呼出气一氧化氮浓度及外周血嗜酸性细胞百分比检测在支气管哮喘中的应用价值

Application value of exhaled nitric oxide and peripheral eosinophil percentage in the management of asthma

目的探讨呼出气一氧化氮浓度(FeNO)及外周血嗜酸性细胞百分比(EOS)检测在支气管哮喘中的应用价值。方法选取2016年6月至2018年10月北京核工业医院呼吸内科因支气管哮喘急性发作住院的患者88例(FeNO≥36 ppb或EOS≥3.7%),随机分为观察组1(27例)、观察组2(30例)和对照组(31例)。观察组1根据FeNO值调整布地奈德福莫特罗粉吸入剂剂量,观察组2根据EOS值调整布地奈德福莫特罗粉吸入剂剂量,对照组则按照指南哮喘病情控制分级阶梯式治疗方案治疗。三组均按需吸入硫酸沙丁胺醇气雾剂,每2个月进行随访,随访时检测EOS、FeNO并进行哮喘控制测试(ACT)评分,随访时间为1年。结果观察组与对照组治疗后ACT评分均较治疗前明显升高(P<0.05)。观察组1和观察组2 ACT评分均优于对照组,差异有统计学意义(P<0.05)。两观察组与对照组FeNO比较,除观察组1第四次复查结果外,其余与对照组比较均有下降,差异有统计学意义(P<0.05);两观察组与对照组EOS比较,除观察组2第二次复查结果外,其余与对照组比较均有改善,差异有统计学意义(P<0.05)。结论在36 ppb≤FeNO或3.7%≤EOS的哮喘患者长期管理中,可依据FeNO值、EOS值或ACT评分调整治疗方案;FeNO和EOS值均为客观监测指标,可避免ACT评分主观因素的影响,且检测操作简单、安全,提高患者的依从性。

Objective To investigate the value of detection of exhaled nitric oxide(FeNO)and peripheral eosinophil percentage(EOS)in the management of bronchial asthma.Methods From June 2016 to October 2018,88 patients(FeNO≥36 ppb or EOS≥3.7%)in the Department of Respiratory Medicine at Beijing Nuclear Industry Hospital were randomly divided into observation group 1(27 patients),observation group 2(30 patients)and control group(31 patients).The dose of budesonide formoterol powder inhalation agent was adjusted according to the value of FeNO in observation group 1 and the percentage of peripheral EOS in observation group 2.The control group was treated in accordance with the guidelines of asthma control step-by-step treatment.All three groups were treated with inhaled salbutamol sulfate aerosol and followed up every 2 months.EOS,FeNO and asthma control test score(ACT)were recorded during the 1 year follow-up.Results After treatment,the ACT scores in both observation and control groups were significantly higher than those before treatment(P<0.05).The ACT scores in observation group 1 and observation group 2 were better than those in control group(P<0.05).Compared with the control group,FeNO in the two observation groups were significantly decreased(P<0.05),except for the fourth reexamination in the observation group 1.Compared with the control group,peripheral EOS in the two observation groups were improved(P<0.05),except for the second reexamination in the observation group 2.Conclusion In the long-term management of asthma patients with FeNO≤36 ppb or EOS≤3.7%,the treatment plan can be adjusted according to FeNO value,EOS value or ACT scores.FeNO and EOS are objective monitoring indexes,which can avoid the influence of subjective factors of ACT score,and the detections are simple and safe,therefore can improve the compliance of patients.According to the FeNO or EOS value,adjustment has more advantages;it is worth popularizing in clinical work.