呼出气一氧化氮对预测慢性阻塞性肺疾病急性加重期疗效意义的研究

Study on the effect of exhalation of nitric oxide in the prediction of acute exacerbation of chronic obstructive pulmonary disease

目的:对比慢性阻塞性肺疾病(COPD)患者急性加重期和稳定期呼出气一氧化氮(FENO)水平改变,依据不同的FENO界值相应的慢性阻塞性肺疾病急性加重期患者治疗有效的敏感度和特异度画出的受试者工作特征(ROC)曲线,找到FENO的最佳界值。方法:选取81例COPD急性加重期、78例健康者为研究对象,并行肺功能检查记录第1 s用力呼气容积占预计值百分比(FEV1%pred),FENO使用一氧化氮测定仪测定,据不同的FENO界值所相应的COPD急性加重期患者治疗有效的敏感度和特异度画出ROC曲线。结果:(1)COPD急性加重期组FENO明显高于稳定期及健康对照组(P<0.05)、稳定期组FENO明显高于健康对照组(P<0.05);(2)COPD急性加重期组及经治疗达到稳定期组后FENO水平与FEV1%均无相关性(P>0.05);急性加重期到稳定期FENO改善值与急性加重期到稳定期FEV1%改善值之间存在正相关关系(P<0.05);(3)绘制的曲线下面积是0.770,FENO的截点是26.15 ppb,用FENO>26.15 ppb作为截点判断COPD急性加重期治疗有效的敏感度为77.8%,特异度为70.4%,95%CI为(0.680~0.860);(4)COPD急性加重FENO值>26.15 ppb组住院天数明显少于FENO值<26.15 ppb组(P<0.05);COPD急性加重组中FENO值>26.15 ppb经治疗后FEV1%明显改善(P<0.05),FENO值<26.15 ppb组经治疗后FEV1%改善不明显(P>0.05)。结论:FENO反映COPD患者病情严重程度可以用呼出气一氧化氮来衡量,同时它可以预测COPD急性加重患者的治疗效果是一种安全、有效的方法,值得推广应用。

Objective To explore the differences of Fractional exhaled Nitric Oxide(FENO)level between chronic obstructive pulmonary disease(COPD)patients at stable stage and acute exacerbations.According to the difference FENO values corresponding sensitivity and specificity of effective treatment of patients in Chronic obstructive pulmonary disease in acute exacerbation period to depict a Receiver operating characteristic(ROC)curve and find the best cutoff for FENO.Method A total of81patients with acute exacerbation of COPD and78healthy subjects were enrolled in this study.The first forced expiratory volume accounted for the predicted percentage(FEV1%pred)and the FENO were measured in all people,the ROC curve was depicted.depend on the different FENO value corresponding to the sensitivity and specificity of AECOPD patients hospitalized therapeutically effective.Results①FENO was significantly higher in the acute exacerbation group than in the stable and healthy control group(P<0.05).The FENO of the stable group was significantly higher than in the healthy control group(P<0.05);②There was no correlation between FENO level and FEV1%in patients with acute exacerbation and stable of COPD(P>0.05);There was a positive correlation between the improvement of FENO and the improvement of FEV1%in the acute exacerbation period(P<0.05).③The area under the ROC curve was0.770,the best cutoff of FENO was26.15ppb,put26.15ppb as the standard to predict the acute exacerbation of COPD patients therapeutically effective sensitivity was77.8%,specificity70.4%and95%CI(0.680~0.860);④The hospital days in the AECOPD patients who measured FENO value>26.15ppb was significantly less than the patients who measured FENO value of<26.15ppb(P<0.05),Aftertreatment,FEV1%was significantly increased in the FENO value>26.15ppb acute exacerbation group(P<0.05),but the improvement of FEV1%in the FENO value<26.15ppb group was not significant(P>0.05).Conclusion FENO may serve as an indicator of the severity of COPD patients,and can be used as a simple and effective way to predict the treatment response in COPD patients with acute exacerbations.