呼出气一氧化氮在慢性阻塞性肺疾病急性加重期的临床意义

Clinical Significance of Fractional Exhaled Nitric Oxide in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:研究呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)在慢性阻塞性肺疾病急性加重期(AECOPD)的临床意义。方法:回顾性分析2016年11月-2017年4月在笔者所在医院呼吸内科住院的AECOPD患者。所有患者均行FeNO检测;FeNO≥25 ppb为试验组,FeNO<25 ppb为对照组。所有患者均接受氧疗、糖皮质激素、抗感染、化痰、止咳、支气管舒张剂等常规治疗;对比治疗前后不同时间点COPD症状评估及疗效判定(mMRC评级)、肺功能及住院时间。结果:试验组和对照组D0时m MRC评级比较,差异无统计学意义(P>0.05)。治疗后D3和D7,试验组和对照组mMRC评级均较治疗前降低,且试验组均优于对照组,差异均有统计学意义(P<0.05)。试验组和对照组D0 FEV1和FEV1%/pred比较差异有统计学意义(P<0.05);试验组D7 FEV1和FEV1%/pred均较D0改善,差异有统计学意义(P<0.05);对照组D7 FEV1%/pred较D0改善,但是FEV1与D0比较差异无统计学意义(P>0.05)。试验组住院时间短于对照组(P<0.05)。结论:在接受包含糖皮质激素在内的综合治疗下,FeNO≥25 ppb患者在肺功能、mMRC评分、住院时间方面表现更优。

Objective:To investigate the changes of fraction of exhaled nitric oxide(FeNO)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:A retrospective analysis of AECOPD patients in our hospital from November2016to April2017was conducted.All patients were tested for FeNO,the experimental group with FeNO≥25ppb and the control group with FeNO<25ppb.All patients received routine treatment such as oxygen therapy,glucocorticoid,anti-inflammatory,phlegm-resolving,cough-relieving,bronchodilator and so on.The differences of mMRC rating,lung function and length of stay between two groups at different time points before and after treatment were compared.Result:There was no significant difference in the mMRC rating among experimental group and control group at D0(P>0.05).The mMRC rating decreased gradually in both groups at D3and D7,and the experimental group were better,the differences were statistically significant(P<0.05).The lung function indexes in experimental group was significantly lower than that in control group,the differences were statistically significant(P<0.05).FEV1,FEV1%/pred in the experimental group increased significantly after the treatment at D7,the difference was statistically significant(P<0.05).FEV1%/pred in the control group was better after treatment at D7,the difference was statistically significant(P<0.05),but there was no significant difference in FEV1at D7than D0(P>0.05).Compared to control group,the length of hospital stay in the experimental group was shorter,the difference was statistically significant(P<0.05).Conclusion:Under the comprehensive treatment including glucocorticoid,the experimental group performed better in lung function,mMRC rating and length of stay.