呼出气一氧化氮测定在咳嗽变异性哮喘患者分层管理中的应用

Application of exhaled nitric oxide detection in stratification management of patients with cough variant asthma

目的评价呼出气一氧化氮(FeNO)测定在咳嗽变异性哮喘患者分层管理中的应用价值。方法根据治疗前的FeNO值将80例咳嗽变异性哮喘患者均分为两组:A组FeNO≥50ppb;B组FeNO<50ppb。均给予布地奈德福莫特罗粉吸入剂吸入治疗;A组又分为常规剂量(A1)组和高剂量(A2)组,B组分为常规剂量(B1)组和低剂量(B2)组,每组20例。比较治疗前后咳嗽症状评分和FeNO值变化。结果治疗第4、8和12周,A2组咳嗽症状评分改善较A1组更显著[(2.71±0.65)分vs.(3.31±0.77)分、(1.23±0.41)分vs.(3.21±0.87)分和(0.99±0.52)分vs.(2.89±0.69)分](P<0.05)。B1组和B2组治疗前后咳嗽症状评分无统计学差异(P>0.05)。治疗第8和12周,A2组FeNO值下降较A1组更显著[(30.33±5.78)ppb vs.(57.32±9.21)ppb和(18.45±6.23)ppb vs.(55.49±7.90)ppb](P<0.01)。B1组和B2组治疗前后FeNO值无统计学差异(P>0.05)。结论 FeNO测定在咳嗽变异性哮喘患者实施分层治疗管理中有重要价值,根据FeNO值选择不同优化给药方案患者可能获益更多。

Objective To evaluate the application value of fractional exhaled nitric oxide （FeNO） detection in the stratification management of patients with cough variant asthma. Methods On the basis of FeNO level measured before treatment, 80 patients with cough variant asthma were equally assigned into two groups of A（FeNO≥50 ppb） and B（FeNO〈50 ppb） ,who were treated with budesonide and formoterol fumarate powder for inhalation. The patients of group A were treated with conventional dosage（group A1,20 cases） or high dosage（group A2,20 cases）. The patients of group B were treated with conventional dosage（group B1,20 cases） or low dosage（group B2,20 cases）. The cough symptom scores and FeNO levels were compared before and after treatment. Results The improvement of cough symptom scores on the 4^th , 8^th and 1^th week during treatment was better in group A2 than that in group A1[（2. 71±0. 65） points vs. （3.31±0. 77） points, （1.23±0. 41） points vs. （3. 21±0. 87） points and （0. 99±0. 52） points vs. （2.89±0. 69） points]（P〈0. 05） ,which was not significantly different between groups of B1 and B2（P〈0. 05）. The decrease of FeNO levels on the 8~ and iTh week during treatment was more in group A2 than that in group A1[（30. 33±5. 78） ppb vs. （57. 32±9. 21） ppb and （ 18. 45 ± 6. 23） ppb vs. （55. 49 ± 7. 90） ppb] （P（0. 01 ）, which was not significantly different between groups of B1 and B2（P〉0. 05）. Conclusion FeNO detection has an important value in the stratification management of patients with cough variant asthma, who may benefit front FeNO detection by selecting the optimized dosage regimen.