FENO在预测COPD患者对激素治疗反应中的作用

Effect of FENO in Predicting the Reactions of COPD Patients to the Hormone Therapy

目的讨论FeNO指标对COPD患者糖皮质激素治疗方案选择方面的具体指导意义。方法方便选取2015年3月—2018年3月在厦门长庚医院住院和门诊治疗的缓解期COPD患者共计50例,将其随机分成A、B两组。A组首先给予口服泼尼松10 mg bid,共10 d,经4周洗脱期后给予空白药物。B组首先给予空白药物,4周洗脱期后给予口服泼尼松10 mg bid,共10 d。分别于治疗前、第1次用药后及第2次用药后的3 d内检测患者FeNO、FEV1,并进行6 min步行试验和SGRQ。以FeNO值为标准分层分析不同患者对口服泼尼松治疗的反应。结果两组患者服用泼尼松后,6 min步行距离分别由(348±59)、(362±72)m增加至(425±48)和(407±91)m,FeNO值分别由(30±11)ppb和(28±12)ppb降低至(25±3)ppb和(25±9)ppb,SGRQ中症状评分分别由(42±3)分和(45±6)分降至(35±5)分和(41±6)分,活动评分由(39±5)分和(38±3)分降至(32±7)分和(35±3)分,影响评分由(42±10)分和(35±8)分降至(38±8)分和(36±5)分,两组患者各项评分均有明显改善(P<0.05)。分层分析显示,FeNO值≥30 ppb的患者,服用泼尼松后,FeNO由(35±6)ppb降低至(24±3)ppb,6 min步行距离由(368±79)m增加至(425±6)m,SGRQ中症状评分由(44±5)分降低至(35±4)分,活动评分由(40±5)分降低至(39±6)分,影响评分由(46±6)分降低至(38±8)分,各项指标较治疗前均有明显改善(P<0.05);而FeNO<30 ppb的患者,各项指标同用药前对比无明显改善(P>0.05)。结论在治疗开始前,首先测定患者FeNO值,并据其选择治疗方案,对FeNO值低的患者不进行激素治疗,可以避免或减少无效或效果较差的激素治疗。

Objective To discuss the specific guidance significance of FENO in predicting the reactions of COPD patients to the hormone therapy. Methods 50 cases of COPD patients in the relief period in our hospital from March 2015 to March 2018 were convenient selected and randomly divided into two groups, the group A took the 10 mg bid prednisone orally for 10 days, and were given the blank drugs after 4-week washout period, while the group B used the blank drugs, and took the 10 mg bid prednisone orally for 10 days, and the FeNO、FEV1 of patients were tested before treatment, after the first medication and second medication, and the patients were for 6-min walking test and SGRQ, and the reactions of different patients to the oral administration of prednisone were analyzed according to the FeNO value. Results After oral administration of prednisone, the 6-min walking distance increased from （348±59）、（362±72）m to （425±48）m,（407±91） m, and the FeNO value decreased from （30±11） ppb, （28±12） ppb to （25±3） ppb, （25±9） ppb, and the symptom score in SGRQ decreased from （42±3） marks, （45±6）points to （35±5）points, （41±6）points, and the activity score decreased form （39±5）points, （38±3）pointsvs （32±7）points, （35±3）points, and the effect score decreased from （42±10） marks, （35±8） marks to （38±8）points,（36±5） marks, and various scores were obviously improved（P〈0.05）, and the layer analysis showed that the FeNO value was ≥ 30ppb, after the administration of prednisone, the FeNO deceased from （35±6） ppb to （24±3） ppb, and the 6-min walking distance increased from （ 368±79） m to （425±6） m, and the symptom score in SGRQ decreased from （44±5） points to （35±4）points, and the activity score decreased from （40±5）points to（39±6）points, and the effect score decreased from （46±6）points vs （38±8）points, and various indexes were obviously improved compared with those before treatment （P〈0.05）, and various indexes were not obviously improved compared with those before medication for patients whose FeNO 〈 30 ppb （P〈0.05）. Conclusion We should firstly measure the FeNO value at the beginning of the treatment, and select the treatment plan, and for patients with low FeNO value, we should not conduct the hormone treatment, thus avoiding or reducing the hormone treatment without effect or with bad effect.