一氧化氮联合血清总IgE在诊断哮喘与慢性阻塞性肺气肿重叠综合征中的临床价值

Clinical value of fractional exhaled nitric oxide combined with serum total IgE for diagnosis of asthma-obstructive pulmonary disease overlap syndrome

目的:探讨呼出气一氧化氮(FeNO)联合血清总IgE在诊断哮喘与慢性阻塞性肺气肿重叠综合征(ACOS)中的临床价值。方法:纳入48例ACOS患者和15例单纯慢性阻塞性肺气肿患者、16例单纯哮喘患者,测定其FeNO和血清总IgE,采用受试者工作曲线和支持向量机分析两指标诊断及联合诊断ACOS的敏感性和特异性。结果:三组病例的FeNO值差异有统计学意义(F=4.38,P=0.041);三组病例的IgE值差异亦有统计学意义(F=6.67,P=0.027),FeNO与IgE的值哮喘组最高,其次为ACOS组,在慢性阻塞性肺气肿组中最低;ROC曲线结果表明:FeNO诊断的敏感性为0.833,特异性为0.677,IgE诊断的敏感性为0.771,特异性为0.710;FeNO联合IgE诊断的敏感性为0.896,特异性为0.645,准确性为0.797。结论:FeNO、IgE对诊断哮喘有较大意义大,而ACOS介于哮喘和COPD之间,对于ACOS的诊断,FeNO联合IgE的特异性较低,还需结合临床进行综合判断。

Objective： To detect the clinical value of FeNO combined with serum total IgE for diagnosis of ACOS. Methods： Total 48 patients with ACOS, 15 patients with chronic obstructive pulmonary disease, and 16 patients with asthma were included. Their FeNO and serum total IgE were measured. Then clinical values of FeNO combined with serum total IgE for diagnosis of ACOS were evaluated by receiver operating curve and SVM. Results ： The difference of FeNO values among the three groups was statistically significant （ F = 4. 38, P = 0. 041 ） , The difference of IgE values among the three groups was statistically significant （ F = 6. 67, P = 0. 027 ） ; The values of FeNO and IgE in asthmatic group was the highest, followed by ACOS and chronic obstructive pulmonary disease group ; The result of ROC curve showed that the sensitivity of FeNO was 0. 833, the specificity was 0. 677, the sensitivity of IgE was 0. 771, the specificity was 0. 710 ; The sensitivity of FeNO combined with IgE was 0. 896, the specificity was 0. 645, and the accuracy was 0. 797. Conclusion ： FeNO, IgE on the diagnosis of asthma have greater significance, And ACOS between asthma and COPD, for the diagnosis of ACOS, FeNO combined with IgE specific low, need to be combined with clinical judgment.