IgE介导的支气管哮喘患者呼出气一氧化氮水平与肺功能的相关性分析

Correlation between level of fractional exhaled nitric oxide and lung function in patients with IgE-mediated bronchial asthma

目的探讨免疫球蛋白E(IgE)介导的支气管哮喘患者呼出气一氧化氮(FeNO)水平与肺功能的相关性。方法抽取2019年1月至2020年12月于河南省人民医院住院的哮喘急性发作患者77例,按照血清总IgE结果分为IgE介导组(51例)及非IgE介导组(26例),检测两组FeNO、血清嗜酸性粒细胞水平、中性粒细胞水平及支气管舒张试验前后肺通气功能指标,采用Spearman检验对FeNO与血清嗜酸性粒细胞、中性粒细胞、肺功能各项指标行相关性分析。结果IgE介导组FeNO水平、血清嗜酸性粒细胞计数、嗜酸性粒细胞百分比高于非IgE介导组(P<0.05);IgE介导组存在小气道功能障碍,且住院时间长于非IgE介导组(P<0.05)。哮喘患者血清总IgE水平与血清嗜酸性粒细胞计数及百分比、FeNO呈正相关(r=0.66、0.62、0.37,P均<0.05)。IgE介导组FeNO水平与血清嗜酸性粒细胞水平呈正相关(P<0.05),FeNO水平与肺功能指标及支气管舒张试验用药前后第1秒末用力呼气量的改变量、第1秒末用力呼气量占预计值百分比的改变量及气道舒张反应改善率未见相关性(P>0.05),非IgE介导组FeNO与上述指标均未见相关性(P均>0.05)。结论IgE介导的哮喘患者气道炎症水平明显增高,且易存在小气道功能障碍,可能与IgE诱导嗜酸性粒细胞活性增加、FeNO的产生增多、气道炎症水平升高有关,需在疾病早期控制患者气道炎症水平,避免肺功能进一步下降,但FeNO对于间接反映气道可逆性的价值较有限。

Objective To investigate the correlation between the level of fractional exhaled nitric oxide(FeNO)and lung function in patients with immunoglobulin E(IgE)-mediated bronchial asthma.Methods Seventy-seven patients with acute asthma attack who were hospitalized in Henan Provincial People’s Hospital from January 2019 to December 2020 were selected,and the patients were divided into IgE-mediated group(51 cases)and non-IgE-mediated group(26 cases)according to the results of serum total IgE.FeNO,serum eosinophil level,neutrophil level and pulmonary ventilation function indexes before and after bronchodilation test in the two groups were detected.Spearman test was used to analyze the correlation of FeNO with serum eosinophils,neutrophils,and lung function indexes.Results The level of FeNO,serum eosinophil count and percentage of eosinophils in the IgE-mediated group were higher than those in the non-IgE-mediated group(P<0.05).The IgE-mediated group had small airway dysfunction,and the hospitalization time of the IgE-mediated group was longer than that of the non-IgE-mediated group(P<0.05).The total serum IgE level in asthmatic patients was positively correlated with the count and percentage of serum eosinophils and FeNO(r=0.66,0.62,0.37;all P<0.05).The level of FeNO in the IgE-mediated group was positively correlated with the level of serum eosinophil(P<0.05).The level of FeNO had no relationship with the changes in the forced expiratory volume at the end of the first second,and had no relationship with changes and improvement rate of bronchodilator reversibility of percentage of forced expiratory volume at the end of the first second before and after bronchodilation test in the IgE-mediated group(P>0.05);there was no correlation between FeNO and the above indicators in the non-IgE-mediated group(P>0.05).Conclusions The level of airway inflammation in the IgE-mediated asthma patients is significantly increased,and small airway dysfunction is prone to occur,which may be related to the increase in eosinophil activity induced by IgE,FeNO production,and airway inflammation.It is necessary to control the level of airway inflammation in patients in the early stage of the disease to avoid further decline in lung function,but the value of FeNO in indirectly reflecting the reversibility of the airway is limited.