呼出气一氧化氮测定对成人支气管哮喘治疗的指导价值

Value of exhaled nitric oxide in treatment of adult bronchial asthma

目的探讨呼出气一氧化氮测定对成人支气管哮喘治疗的指导作用。方法选取于合肥市第一人民医院门诊就诊的74例明确诊断的哮喘患者,所有患者完善呼出气一氧化氮(FeNO)检查,肺功能测定,记录第一秒用力呼气容积(FEV_1)及一秒率(FEV_1/FVC),并填写哮喘控制测试(ACT)评分表。根据FeNO值,分为FeNO升高组(n=40)和FeNO正常组(n=34),两组患者均给予吸入用糖皮质激素/长效β_2受体激动剂(ICS/LABA,布地奈德福莫特罗粉吸入剂,160ug,4.5ug)1吸bid规律治疗。3月后复诊,复测FeNO,肺功能(FEV_1和FEV_1/FVC)及ACT评分量表。结果两组患者治疗后ACT评分较治疗前均有好转(治疗前后有统计学差异,P<0.05),治疗后FeNO升高组较FeNO正常组ACT评分更高,差异具有统计学意义(P<0.05)。两组治疗前均无完全控制患者,治疗后FeNO升高组完全控制率明显高于FeNO正常组,差异具有统计学意义(χ~2=6.796,P<0.05)。两组患者FEV_1和FEV_1/FVC治疗后较治疗前均有好转(治疗前后有统计学差异,P<0.05),治疗后两组间无统计学差异(P>0.05)。治疗前FeNO升高组FeNO值与ACT评分呈负相关(r=-0.783,P<0.05);治疗前FeNO正常组FeNO值与ACT评分无相关性。两组ACT改善程度与FeNO下降程度均无相关性。结论吸入ICS/LABA对FeNO升高的支气管哮喘患者疗效较好,可用于预测哮喘患者对吸入ICS/LABA治疗的反应,指导哮喘治疗方案。

Objective To explore the role of exhaled nitric oxide in treatment of adult bronchial asthma.Methods 74 patients diagnosed as asthma were selected in the outpatient clinic of the first people's hospital of Hefei city. All patients completed exhaled nitric oxide( FeNO),lung function,the first-second forced expiratory volume( FEV_1),one second Rate( FEV_1/FVC),and asthma control test( ACT). The patients were classified into the higher FeNO group( N = 40) and the normal FeNO group( n = 34) according to FeNO level. All patients were given regular inhaled ICS/LABA treatment( budesonide formoterol,160 ug,4. 5 ug). All patients re-accepted FeNO,lung function( FEV_1 and FEV_1/FVC) and ACT three months later. Results The ACT score increased in all patients( P< 0. 05). The ACT score was higher in the higher FeNO group than in the normal FeNO group after treatment( P <0. 05). All patients were not completely controlled before treatment,but the complete control rate of the higher FeNO group increased significantly higher than the normal FeNO group after treatment( χ~2= 6. 796,P < 0. 05). The FEV_1 and FEV_1/FVC increased in all patients( P < 0. 05). There was no significant difference in FEV_1 and FEV_1/FVC between the two groups after treatment( P > 0. 05). There was a negative correlation between the FeNO value and the ACT score in the higher FeNO group( r =-0. 783,P < 0. 05). The FeNO value of the FeNO normal group before treatment was not correlated with the ACT score. There was no correlation between the degree of improvement of ACT and the decrease of FeNO. Conclusion ICS/LABA has a better effect on patients with bronchial asthma with elevated FeNO,which can be used to predict the response of asthmatic patients received inhaled ICS/LABA therapy,and to guide the treatment of asthma.