呼出气一氧化氮检测在哮喘-慢阻肺重叠综合征中的临床应用

Clinical Value of Fractional Exhaled Nitric Oxide for Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome

目的:探讨哮喘-慢性阻塞性肺疾病重叠综合征(asthma-chronic obstructive pulmonary disease overlap syndrome,ACOS)患者呼出气一氧化氮浓度(FENO)的变化情况及与一秒用力呼气容积(FEV1)、血嗜酸性粒细胞(eosnophil,EOS)及超敏C反应蛋白(high sensitivity C reactive protein,hs-CRP)的关系。方法:选取上海第九人民医院2016年1月~2016年12月呼吸内科病区收治的ACOS患者30例及无肺部疾病的健康的体检人群20例分别作为实验组和对照组。治疗前后分别检测和比较两组FENO、FEV1值、EOS及血清hs-CRP水平的变化。结果:治疗前,实验组FENO、hs-CRP及EOS水平显著高于对照组(P值分别为0.0081,0.0263及0.0078),FEV1%水平显著低于对照组(P=0.0047)。治疗后,两组间FENO、hs-CRP及EOS水平变化无显著差异(P值分别为0.2614,0.1347及0.2431),而实验组FEV1%水平仍显著低于对照组(P=0.0469)。实验组在治疗前后FENO、hs-CRP及EOS水平均显著下降(P值分别为0.0027,0.0427,0.0031),而FEV1%变化无显著差异(P=0.1427)。在治疗前后,FENO水平与hs-CRP水平呈正相关(γ=0.7392,P=0.0168;γ=0.7214,P=0.0248),与血EOS水平亦呈正相关(γ=0.8782,P=0.0072;γ=0.7642,P=0.0231)。而FENO水平与FEV1%在治疗前后无相关性(P>0.05)。结论:ACOS患者气道内存在嗜酸性粒细胞相关性慢性炎症,短期静脉糖皮质激素治疗可缓解其气道内炎症。ACOS患者FENO水平与血EOS、血清hs-CRP水平有显著相关性,可用于辅助评估ACOS患者静脉糖皮质激素疗效。

Objective： To evaluate the clinical significance of fractional exhaled nitric oxide （FENO） in patients with asthma- chronic obstructive pulmonary disease overlap syndrome （ACOS）. To evaluate the correlation between FENO and FEV 1%, high sensitiv- ity C reactive protein （hs-CRP）, eosnophil （EOS）. Methods： 30 patients with ACOS were selected as the experience group from January 2016 to December 2016 treated in the department of respiration in Shanghai the ninth People＇s Hospital. 20 healthy people were selected as the control group. The FENO and FEVI% and EOS and hs-CRP were examined before the treatment as soon as after the treatment. Results： The FENO level in experience group was higher than it in control group as well as the EOS level and the hs-CRP level before the treatment（P=0.0081, 0.0078, 0.0263）. The FEV1% level in experience group was lower than it in control group before the treatment（P-0. 0047）. After the treatment, the change of FENO and hs-CRP and EOS in experience group was not different compared with the control group （P=0.2614, 0.1347, 0.2431）. But the FEVI% level in experience group was also lower than it in control group （P=0.0469）. After the treatment the level of FENO and hs-CRP and EOS in experience group was lower than it before the treatment （P=0.0027, 0.0427, 0.0031）. But the change of FEVI% level was not（P=0.1427）. Before the treatment there is a positive correlation between FENO and EOS （γ=0.8782, P=0.0072） as well as hs-CRP （γ=0.7392, P=0.0168）. There is also a positive correlation between FENO and EOS（3,-0.7642, P=0.0231） as well as hs-CRP （γ=0.7214, P=0.0248） Before the treatment there is not any correlation between FENO and FEV 1% as well as after the treatment （P〉0.05）. Conclusions： The eosinophilic inflammation is present in ACOS patients, which can be treated by gluco- corticoid. FENO can be used to evaluate the efficacy of glucocorticoid, which induced EOS and hs-CRP.