呼出气一氧化氮测定在妊娠期哮喘管理中的应用价值

The values of fractional exhaled nitric oxide (FeNO) in asthma management during pregnancy

目的探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)测定在妊娠期支气管哮喘管理中的应用价值。方法纳入2015年6月~2016年6月就诊的78例妊娠期哮喘患者,遵照GINA指南常规行3个月以上的临床药物治疗及哮喘管理。采用NIOX MINO分析仪测定所有患者基线及治疗后FeNO水平、哮喘控制测试ACT评分、主要肺功能指标FEV_1%预计值。比较治疗前后情况,同时分析治疗前后FeNO水平与ACT评分和FEV_1%预计值的相关性。结果 ACT评分提示治疗后患者疾病控制状况明显好转,治疗后的ACT评分显著高于治疗前(18.04±3.45 vs 23.69±2.19,t=15.49,P<0.05),治疗后FeNO水平显著低于治疗前(37.64±13.45 vs.28.29±9.78,t=5.51,P<0.05),治疗后FEV_1%预计值较治疗前显著改善(77.33±10.97 vs.85.95±7.85,t=7.94,P<0.05)。治疗前患者的FeNO水平与ACT评分呈显著负相关(r=-0.38,P<0.05),治疗后FeNO水平与ACT评分也呈显著负相关(r=-0.28,P<0.05)。但治疗前、后的FeNO水平与FEV_1%预计值无相关性(治疗前r=-0.09,P=0.45;治疗后r=-0.04,P=0.74)。结论 FeNO检测是妊娠哮喘管理的良好指标,将FeNO检测纳入妊娠哮喘患者管理可能使孕期哮喘患者获益。

Objective To investigate the application values of fractional exhaled nitric oxide（FeNO） in the management of asthma in pregnant women. Methods A total of 78 pregnant women patients with asthma were recruited from June2015 to June 2016. All patients were treated and managed according to the GINA guidelines more than 3 months. All subjects received a FeNO test including baseline and post-treatment by a NIOX MINO analyzer. Meanwhile, asthma control situations were evaluated by ACT. Main spirometry parameter percentage of predicted forced expiratory volume in one second（FEV_1% pre） were examined. Then post-treatment information was compared with the pre-treatment. Associativity between FeNO levels and ACT, FeNO levels and FEV_1% pre were analyzed. Results ACT scores of post-treatment were significantly improved than pre-treatment（18.04±3.45 vs 23.69±2.19, t=15.49, P〈0.05）. FeNO level of post-treatment decreased remarkablely than pre-treatment（37.64±13.45 vs. 28.29±9.78, t=5.51, P〈0.05）. FEV_1% pre of post-treatment was significant higher than pre-treatment（77.33±10.97 vs. 85.95±7.85, t=7.94, P〈0.05）. FeNO level of pre-treatment was closely correlated with ACT sores（r=-0.38,P〈0.05）. FeNO level of post-treatment was closely correlated with ACT sores also（r=-0.28,P〈0.05）. But FeNO level was not correlated with FEV_1% pre（pre-treatment r=-0.09,P=0.45; post-treatment r=-0.04, P=0.74）. Conclusion FeNO may be a good parameter for the asthma management during pregnancy and it may bring benefit to asthma management during pregnancy.