呼出气一氧化氮测定在评估慢性阻塞性肺疾病中的作用

Evaluating value of fractional exhaled nitric oxide in patients with chronic obstructive pulmonary disease

目的探讨呼出气一氧化氮(FeNO)测定在慢性阻塞性肺疾病(COPD)患者评估中的应用价值。方法 60例COPD急性加重期(AECOPD)患者作为AECOPD组,且该60例患者出院60 d后无再次急性加重,符合COPD稳定期标准,作为COPD稳定期组。选取同期体检的30例健康成人作为对照组。比较对照组与AECOPD组的基础资料[包括性别、年龄、体质量指数(BMI)、第1秒用力呼气容积占预计值的百分比(FEV1%)、第1秒用力呼吸容积与用力肺活量之比(FEV1/FVC)];三组气道炎症指标[包括FeNO、降钙素原(PCT)、血清淀粉样蛋白A(SAA)];分析影响AECOPD及COPD稳定期患者FeNO水平的相关因素;COPD不吸烟患者及吸烟患者不同分期的FeNO水平。结果 AECOPD组的FEV1%、FEV1/FVC均低于对照组,差异均具有统计学意义(P<0.05)。AECOPD组的FeNO、SAA均高于COPD稳定期组及对照组, COPD稳定期组的FeNO、SAA均高于对照组, AECOPD组的PCT高于对照组,差异均具有统计学意义(P<0.05)。年龄、BMI、PCT、SAA、FEV1%、FEV1/FVC均不是AECOPD及COPD稳定期患者FeNO水平的影响因素(P>0.05)。COPD不吸烟患者急性加重期的FeNO水平(41.40±35.20)ppb高于稳定期的(26.13±17.81)ppb,差异具有统计学意义(P<0.05)。结论 COPD患者的FeNO水平高于健康人, AECOPD时的FeNO水平高于稳定期, FeNO测定有助于COPD的评估及病情监测。

Objective To discuss the value of fractional exhaled nitric oxide(FeNO) in patients with chronic obstructive pulmonary disease(COPD). Methods 60 patients with acute exacerbation of COPD(AECOPD) were regarded as the AECOPD group, and the patients had no acute exacerbation again 60 d after discharge, which meeting the criteria for stable COPD as the stable COPD group. 30 healthy adults who received physical examination during the same period were selected as the control group. The basic data [including gender, age, body mass index(BMI), the percentage of the forced expiratory volume in the first second to the predicted value(FEV1%), the percentage of the forced expiratory volume in the first second to the forced vital capacity(FEV1/FVC)] was compared between control group and AECOPD group. The airway inflammation indicators [including FeNO, procalcitonin(PCT), serum amyloid A(SAA)] of the three groups was compared. The related factors that affect FeNO levels in patients with AECOPD and stable COPD, and the levels of FeNO in COPD non-smoking and smoking patients at different stages was analyzed. Results FEV1% and FEV1/FVC of AECOPD group was lower than that of the control group, and the difference was statistically significant(P<0.05). FeNO and SAA of AECOPD group was higher than stable COPD group and control group, and stable COPD group was higher than control group, and PCT of AECOPD group was higher than that of control group, and the difference was statistically significant(P<0.05). Age, BMI, PCT, SAA, FEV1%, FEV1/FVC were not influential factors of FeNO levels in patients with stable COPD and AECOPD(P>0.05). FeNO level of non-smoking COPD patients in acute exacerbation(41.40±35.20) ppb was higher than that in stable stage(26.13±17.81) ppb, and the difference was statistically significant(P<0.05). Conclusion FeNO values of COPD patients are higher than those of healthy adults, and FeNO values are higher in AECOPD than of that stable COPD. FeNO measurement is helpful for evaluating and monitoring the condition of COPD.