呼出气一氧化氮测定在哮喘-慢阻肺重叠综合征的临床应用

Clinical Application of Fractional Exhaled Nitric Oxide in Asthma-COPD Overlap Syndrome

目的探讨新型呼出气一氧化氮(Fractional Exhaled Nitric Oxide,FeNO)测定设备在哮喘-慢阻肺重叠综合征(Asthma-COPD Overlap Syndrome,ACOS)治疗中的价值。方法选取2020年1月至2021年12月于我院确诊为ACOS、哮喘以及慢阻肺患者各100例为研究对象,并将ACOS患者作为病例组,哮喘患者作为常规1组,慢阻肺患者作为常规2组。分别给予3组患者对症治疗,采用新型FeNO设备测定并评估3组患者治疗前后呼吸功能指标和实验室指标变化情况,同时分析一氧化氮和ACOS指标间的相关性。结果病例组残气量/肺总量指标在治疗前后均高于其他2组(P<0.05),常规组间对比,常规2组更高(P<0.05)。病例组治疗后第1秒用力呼气容积占用力肺活量比例及第1秒用力呼气容积占预计值百分比低于其他2组,常规组间对比,常规2组更高(P<0.05)。病例组FeNO、嗜酸性粒细胞(Eosinophilic Granulocyte,EOS)、嗜酸性粒细胞比率、C-反应蛋白、降钙素原与其他2组对比差异明显,而常规组间对比,常规2组指标更高(P<0.05)。通过分析得出,ACOS患者的FeNO、EOS指标间存在正相关性(r=0.757,P<0.05),且敏感度达89.7%,特异性达88.3%。结论经测定ACOS患者FeNO水平相较于哮喘和慢阻肺患者偏高,并且与ACOS患者EOS数量呈正相关,其有效、准确的诊断在某种程度上可反映ACOS的疾病情况和治疗效果,在ACOS治疗效果评估、延续管理等应用上有重要的临床价值。

Objective To investigate the value of new fractional exhaled nitric oxide(FeNO)device in the treatment of asthma-COPD overlap syndrome(ACOS).Methods From January 2020 to December 2021,a total of 100 patients diagnosed with ACOS,asthma and chronic obstructive pulmonary disease(COPD)in our hospital were selected as the research objects respectively,and the ACOS patients were case group,asthma patients were routine group 1,and COPD patients were routine group 2.The changes of respiratory function indexes and laboratory indexes before and after treatment were measured and evaluated by the new FeNO device,and the correlation between nitric oxide and ACOS indexes was analyzed.Results The indexes of residual volume/total lung capacity in the case group were higher than those in the other two groups before and after treatment(P<0.05),and compared between the routine groups,the routine group 2 were higher(P<0.05).The levels of forced expiratory volume in one second/forced vital capacity and forced expiratory volume in one second prediction in the case group were higher than those in the other two groups,and compared between the routine groups,the routine group 2 were higher(P<0.05).The FeNO,eosinophilic granulocyte(EOS),eosinophilic granulocyte ratio,C-reactive protein and procalcitonin in the case group were significant difference from those in the other two groups,and compared between the routine groups,the routine group 2 were higher(P<0.05).According to the analysis,there was a positive correlation between FeNO and EOS indexes in ACOS patients(r=0.757,P<0.05),and the sensitivity was 89.7%,the specificity was 88.3%.Conclusion The level of FeNO in patients with ACOS was higher than that of patients with asthma and COPD,and has a positive correlation with the number of EOS in patients with ACOS.Its effective and accurate diagnosis can reflect the disease situation and treatment effect of ACOS to some extent and it has important clinical value in the evaluation of treatment effect and continuous management of ACOS.