慢性阻塞性肺疾病患者呼出气一氧化氮水平的变化及临床意义

Changes of exhaled nitric oxide level in patients with chronic obstructive pulmonary disease and its clinical significance

目的·观察慢性阻塞性肺疾病(COPD)患者接受吸入性糖皮质激素(ICS)治疗前后呼出气一氧化氮(Fe NO)水平的变化,探讨其与炎症及肺功能指标的相关性。方法·选取接受ICS治疗的稳定期COPD患者(COPD组)70例,对治疗前后的外周血嗜酸性粒细胞(Eos)和中性粒细胞(N)水平、Fe NO水平、最大呼气流量(PEF)、第1秒用力呼气容积(FEV1)及FEV1占预计值百分比(FEV1/pred)进行检测,以同期接受体检的50名健康志愿者作为正常对照(正常对照组)。分析各项指标与临床疗效的关系以及Fe NO水平与炎症及肺功能指标的相关性。结果·与正常对照组比较,COPD组治疗前外周血Eos、N水平和Fe NO水平均明显升高,PEF、FEV1、FEV1/pred明显降低(P<0.05);各项指标在治疗后均明显改善(P<0.05)。治疗后,显效组和好转组各项指标均明显优于无效组。相关性分析结果显示:治疗前,Fe NO水平与外周血Eos、N水平呈正相关(P<0.05),与PEF、FEV1、FEV1/pred呈负相关(P<0.05);治疗后,Fe NO水平与外周血Eos、N水平呈正相关(P<0.05),与PEF、FEV1、FEV1/pred的相关性无统计学意义(P>0.05)。结论·Fe NO水平在稳定期COPD患者中显著升高,是气道炎症的敏感指标,结合肺功能指标检查将有助于评价ICS的疗效并指导治疗。

Objective · To observe changes of exhaled nitric oxide （FeNO） level in patients with chronic obstructive pulmonary disease （COPD） before and after inhaled corticosteroid （ICS） therapy and to explore the correlation of FeNO level with inflammation and pulmonary function indexes. Methods. Seventy COPD patients at stable stage who underwent ICS therapy （the COPD group） were enrolled. Levels of peripheral blood eosinophil （Eos） and neutrophil （N）, FeNO, PEF, FEV, and FEVx/pred before and after treatment were measured. Fifty healthy volunteers who received physical examination at the same time served as controls （the control group）. The relationship between these indexes and clinical efficacy and the correlation between FeNO level and inflammation or pulmonary function indexes were analyzed. Results· The COPD group had significantly higher FeNO, Eos, and N levels before treatment, significantly lower PEF, FEV, and FEV1/pred after treatment （P〈0.05）, and remarkably better indexes after treatment （P〈0.05） compared with the control group. Indexes of the effective group and the improved group were significantly better than that of the ineffective group after treatment. Results of correlation analysis showed that before treatment, the FeNO level was positively correlated with peripheral blood Eos and N levels （P〈0.05） and negatively correlated with PEF, FEV1 and FEV,/pred （P〈0.05）. After treatment, the FeNO level was positively correlated with peripheral blood Eos and N levels （/＇〈0.05） and the correlation of the FeNO level with PEF, FEV, and FEV1/pred was not statistically significant （P〉0.05）. Conclusion. The FeNO level increased significantly in patients with COPD at stable stage and is a sensitive index of airway inflammation. Combined with lung function test, it＇s useful for evaluating the efficacy oflCS and guiding treatment.