E)、肺功能及IOS。结果小气道功能异常组Fe NO、Ig E、阻抗面积(AX)、共振频率(Fres)及EOS水平明显高于小气道功能正常组,差异有统计学意义(P均<0.01);小气道功能异常组Fe NO、AX、Fres及EOS水平与最大呼气中期流量占百分比预计值(FEF25%-75%pred)呈负相关(r=-0.856,P<0.001;r=-0.851,P<0.001;r=-0.398,P=0.001;r=-0.288,P=0.014);标准回归系数绝对值的比较:Fe NO>AX>Fres>EOS;不同指标诊断哮喘小气道功能异常的预测价值:Fe NO联合AX及Fres>Fe NO>AX>Fres>EOS。结论 Fe NO水平和IOS指标是诊断哮喘小气道功能异常的敏感特异性指标;二者联合能更好地评估哮喘患者的小气道功能。

Objective To investigate the relationship between exhaled nitric oxide（ Fe NO） / impulse oscillometry（ IOS） and small airway function in asthmatic patients. Methods A total of 140 asthma patients were divided into small airway normal function group（ n = 69） and small airway dysfunction group（ n = 71）. Fe NO,eosinophil（ EOS）count and total immunoglobulin E（ IgE） in peripheral blood and pulmonary function,as well as IOS were measured.Results The levels of Fe NO,Ig E,reactance area（ AX）,resonant frequency（ Fres） and EOS in small airway dysfunction group were significantly higher than those in small airway normal function group（ all P〈0. 01）. Fe NO,AX,Fres and EOS were correlative factors of mid forced expiratory flowof percentages of predicted values（ FEF25%-75% pred）（ r =- 0. 856,P〈0. 001; r =- 0. 851,P〈0. 001; r =- 0. 398,P = 0. 001; r =- 0. 288,P = 0. 014） and the turns of standard errors of partial regression coefficient were as follows： FeNO〉AX〉 Fres〉 EOS. The turns of predictive value in diagnosis of small airway dysfunction were as follows： Fe NO combining AX and Fres FeNO〉AX〉 Fres〉 EOS. Conclusion FeNO and IOS may be highly sensitive and specific in diagnosis of small airway dysfunction,and their combination can better evaluate the function of small airway in asthmatic patients.