不同水平呼出气一氧化氮的支气管哮喘急性发作临床特征比较

Clinical characteristics of bronchial asthma in different levels of fractional exhaled nitric oxide

目的比较不同水平呼出气一氧化氮浓度(fractional exhaled nitric oxide,FeNO)的支气管哮喘急性发作期的临床特征。方法纳入2018年12月至2020年11月福建省立医院呼吸与危重症医学科确诊的支气管哮喘急性发作期患者130例,收集患者的FeNO水平、血免疫球蛋白E(immunoglobulin E,IgE)水平、嗜酸性粒细胞(eosinophil,EOS)绝对值、外周血嗜酸性粒细胞百分率(percentage of peripheral eosinophil,用EOS%表示)、C反应蛋白(C reactive protein,CRP)、血脂检查指标,根据FeNO水平分级标准将支气管哮喘急性发作患者分为3组,低水平组(FeNO<25ppb)共52例,中水平组(25ppb≤FeNO<50ppb)共38例,高水平组(FeNO≥50ppb)共40例,比较各组的临床特征。结果不同FeNO水平组间患者的年龄、性别、体重指数、高血压史、糖尿病史、心功能不全史、CRP、IgE水平、血脂水平(包括胆固醇、甘油三酯、高低密度脂蛋白)差异无统计学意义(P>0.05)。ROC曲线显示,EOS%以3%、4%、5%、6%和7%为界时,ROC曲线下面积(area under the curve,AUC)分别为0.524、0.516、0.506、0.823、0.537。EOS%以6%为界时,ROC曲线的敏感度和特异度分别为68.4%和96.2%,明显高于其他EOS%分界点。各组吸入激素年限:低水平组12.50(3.00,30.00)年,中水平组4.50(0.65,10.25)年,高水平组2.00(0.93,5.75)年,3组差异有统计学意义(H=17.968,P<0.05)。结论较高水平EOS%(≥6%)能较好地预测FeNO水平。不同FeNO水平组吸入激素的年限有差异,吸入激素的年限越长,FeNO水平越低。

Objective To compare the clinical characteristics of bronchial asthma in different levels of fractional exhaled nitric oxide (FeNO).Method 130 cases of patients (18-87 years old) who had been diagnosed with bronchial asthma in Fujian Provincial Hospital from December 2018 to November 2020 were included in this study.FeNO value,blood immunoglobulin E (IgE) value,percentage of blood eosinophil (blood EOS%),absolute value of blood EOS,C-reactive protein (CRP) and blood lipid value were collected.Patients were divided into three groups according to FeNO value:52 cases in the low-level group (FeNO < 25ppb),38 cases in the middle-level group (25≤FeNO < 50ppb) and 40 cases in the high-level group (FeNO≥50ppb).Clinical characteristics were compared among each group.Result Data show no significant difference among the three groups with respect to age,gender categories,body mass index,hypertension history,diabetes mellitus history,cardiac dysfunction history,blood CRP,blood total IgE value,and blood lipid level including cholesterol,triglyceride and high-density lipoprotein.The area under the ROC curve (AUC) was 0.524,0.516,0.506,0.823 and 0.537 when EOS% was 3%,4%,5%,6% and 7%,respectively.The optimal cut-off value was 6%,and the sensitivity and specificity of ROC curve was 68.4% and 96.2%,respectively.The median duration of inhaled hormone was 2.00 years(Q;-0.93,Q;-5.75) in the high-level group.The median duration of inhaled hormone was 4.50 years(Q;-0.65,Q;-10.25) in the middle-level group.The median duration of inhaled hormone was 12.50 years(Q;-3.00,Q;-30.00) in the low-level group.Conclusion FeNO value may be predicted by blood EOS% at a high EOS% value(≥6%),the longer the duration of inhaled hormone,the lower the FeNO value.