吸烟对慢性咳嗽患者FeNO与小气道功能的影响

Influence of Smoking on Fractional Exhaled Nitric Oxide and Small Airway Function in Patients with Chronic Cough

目的评估吸烟对慢性咳嗽患者呼出气一氧化氮(FeNO)与小气道功能的影响。方法选取2017年5月至2018年6月呼吸科门诊就诊的205例慢性咳嗽患者作为研究对象。根据吸烟与否将研究对象分为吸烟组(63例)、从不吸烟组(95例)和已戒烟组(47例)。对所有患者进行FeNO测定,比较三组患者肺功能小气道指标及FeNO值,并分析各组患者肺功能小气道指标与FeNO值的相关性。结果吸烟组肺功能小气道指标用力呼出气量为75%、50%、25%时的平均流量占预计值百分比(分别为FEF75%pred、FEF50%pred和FEF25%pred),以及用力呼出气量为25%~75%时的平均流量(MMEF)明显低于从不吸烟组(F值分别为2.83、2.74、3.54、3.84,P值分别是0.027、0.031、0.026、0.028);吸烟组FEF75%pred、MMEF明显低于已戒烟组(F值为3.05,P值为0.046);吸烟组FeNO明显低于从不吸烟组(F值为4.22,P值为0.02)。吸烟患者FeNO与肺功能小气道各指标无明显相关性(P>0.05);不吸烟与已戒烟患者FeNO与肺功能小气道指标(FEF25%pred、MMEF)呈负相关(r值分别为-0.52、-0.49和-0.54、-0.02;P值分别为0.021、0.036和0.003、0.029)。结论吸烟可致慢性咳嗽患者肺功能小气道功能降低,且吸烟患者FeNO值会出现"降低"现象。

Objective To investigate the influence of smoking on fractional exhaled nitric oxide(FeNO)and small airway function in patients with chronic cough.Methods A total of 205 patients with chronic cough who attended the outpatient service of Department of Respiration from May 2017 to June 2018 were collected as subjects.According to smoking or not,the subjects were divided into smoking group with 63 patients,never smoking group with 95 patients,and smoking cessation group with 47 patients.FeNO was measured for all patients,and the function parameters of small airway and FeNO values were compared among the three groups.The correlation between small airway function parameters and FeNO was analyzed for each group.Results Compared with the never smoking group,the smoking group had significantly lower percentages of mean flow at 75%,50%,25%expiratory volume in the predicted value(FEF75%pred,FEF50%pred,and FEF25%pred,respectively)and maximal mid-expiratory flow(MMEF)at 25%~75%of forced exhalation volume(F=2.83,2.74,3.54,and 3.84,P=0.027,0.031,0.026,and 0.028);the smoking group had significantly lower FEF75%pred and MMEF than the smoking cessation group(F=3.05,P=0.046)and a significantly lower FeNO than the never smoking group(F=4.22,P=0.025).There was no significant correlation between FeNO and small airway function parameters in smoking patients(P>0.05),while FeNO was negatively correlated with small airway function parameters(FEF25%pred and MMEF)in non-smokers(r=-0.52 and-0.49,P=0.021 and 0.036)and the patients with smoking cessation(r=-0.54 and-0.02,P=0.003 and 0.029).Conclusion Patients with chronic cough have significant reductions in small airway function parameters and a reduction in FeNO by smoking.