呼出气一氧化氮测定对不同急性加重频率慢性阻塞性肺疾病表型治疗效果的预测作用

The predictive effect of fractional exhaled nitric oxide measurement on treatment in COPD patients with different phenotype of acute exacerbation frequency

目的了解不同急性加重频率的慢性阻塞性肺疾病(简称慢阻肺)患者的呼出气一氧化氮(FeNO)和外周血嗜酸性粒细胞水平对糖皮质激素治疗效果的预测作用。方法选取2017年2月至2019年10月在遂宁市中心医院就诊的慢阻肺急性加重患者127例,依据过去1年里急性加重次数及治疗方案分为4组:频发急性加重糖皮质激素治疗组34例,频发急性加重非糖皮质激素治疗组31例,非频发急性加重糖皮质激素治疗组30例,非频发急性加重非糖皮质激素治疗组32例。治疗前及治疗第10天分别检测患者FeNO、外周血嗜酸性粒细胞百分比及慢阻肺评估测试(CAT)评分、白细胞介素-8(IL-8)浓度,比较治疗前后组内及组间差异。结果4组患者治疗后第10天CAT评分、FeNO、嗜酸性粒细胞百分比、IL-8水平较治疗前均有显著改善(均P<0.05)。频发急性加重糖皮质激素治疗组、频发急性加重非糖皮质激素治疗组治疗第10天与治疗前相比,FeNO、嗜酸性粒细胞百分比、IL-8的下降幅度大于非频发急性加重糖皮质激素治疗组和非频发急性加重非糖皮质激素治疗组,且频发急性加重糖皮质激素治疗组治疗前后上述指标的的下降幅度大于频发急性加重非糖皮质激素治疗组,差异有统计学意义(均P<0.05)。频发急性加重糖皮质激素治疗组CAT评分改善程度大于其余3组(均P<0.05)。非频发急性加重糖皮质激素组与非频发急性加重非糖皮质激素治疗组之间CAT评分差异无统计学意义(P>0.05)。结论频发急性加重表型慢阻肺患者气道炎症程度更明显,FeNO可反映频发急性加重慢阻肺患者气道炎症水平并评估糖皮质激素治疗反应。

Objective Through measuring fractional exhaled nitric oxide(FeNO)and eosinophil levels of peripheral blood in chronic obstructive pulmonary disease(COPD)patients with different phenotype of acute exacerbation frequency,to predict the therapeutic effect of glucocorticoid therapy and guide the clinical treatment of different subtypes patients with acute exacerbations of COPD.Methods A total of 127 patients with acute exacerbation of COPD in Suining Central Hospital from February 2017 to October 2019 were recruited.They were divided four groups according to the number of acute exacerbations in the past one year and the treatment scheme,ie.a frequent acute exacerbation with glucocorticoid treatment group(34 cases),a frequent acute exacerbation with non-glucocorticoid treatment group(31 cases),a non-frequent acute exacerbation with glucocorticoid treatment group(30 cases),and a nonfrequent acute exacerbation with non-glucocorticoid treatment group(32 cases).FeNO value,eosinophil ratio in peripheral blood,COPD assessment test(CAT)score,and interleukin-8(IL-8)concentration were measured before and on the 10 th day of treatment,and the differences within group and between groups before and after treatment were compared.Results CAT score,FeNO,eosinophil ratio and IL-8 level in the four groups were significantly improved on the 10 th day after treatment(all P<0.05).The declines of FeNO value,eosinophil ratio,and IL-8 level on the 10 th day of treatment compared with those before treatment in the frequent acute exacerbation with glucocorticoid treatment group and the frequent acute exacerbations with non-glucocorticoid treatment group were larger than those in the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group(all P<0.05).The declines of FeNO value,blood eosinophil ratio and IL-8 level in the frequent acute exacerbation with glucocorticoid treatment group were also statistically significantly larger than those in the frequent acute exacerbations with non-glucocorticoid treatment group(all P<0.05).The improvement of CAT score in the frequent acute exacerbation with glucocorticoid treatment group was greater than that in other three groups(all P<0.05).There was no significant difference in CAT score between the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group(P>0.05).Conclusions The degree of airway inflammation is more obvious in patients with frequent acute exacerbation phenotype of COPD.FeNO value can reflect the level of airway inflammation in patients with frequent acute exacerbation of COPD and evaluate the response to glucocorticoid therapy.