Diagnostic role of fractional exhaled nitric oxide in pediatric eosinophilic esophagitis, relationship with gastric and duodenal eosinophils

BACKGROUND Eosinophilic esophagitis(EoE)is an eosinophilic-predominant inflammation of the esophagus diagnosed by upper endoscopy and biopsies.A non-invasive and cost-effective alternative for management of EoE is being researched.Previous studies assessing utility of fractional exhaled nitric oxide(FeNO)in EoE were low powered.None investigated the contribution of eosinophilic inflammation of the stomach and duodenum to FeNO.AIM To assess the utility of FeNO as a non-invasive biomarker of esophageal eosinophilic inflammation for monitoring disease activity.METHODS Patients aged 6-21 years undergoing scheduled upper endoscopy with biopsy for suspected EoE were recruited in our observational study.Patients on steroids and with persistent asthma requiring daily controller medication were excluded.FeNO measurements were obtained in duplicate using a chemiluminescence nitric oxide analyzer(NIOX MINO,Aerocrine,Inc.;Stockholm,Sweden)prior to endoscopy.Based on the esophageal peak eosinophil count(PEC)/high power field on biopsy,patients were classified as EoE(PEC≥15)or control(PEC≤14).Mean FeNO levels were correlated with presence or absence of EoE,eosinophil counts on esophageal biopsy,and abnormal downstream eosinophilia in the stomach(PEC≥10)and duodenum(PEC≥20).Wilcoxon rank-sum test,Spearman correlation,and logistic regression were used for analysis.P value<0.05 was considered significant.RESULTS We recruited a total of 134 patients,of which 45 were diagnosed with EoE by histopathology.The median interquartile range FeNO level was 17 parts per billion(11-37,range:7-81)in the EoE group and 12 parts per billion(8-19,range:5-71)in the control group.After adjusting for atopic diseases,EoE patients had significantly higher FeNO levels as compared to patients without EoE(Z=3.33,P<0.001).A weak yet statistically significant positive association was found between the number of esophageal eosinophils and FeNO levels(r=0.30,P<0.005).On subgroup analysis within the EoE cohort,higher FeNO levels were noted in patients with abnormal gastric(n=23,18 vs 15)and duodenal eosinophilia(n=28,21 vs 14);however,the difference was not statistically significant.CONCLUSION After ruling out atopy as possible confounder,we found significantly higher FeNO levels in the EoE cohort than in the control group.

Significance of Fractional Exhaled Nitric Oxide Combined with Serum Procalcitonin and C-Reactive Protein in Evaluation of Elderly Asthma

Bronchial asthma is a common chronic airway inflammatory disease. Asthma is associated with high mortality, especially in the elderly patients. Repeated exacerbations cause disease progression. Therefore, identifying the onset of acute elderly asthma as soon as possible and giving the effective treatment is crucial to improve the prognosis. This study was to investigate the significance of fractional exhaled nitric oxide （FeNO） combined with serum procalcitonin （PCT） and C-reactive protein （CRP） in the evaluation of elderly asthma. A total of 120 elderly patients with an acute attack of asthma from July, 2010 to May, 2012 were studied. On presentation, FeNO, serum PCT and CRP concentrations were measured and sputum culture was also performed. The elderly patients were re-evaluated when they had returned to their stable clinical state. The elderly patients were classified into two groups： positive bac- terial culture group （A） and negative bacterial culture group （B）. The results showed that： （1） In patients with an acute exacerbation of asthma, 48 （40%） patients had positive sputum bacterial culture and 72 （60%） had negative sputum bacterial culture. （2） The levels of FeNO in patients with acute exacerbation of asthma were significantly higher than in those with no acute exacerbation state （63.8±24.6 vs. 19±6.5 ppb, P〈0.05）. There was no significant difference in FeNO between group A and group B （P〉0.05）. （3） The levels of PCT and CRP in group A patients with an acute exacerbation of asthma were significantly higher （P〈0.05） than in group B （for PCT： 27.46±9.32 vs. 7.85±3.52 ng/mL; for CRP： 51.25±11.46 vs. 17.11±5.87 mg/L, respectively）. When they had returned to stable clinical state, the levels of PCT and CRP in group A were decreased significantly （P〈0.05）, and those in group B had no significant change （P〉0.05） when compared with the exacerbation group. There were no significant differences in the levels of PCT and CRP between the two groups in non-acute exacerbation state （/9〉0.05）. These results suggest that the increase in FeNO indicates the acute exacerbation of asthma, and the elevation of serum PCT and CRP levels may be associated with bacterial infection.

Usefulness of Fractional Exhaled Nitric Oxide-Guided Treatment in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap

Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.

Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children

Aim: The goal of this study was to compare asthma treatment guidance based on bronchial hyper-responsiveness to mannitol, spirometry or exhaled nitric oxide (FeNO) in stable asthmatic children. Methods: 60 stable allergic asthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaled corticosteroids (ICS) were recruited to a double blind randomised controlled trial. At study entry (visit 1), the following was assessed: FeNO, spirometry, bronchial hyper-responsiveness to mannitol (MDP-?test), quality of life (paediatric asthma quality-of-life questionnaire;PAQLQ) and asthma control (asthma control test;ACT). Subjects were randomly assigned to one of three groups and treatment was modified by a blinded respiratory physician according to the test results of visit 1: ICS dose was doubled when FeNO was >22 ppb (group 1), in case of a positive MDP-test (group 2) or when FEV1 was <80% of a predicted one (group 3), respectively, or remained unchanged for the remaining subjects. After 3 months (visit 2), the subjects were reassessed and all tests were repeated. Results: 48 children successfully completed the study. At the first visit, 8 out of 16 (50%) children in group 1 showed a FeNO > 22 ppb, 8 children out of 16 (50%) in group 2 showed a positive MDP-test and 3 children out of 16 (18.7%) in group 3 had a FEV1 < 80% of that predicted and had their ICS-dose doubled. In group 1, FeNO decreased significantly after the intervention (p = 0.005), whereas the self-administered and the interviewer-administered PAQLQ (p = 0.02 resp. p = 0.033) as well as the ACT (p = 0.031) increased. Neither the number of children with a positive mannitol challenge nor spirometric results changed significantly. In group 2 and group 3, there were no significant changes in none of the assessed parameters. Conclusion: In this small pragmatic double blind randomised controlled study, we showed that ICS dose modification based on FeNO led to increased quality of life and enhanced asthma control, and to a reduction in airway inflammation and was superior to treatment modifications based on bronchial hyper-responsiveness to mannitol or on FEV1.

Association between endothelial nitric oxide synthase(ENOS) G894T polymorphism and high altitude(HA) adaptation： a meta-analysis

Objective: Highland natives adapt well to the hypoxic environment at high altitude(HA). Several genes have been reported to be linked to HA adaptation. Previous studies showed that the endothelial nitric oxide synthase(ENOS) G894 T polymorphism contributed to the physiology and pathophysiology of humans at HA by regulating the production of NO. In this meta-analysis, we evaluate the association between the ENOS G894 T polymorphism and HA adaptation through analyzing the published data. Methods: We searched all relevant literature about the ENOS G894 T polymorphism and HA adaptation in Pub Med, Medline, and Embase before Step 2015. A random-effects model was applied(Revman 5.0), and study quality was assessed in duplicate. Six studies with 634 HA native cases and 621 low-altitude controls were included in this meta-analysis. Results: From the results, we observed that the wild-type allele G was significantly overrepresented in the HA groups(OR=1.85; 95% CI, 1.47–2.33; P<0.0001). In addition, the GG genotype was significantly associated with HA adaptation(OR=1.99; 95% CI, 1.54–2.57; P<0.0001). Conclusion: Our results showed that in 894 G allele carriers, the GG genotype might be a beneficial factor for HA adaptation through enhancing the level of NO. However, more studies were needed to confirm our findings due to the limited sample size.

FeNO联合TSLP对儿童咳嗽变异性哮喘与感染后咳嗽的鉴别价值及与小气道功能的关系

目的探究呼出气一氧化氮(FeNO)联合胸腺基质淋巴细胞生成素(TSLP)对儿童咳嗽变异性哮喘(CVA)与感染后咳嗽(PIC)的鉴别价值,并分析FeNO、TSLP与CVA病情、小气道功能的关系,为临床诊疗提供有利依据。方法选取2021年6月至2023年4月郑州大学第一附属医院儿科诊治收治的90例CVA患儿作为CVA组,另选取同期90例PIC患儿作为PIC组。比较两组患儿的临床资料和FeNO、TSLP水平,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析FeNO联合TSLP对CVA与PIC的鉴别价值;比较CVA不同病情严重程度和病情阶段患儿的小气道功能[FEF25(%)、FEF50(%)、FEF75(%)、FEF25~75(%)]和FeNO、TSLP水平,采用Spearman和Pearson相关系数法分析FeNO、TSLP与CVA小气道功能、病情阶段、病情严重程度的相关性。结果CVA组患儿的FeNO、TSLP水平明显高于PIC组,差异均有统计学意义(P<0.05);ROC分析结果显示,FeNO联合TSLP鉴别CVA与PIC的AUC最大(0.934),敏感度、特异度为87.78%、82.22%,明显高于各指标单独诊断(P<0.05);轻度组患儿的FEF25、FEF50、FEF75和FEF25~75>中度组>重度组,差异均有统计学意义(P<0.05);轻度组患儿的FeNO、TSLP水平<中度组<重度组,差异均有统计学意义(P<0.05);临床缓解期组患儿的FEF25、FEF50、FEF75、FEF25~75明显高于急性发作期组,FeNO、TSLP水平明显低于急性发作期组,差异均有统计学意义(P<0.05);Pearson相关系数法分析结果显示,FeNO、TSLP与FEF25、FEF50、FEF75、FEF25~75均呈负相关(P<0.05);Spearman相关系数法分析结果显示,FeNO、TSLP与病情阶段、病情严重程度均呈正相关(P<0.05)。结论与PIC患儿比较,CVA患儿FeNO、TSLP水平异常升高,其联合鉴别诊断CVA与PIC具有较高价值,且FeNO、TSLP水平与患儿病情、小气道功能密切相关。

藏族慢性阻塞性肺疾病急性加重期患者伴高FeNO水平的临床预测因素

目的 探讨藏族慢性阻塞性肺疾病急性加重期(AECOPD)患者呼出气一氧化氮(FeNO)水平增高的临床预测因素。方法 回顾性收集2018年6月-2023年2月三六三医院收治的藏族AECOPD患者FeNO水平,及其人口学特征、生活环境、个人史、家族史、肺功能和血检指标。将患者分为高FeNO组(FeNO>25ppb)和低FeNO组(FeNO≤25ppb),行单因素组间比较,选取差异性变量,进一步采用广义倾向性得分加权分析,评价其与FeNO水平的关联程度。结果 共235例藏族AECOPD患者纳入本次研究,其中高FeNO组71例(30.2%),低FeNO组164例(69.8%)。单因素分析提示,与低FeNO组相比,高FeNO组患者生物燃料的使用时间更长(P<0.001)、目前使用生物燃料者的占比更高(P<0.001),外周血嗜酸性粒细胞(EOS)计数更高(P=0.040),C反应蛋白(CRP)水平更低(P=0.045),目前吸烟人数占比更低(P=0.011),居住海拔更低(P=0.016)。广义倾向性得分加权分析进一步显示,高FeNO组患者目前使用生物燃料者的占比更高(P<0.001),外周血EOS计数更高(P=0.032),身高更高(P=0.016),年龄更大(P=0.037);目前吸烟人数占比更低(P=0.001),居住海拔更低(P=0.023)。结论 本研究发现在藏族AECOPD患者中,使用生物燃料、外周血高EOS计数、较高身材、更大年龄,而非目前吸烟和居住高海拔,可能是高FeNO水平的临床预测因素。

FeNO_(50)+CaNO联合检测对慢性阻塞性肺疾病急性加重期激素治疗的应用价值

目的:探讨呼出气流速为50 mL·s^(-1)时呼出气一氧化氮(FeNO_(50))+肺泡呼出气一氧化氮(CaNO)联合检测对慢性阻塞性肺疾病急性加重期(AECOPD)患者使用糖皮质激素治疗的应用价值。方法:前瞻性地纳入2021年6月1日至2023年5月31日在深圳市第二人民医院呼吸与危重症医学科住院的AECOPD患者62例。根据入院时FeNO_(50)、CaNO水平分为4组(Ⅰ组:FeNO_(50)<25 ppb,CaNO≤5 ppb;Ⅱ组:FeNO_(50)≥25 ppb,CaNO≤5 ppb;Ⅲ组:FeNO_(50)<25 ppb,CaNO>5 ppb;Ⅳ组:FeNO_(50)≥25 ppb,CaNO>5 ppb)。对所有患者使用全身糖皮质激素治疗。分别记录入院时及出院时的FeNO_(50)水平、CaNO水平、外周血嗜酸性粒细胞(EOS)、肺功能[第1秒用力呼气容积(FEV1)]、慢性阻塞性肺疾病评估测试(CAT)评分。使用Pearson相关性分析EOS、FeNO_(50)、CaNO三者关系,比较4组间FEV1、CAT评分治疗前后的改善值变化情况;采用受试者工作特征曲线(ROC)分析FeNO_(50)、CaNO、EOS对治疗后肺功能改善的预测价值。结果:各组患者的年龄、性别、身体质量指数(BMI)、吸烟史及平素症状之间比较,差异无统计学意义(P>0.05)。Pearson分析提示入院时EOS与FeNO_(50)呈正相关(r=0.521,P<0.05);经过治疗,EOS改善值与FeNO_(50)改善值呈正相关(r=0.472,P<0.05)。经全身糖皮质激素治疗后,4组间FEV1改善值、CAT评分改善值差异均有统计学意义(P<0.001;P=0.002);Ⅳ组患者较其他三组FEV1改善值更明显,差异有统计学意义(P<0.05),Ⅲ组和Ⅳ组患者较其他两组CAT评分改善更明显,差异有统计学意义(P<0.05)。ROC曲线下面积未观察到EOS、FeNO_(50)、CaNO对AECOPD患者治疗后肺功能显著改善有明显预测价值。结论:FeNO_(50)+CaNO联合检测对AECOPD患者使用全身糖皮质激素疗效具有一定的预测作用,FeNO_(50)与CaNO均升高的患者经全身糖皮质激素治疗后肺功能的改善更明显,而CANO升高的患者治疗后症状的改善更明显,但有待扩大样本量进一步验证。

Dexamethasone, tetrahydrobiopterin and uncoupling of endothelial nitric oxide synthase

Objective To find out whether dexamethasone induces an uncoupling of the endothelial nitric oxide synthase （eNOS）. Methods ＆ Results A major cause of eNOS uncoupling is a deficiency of its cofactor tetrahydrobiopterin （BH4）. Treatment of human EA.hy 926 endothelial cells with dexamethasone decreased mRNA and protein expression of both BH4-synthesizing enzymes： GTP cyclobydrolase I and dihydrofolate reductase. Consistently, a concentration- and time-dependent reduction of BH4, dihydrobiopterin （BH2） as well as BH4：BH2 ratio was observed in dexamethasone-treated cells. Surprisingly, no evidence for eNOS uncoupling was found. We then analyzed the expression and phosphorylation of the eNOS enzyme. Dexamethasone treatment led to a down-regulation of eNOS protein and a reduction of eNOS phosphorylation at serine 1177. A reduction of eNOS expression may lead to a relatively normal BH4： eNOS molar ratio in dexamethasone-treated cells. Because the BH4-eNOS stoichiometry rather than the absolute BH4 amount is the key determinant of eNOS functionality （i.e., coupled or uncoupled）, the down-regulation of eNOS may represent an explanation for the absence of eNOS uncoupling. Phosphorylation of eNOS at serine 1177 is needed for both the NO-producing activity of the coupled eNOS and the superoxide-producing activity of the uncoupled eNOS. Thus, a reduction of serine 1177 phosphorylation may render a potentially uncoupled eNOS hardly detectable. Conclusions Although dexamethasone reduces BH4 levels in endothelial cells, eNOS uncoupling is not evident. The reduction of NO production in dexamethasone-treated endothelial cells is mainly attributable to reduced eNOS expression and decreased eNOS phosphorylation at serine 1177.

Age dependent expression and distribution of nitric oxide (NO) synthase isoforms in the ovine kidney

The aim of the present study was to measure intrarenal spatial and temporal localization of all three nitric oxide synthase (NOS) isoforms in the developing ovine kidney. Reverse transcriptase-polymerase chain reaction (RT-PCR), Western Blot analyses, and in situ hybridization techniques were performed for NOS I -III isoforms in renal tissue obtained from sheep aged ~24 h, one, three, six, and 12 weeks post natally (N = 3). RT-PCR performed on cortical and medullary kidney tissue revealed the presence of all three NOS isoforms from day one to 12 weeks postnatally. NOS I and NOS II mRNA levels were greater in cortex compared to medulla during the first three weeks whereas NOS III mRNA levels were predominantly transcribed within the medulla. In all NOS isoforms, there was a decrease in cortical mRNA levels after three to six weeks. Protein levels confirmed the presence of all three NOS isoforms over the first three months of postnatal life. By demonstrating NOS isoform transcripts to be more abundant in the early post natal period, these findings may provide insight into the age dependent role of NO in modulating kidney function during ontogeny.

An Improved Assay for Measuring Low Levels of Nitric Oxide in Cultured Pulmonary Myofibroblasts

Quantification of nitric oxide (NO) from cultured cells is a valuable tool for studying cell signaling. Detection of NO in biological fluids can be difficult however, due to its transient half-life and low physiological concentrations. In this study, we have refined an existing amperometric method to determine relative levels of accumulated nitrogen oxides (NOX) in cell culture and have used this method to reproducibly quantify NO from cultured pulmonary myofibroblasts. Basal levels of NO produced by pulmonary myofibroblasts ranged from 0.6 nM to 20 nM and varied due to the growth conditions of the cells, i.e. higher NO concentrations were observed in differentiated cells. The constitutive eNOS isoform is primarily responsible for the observed NO accumulation in these cells since transcript levels of eNOS are 10-fold higher than the inducible iNOS form while nNOS was undetectable. Treatment of myofibroblasts with the inhibitors L-NNA and L-NAME resulted in a concentration dependent decrease in measured NOx. Overall, the improved assay presented here should be applicable to measuring NOX levels from many different cell types and under a wide variety of conditions.

临床控制哮喘与咳嗽变异性哮喘的小气道功能及FeNO变化差异分析

目的:探究临床控制哮喘(CCA)与咳嗽变异性哮喘(CVA)的小气道功能及呼出气一氧化氮(FeNO)变化差异,并分析各指标对CCA与CVA的鉴别诊断价值。方法:选取2021年1月—2023年12月厦门市海沧医院的51例CCA与51例CVA患者的病历资料进行回顾性分析,比较两组肺通气功能指标[用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气量占预计值百分比(FEV1%pred)、呼气峰值流量占预计值百分比(PEF%pred)]、小气道功能指标[中段呼气流量占预计值百分比(FEF_(25%~75%)%pred)、75%和50%用力肺活量时的呼吸流速占预计值百分比(FEF_(75%)%pred和FEF_(50%)%pred)]及FeNO,采用Pearson相关性分析各组FeNO与气道功能指标的关系,采用受试者操作特征(ROC)曲线分析FeNO与小气道功能指标对CVA的诊断价值。结果:与CCA组比较,CVA组FEV_(1)%pred、PEF%pred、FEF_(25%~75%)%pred、FEF_(50%)%pred、FEF_(75%)%pred均较低,FeNO指标较高,差异均有统计学意义(P<0.05)。Pearson相关性结果显示,CCA组与CVA组气道功能指标与FeNO指标均呈负相关(P<0.05)。ROC曲线结果显示,FEF_(25%~75%)%pred、FEF_(50%)%pred、FEF_(75%)%pred和FeNO诊断CVA的AUC分别为0.824、0.836、0.790、0.793,均有一定的诊断价值(P<0.001),但各指标之间AUC值比较差异均无统计学意义(P>0.05)。结论:相较于CCA患者,CVA患者的小气道功能较差,FeNO较高,且FEF_(25%~75%)%pred、FEF_(50%)%pred、FEF_(75%)%pred和FeNO对CVA有一定的诊断价值。

支气管哮喘患儿病情评估中呼出气FeNO与血清总IgE检测的意义

目的探讨呼出气一氧化氮(FeNO)、血清总免疫球蛋白E(IgE)水平检测用于支气管哮喘患儿病情评估中的价值研究。方法回顾性分析本院2022年2月至2023年10月收治的90例支气管哮喘患儿,对患儿近4周的症状控制情况进行评估、分组,分别为A组(控制良好组,n=30)、B组(部分控制组,n=30)、C组(未控制组,n=30),另遵循均衡原则选取30名同期健康体检小儿,设为D组(健康人群组,n=30),均行FeNO、血清总IgE水平检测,并对比水平差异及阴性检测率,分析各指标与支气管哮喘病情发展的相关性。结果经对比,D组FeNO、IgE水平均低于A、B、C三组,P<0.05;B、C组FeNO、IgE水平均高于A组,P<0.05;C组FeNO、IgE水平均高于A、B、D三组,P<0.05;D组FeNO、IgE水平检测阳性率均低于A、B、C三组,P<0.05;A、B组FeNO、IgE水平检测均低于C组,P<0.05;FeNO、IgE水平均与支气管哮喘病情控制水平呈负相关,二者指标越高,则代表支气管哮喘病情控制水平越差(r=-0.629、-0.528,P<0.05)。结论FeNO、IgE水平检测用于支气管哮喘患儿病情评估中有一定应用价值,两组指标水平愈高,表明患者病情控制效果愈差。

反复呼吸道感染患儿FeNO水平与肺功能、Th1/Th2平衡的关系

目的 分析反复呼吸道感染患儿呼出气一氧化氮(FeNO)水平与肺功能、辅助性T细胞1(Th1)/辅助性T细胞2(Th2)(Th1/Th2)平衡的关系。方法 选择2021年10月至2023年10月宣城市中心医院收治的83例反复呼吸道感染患儿作为研究组,另选同期普通呼吸道感染住院患儿95例作为对照组。所有纳入对象入院后24 h内检测FeNO水平及肺功能指标第一秒用力呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)、峰值呼气流量(PEF),同时利用流式细胞仪检测Th1、Th2细胞水平,并计算Th1/Th2比值,采用酶联免疫吸附法检测血清γ-干扰素(IFN-γ)、白细胞介素-4(L-4),并进行组间比较。采用Pearson相关性分析反复呼吸道感染患儿FeNO水平与FEV1%、FEV1/FVC、PEF%、Th1/Th2,以及IFN-γ、IL-4与FeNO、FEV1、FEV1/FVC、PEF、Th1/Th2的关系。结果 研究组患儿FeNO水平明显高于对照组,差异有统计学意义(P<0.05)。研究组患儿FEV1、FEV1/FVC、PEF均明显低于对照组,差异有统计学意义(P<0.05)。研究组患儿外周血Th2细胞水平明显高于对照组,差异有统计学意义(P<0.05)。研究组患儿外周血Th1细胞水平、Th1/Th2均明显低于对照组,差异有统计学意义(P<0.05)。研究组患儿血清IFN-γ、IL-4水平均明显高于对照组,差异有统计学意义(P<0.05)。相关性分析显示,反复呼吸道感染患儿FeNO水平与FEV1、FEV1/FVC、PEF及Th1/Th2均呈负相关(均P<0.05)。血清IFN-γ、IL-4与FeNO水平均呈正相关(均P<0.05),与FEV1、FEV1/FVC、PEF及Th1/Th2均呈负相关(均P<0.05)。结论 反复呼吸道感染患儿FeNO水平明显升高,且高FeNO水平与肺功能降低、Th1/Th2免疫失衡密切相关,其之间的相互作用共同影响反复呼吸道感染患儿疾病发生发展。

血清ORMDL3结合FeNO对哮喘稳定期急性发作的预测分析

目的 分析血清类黏蛋白1样蛋白3(ORMDL3)结合呼出气一氧化氮(FeNO)对哮喘稳定期急性发作的预测价值。方法 选择2018年7月—2023年8月在本院门诊随访的120例哮喘稳定期患者作为疾病组,另同期选取120名健康体检者作为对照组,检测两组ORMDL3 mRNA表达量和FeNO浓度。依据疾病组3个月内是否出现哮喘急性发作将其分为急性发作组和非急性发作组,比较两组患者ORMDL3 mRNA表达量和FeNO浓度,采用多因素Logistic回归分析哮喘稳定期急性发作的影响因素,采用受试者工作特征(ROC)曲线分析ORMDL3 mRNA、FeNO单项及联合对哮喘稳定期急性发作的预测价值。结果 疾病组ORMDL3 mRNA表达量、FeNO浓度均高于对照组(P<0.05);急性发作组ORMDL3 mRNA表达量、FeNO浓度、体质量指数(BMI)以及吸烟史占比均高于非急性发作组(P<0.05),淋巴细胞计数、用力肺活量占预计值百分比(FVC%)、第一秒用力呼气末容积占预计值百分比(FEV1%)低于非急性发作组(P<0.05);经多因素Logistic回归分析显示,高ORMDL3 mRNA、高FeNO、高BMI均为哮喘稳定期患者急性发作的危险因素(P<0.05),高FVC%、高FEVI%为其保护因素(P<0.05)。ORMDL3 mRNA、FeNO联合预测哮喘稳定期患者急性发作的灵敏度高于单独预测,联合预测的AUC高于单独预测(P<0.05),联合预测的特异度与单独预测相近。结论 ORMDL3、FeNO均在哮喘稳定期急性发作患者中存在异常高表达,均是哮喘稳定期急性发作的影响因素,且两者联合对哮喘稳定期急性发作具有较好的预测价值。

慢阻肺患者外周血EOS与FeNO水平及肺功能的相关性分析

目的对慢性阻塞性肺疾病(慢阻肺)患者外周血嗜酸性粒细胞(EOS)与呼出气一氧化氮(FeNO)水平及肺功能的相关性进行分析。方法选取2019年10月至2023年6月徐州市第一人民医院收治的200例慢阻肺患者作为研究对象,并设为观察组。其中男138例,女62例;年龄55~88(66.45±5.45)岁;病程1~18(10.23±3.23)年。根据疾病分期,将观察组患者分为急性发作组(150例)和稳定期组(50例)。另选取同期住院的100例非慢阻肺患者作为对照组。收集300例受试者的一般资料,如吸烟史、饮酒史、基础疾病及体重指数(BMI)等。采用全自动血细胞分析仪检测EOS水平,采用FeNO检测仪检测FeNO水平,采用肺功能检测仪检测肺功能。采用Pearson相关分析法分析慢阻肺患者外周血EOS与FeNO水平及肺功能的相关性。采用独立样本t检验、F检验和χ^(2)检验。结果观察组吸烟史人数占比[52.50%(105/200)]高于对照组[17.00%(17/100)](P<0.05)。稳定期组和急性发作组外周血EOS[(6.23±0.21)%、(6.42±0.58)%]与FeNO[(35.52±7.28)ppb、(46.28±7.08)ppb]水平均高于对照组[(2.23±0.59)%、(15.23±7.34)ppb],且急性发作组FeNO水平高于稳定期组(均P<0.05)。稳定期组和急性发作组用力肺活量(FVC)[(2.18±0.18)L、(2.16±0.15)L]、第1秒用力呼气容积(FEV1)[(1.16±0.31)L、(1.14±0.28)L]、FEV1/FVC[(60.56±8.24)%、(59.23±8.21)%]及FEV1%[(65.23±8.59)%、(64.11±8.12)%]均低于对照组[(3.16±0.38)L、(2.21±0.41)L、(82.28±9.16)%、(89.62±5.23)%](均P<0.05)。Pearson相关性分析显示,慢阻肺患者外周血EOS水平与FeNO水平呈正相关(r=0.584,P=0.002),与FEV1/FVC呈负相关(r=-0.213,P=0.005)。结论慢阻肺患者外周血EOS与FeNO水平及肺功能存在明显相关性,临床可根据其水平变化来判断患者病情,并为后期治疗提供一定的指导。

哮喘患儿血清MP-IgM抗体与潮气肺功能和FeNO水平的相关性研究

目的探讨哮喘患儿血清肺炎支原体IgM(MP-IgM)抗体与潮气肺功能、呼出气一氧化氮(FeNO)水平的相关性。方法选取2020年9月~2021年12月在重庆市永川区妇幼保健院儿科住院并确诊为哮喘的患儿100例,分别在急性发作期和缓解期检测患儿血清MP-IgM抗体、潮气肺功能指标和FeNO,对比不同时期MP-IgM抗体阳性率,分析血清MP-IgM抗体与潮气肺功能指标和FeNO水平间的相关性。结果急性发作期MP-IgM抗体阳性率为37%,显著高于缓解期的18.0%(P<0.05)。在急性发作期,MP-IgM抗体阳性患儿的达峰时间比(TPTEF/TE)和达峰容量比(VPEF/VE)显著低于MP-IgM抗体阴性组(P<0.05);MP-IgM抗体阳性组的FeNO水平高于MP-IgM抗体阴性组(P<0.05)。在缓解期,MP-IgM抗体阳性患儿FeNO水平显著高于MP-IgM抗体阴性组(P<0.05),而TPTEF/TE、VPEF/VE在MP-IgM抗体阳性组和阴性组的差异无统计学意义(P>0.05)。相关性分析显示,在急性发作期,患儿的TPTEF/TE与MP-IgM抗体阳性呈负相关(r=-0.250,P=0.012)。在缓解期,患儿的FeNO与MP-IgM抗体阳性呈正相关(r=0.410,P=0.000)。结论肺炎支原体感染与哮喘急性发作和气道炎症控制不良相关,对于优化现有的临床评估方案具有一定的临床意义。

COPD稳定期患者血清Fbg、IgE及FeNO水平变化及其与疾病严重程度与肺功能的关系分析

目的:探讨慢性阻塞性肺疾病(CDPD)稳定期患者血清纤维蛋白原(Fbg)、免疫球蛋白E(IgE)及呼出气一氧化氮(FENO)水平变化,分析其与疾病严重程度与肺功能的关系。方法:选取本院2020年8月-2023年11月60例COPD稳定期患者纳入COPD组(轻度23例、中度22例、重度15例),另选60例健康体检者作为对照组,检测两组肺功能指标第1秒用力呼气容积实测与预计值比值(FEV1%)、呼气峰流速(PEF)、最大呼气中段流量(MMF)水平,对比两组血清Fbg、IgE水平及FeNO水平差异,采用Spearman相关性分析其与疾病严重程度的关系,通过Pearson相关性分析COPD组患者肺功能指标与血清Fbg、IgE水平及FeNO水平的相关性。结果:COPD组肺功能指标FEV1%、MMF、PEF水平低于对照组(P<0.05);COPD组血清Fbg、IgE及FeNO水平高于对照组(P<0.05);重度患者血清Fbg、IgE及FeNO水平均高于中度组,中度组高于轻度组(P<0.05);Spearman相关性分析结果显示Fbg、IgE及FeNO水平分别与疾病严重程度呈现正相关(P<0.05);Pearson相关性分析结果显示Fbg、IgE及FeNO水平分别与肺功能指标FEV1%、MMF、PEF水平呈现负相关(P<0.05)。结论:COPD稳定期患者血清Fbg、IgE呈现高表达,FeNO水平升高,且其水平可在一定程度上反映患者疾病严重程度和肺功能水平。

FeNO与Eos对AECOPD患者糖皮质激素反应性及预后的评估价值研究

目的探究呼出气一氧化氮(FeNO)和嗜酸性粒细胞(Eos)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的预后影响,并对糖皮质激素给药的指导价值。方法选取2017年1月—2021年12月首都医科大学附属北京潞河医院呼吸内科收治的279例AECOPD患者,根据入院时测定的FeNO、Eos水平,将患者分为高FeNO组(n=103)与低FeNO组(n=176),Eos组(n=95)和非Eos组(n=184)。比较每组患者激素反应性。根据患者住院期间不同预后分为死亡组(36例)与生存组(243例),以多因素Logistic回归分析模型确定AECOPD患者的死亡因素,并以受试者工作特征曲线(ROC)对其预后效能检测。结果高FeNO组肺部及全身激素的使用率、激素总量低于低FeNO组(P<0.05),激素疗程、住院时间短于低FeNO组(P<0.05);Eos组肺部及全身激素的使用率、激素总量低于非Eos组(P<0.05),且激素疗程、住院时间短于非Eos组(P<0.05);死亡组吸烟患者占比、加重频次、超敏C反应蛋白(hs-CRP)、中性粒细胞的绝对值(NE绝对值)均高于生存组,高FeNO、Eos%≥2%低于生存组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,加重频次、高hs-CRP水平、高FeNO、Eos%≥2%均是导致患者死亡的危险因素(P<0.05);ROC曲线分析显示,高FeNO、Eos%≥2%及二者联合预测AECOPD患者住院期间死亡的AUC(95%CI)分别为0.738(0.682~0.789)、0.766(0.712~0.815)、0.876(0.831~0.912),二者联合预测效能高于单项检测。结论高FeNO、Eos水平与AECOPD患者的预后密切相关,二者联合检测有助于对AECOPD患者的病情判断,可更好的指导糖皮质激素的应用。

参术定喘汤联合布地奈德福莫特罗对支气管哮喘慢性持续期患者中医证候、肺功能、FeNO、TIgE的影响及疗效观察

目的分析参术定喘汤联合布地奈德福莫特罗对支气管哮喘慢性持续期患者中医证候、肺功能、呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)、血清总免疫球蛋白E(total immunoglobulin E,TIgE)的影响及疗效观察。方法选取2021年8月至2022年5月温州市中医院收治的支气管哮喘慢性持续期患者60例,采用随机数字表法分为对照组(n=30)和试验组(n=30)。对照组给予布地奈德福莫特罗,试验组给予参术定喘汤联合布地奈德福莫特罗治疗。评估两组中医证候评分水平,采用肺功能测定仪检测第一秒用力呼气容积(forced expiratory volume in one second,FEV1)、用力肺活量(forced vital capacity,FVC)、一秒率(forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用双抗体夹心酶联免疫吸附法检测TIgE水平,呼气分析仪检测FeNO水平。结果治疗后,试验组中医证候评分水平、Fe NO、TIgE均低于对照组,差异有统计学意义(P<0.05);FEV1、FVC、FEV1/FVC水平均高于对照组,差异有统计学意义(P<0.05)。试验组总有效率高于对照组,差异有统计学意义(P<0.05)。结论对支气管哮喘慢性持续期患者采用参术定喘汤进行治疗,能够显著降低中医证候水平、改善患者肺功能、下调Fe NO、TIgE水平,临床治疗效果显著。