呼出气一氧化氮测定在成人支气管哮喘诊治中的临床意义

The clinical significance of diagnosis and therapy in patients with adult bronchial asthma by fractional exhaled nitric oxide levels

目的评估呼出气一氧化氮(FeNO)测定在支气管哮喘诊断中的敏感性和特异性,比较FeNO测定值在支气管哮喘患者治疗前及治疗(临床症状缓解)后的变化情况,探讨FeNO水平与第一秒用力呼气量(FEV1)占预计值百分比、外周血嗜酸性粒细胞(EOS)计数、哮喘控制实验(ACT)评分、诱导痰EOS百分比等指标的关系和临床意义.方法选取2016年1月至2017年12月洛阳市中心医院收治的支气管哮喘患者87例为哮喘组,并纳入同期的健康体检者40例为健康对照组,分别测定各组FeNO水平、FEV1占预计值百分比、外周血EOS计数、ACT评分、诱导痰EOS百分比,并进行比较和相关性分析.结果FeNO测定在哮喘组的阳性率为56.3%(49/87),在健康对照组的阳性率为5.0%(2/47);复查患者在治疗前FeNO水平为(70.9±53.6)ppb,高于治疗后的(12.2±8.7)ppb,差异有统计学意义(t=4.323,P=0.001);哮喘组的FeNO水平(42.4±42.5)ppb,高于健康对照组(9.4±5.8)ppb,差异有统计学意义(t=2.871,P=0.001);FeNO水平与外周血EOS计数、ACT评分的相关系数分别为0.376、0.361,P值分别为0.000、0.001,均呈正相关;而与FEV1/pred、诱导痰EOS百分比的相关系数分别为0.376、0.306,P值分别为0.306、0.805,均无相关性.结论FeNO测定在支气管哮喘的辅助诊断中有重要的临床意义,对支气管哮喘的治疗效果评估有指导意义.

Objective To evaluate the sensitivity and specificity of exhaled nitric oxide in the diagnosis and therapy of bronchial asthma.Methods From January 2016 to December 2017,87 patients diagnosed with bronchial asthma in Luoyang Central Hospital Affiliated to Zhengzhou University were selected as asthma group,and 40 healthy people were selected as healthy control group at the same term.The levels of FeNO,FEV1/pred,peripheral blood EOS count,ACT score,percentage of sputum EOS were measured.Results The positive rate of FeNO was 56.3%(49/87)in the asthma group,which in the healthy control group was 5.0%(2/47).The fractional exhaled nitric oxide level of reexamined patients before treatment[(70.9±53.6)ppb]was higher than that after treatment[(12.2±8.7)ppb],and the difference was statistically significant(t=4.323,P=0.001).The fractional exhaled nitric oxide level in the asthma group[(42.4±42.5)ppb]was higher than that in the healthy control group[(9.4±5.8)ppb],and the difference between the two groups was statistically significant(t=2.871,P=0.001).The frac-tional exhaled nitric oxide level was positively correlated with peripheral blood EOS count(r=0.376,P=0.000)and ACT score(r=0.361,P=0.001),but had no correlation with FEV1/pred(r=-0.111,P=0.306)and sputum EOS(r=-0.036,P=0.805).Conclusion The measurement of fractional exhaled nitric oxide levels has an important clinical significance in the diagnosis of bronchial asthma.And it has a guiding significance for the evaluation of the therapeutic effect of bronchial asthma.