呼出气一氧化氮在哮喘中的临床意义

doi:10.3877/cma.j.issn.1674-6902.2020.03.002

目的

哮喘以慢性气道炎性反应为特征，主要涉及嗜酸性粒细胞的募集和活化。呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)是气道炎症的一个非侵入性标志物。本文探讨了FeNO在哮喘中的临床意义。

方法

我们评估了94例哮喘患者治疗前后的FeNO和肺功能参数及哮喘控制检测(asthma control test, ACT)评分，其中完成1个月随访的有75例，完成3个月随访的有73例，分析了我院哮喘患者控制水平的一些相关因素。

结果

发现诊断时的FEV1%在预测哮喘控制时最具优势，哮喘患者根据ACT评分划分的不同控制状态的FeNO和肺功能参数无明显差异。FeNO和肺功能参数，ACT评分及血IgE，血嗜酸性粒细胞计数之间无明显相关性。FEV1%与ACT评分之前存在正相关(r＝0.04184，P＝0.0492)。无过敏性鼻炎(allergic rhinitis, AR)组，FeNO和ACT评分之间存在负相关(r＝0.2015，P＝0.0128)。3个月治疗后FeNO和ACT评分之间仍无明显相关性。

结论

哮喘患者治疗前后的FeNO可以评估患者的治疗效果，而FeNO并不能预测哮喘的控制状态及恶化风险，FEV1%在预测哮喘控制方面具有临床意义。

关键词: 支气管哮喘, 呼出气一氧化氮, 肺功能, 哮喘控制检测评分, 临床意义

Objective

Asthma is characterized by chronic airway inflammatory responses, mainly involving the recruitment and activation of eosinophils. Exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation. The article aims to explore the clinical role of FeNO in asthma patients.

Methods

We evaluated the FeNO, the pulmonary function parameters and the asthmatic control test (ACT) scores of 94 asthma patients before and after treatment. Among them, 75 patients completed the follow-up visits for one month and 73 patients completed the follow-up visits for three months. We analyzed some related factors of the control level of asthma patients in our hospital.

Results

The percentage of forced expiratory volume in one second (FEV1%) at diagnosis had the most advantage in predicting asthma control, and there was no significant difference in FeNO and pulmonary function parameters of asthma patients according to the ACT scores. There was no significant correlation between FeNO and pulmonary function parameters, ACT scores, IgE and eosinophil count. There was a positive correlation between FEV1% and ACT scores (r=0.04184, P=0.0492). There was a negative correlation between FeNO and ACT scores in the allergic rhinitis (AR) group (r=0.2015, P=0.0128). There was no significant correlation between FeNO and ACT scores after 3 months of treatment.

Conclusion

FeNO before and after treatment can evaluate the therapeutic effect of the patients with asthma, but FeNO cannot predict the control status and the risk of asthma deterioration. FEV1% has more advantages in predicting asthma control.

Key words: Bronchial asthma, Exhaled nitric oxide, Lung functions, Asthmatic control test scores, Clinical significance

图1 A：FeNO，FEV1%，MEF25%+MEF50%的ROC曲线；B：FeNO+FEV1%, FeNO+FEV1%+MEF25%+MEF50%，FEV1%+MEF25%+MEF50%，FeNO+MEF25%+MEF50%的联合ROC曲线

表1 入组时的哮喘患者不同指标ROC曲线

变　量	AUC	P值	95%CI
FeNO	0.474	0.695	0.337～0.611
FEV1%	0.609	0.098	0.479～0.739
MEF25%+MEF50%	0.598	0.138	0.473～0.724
FeNO+FEV1%	0.596	0.145	0.466～0.726
FeNO+FEV1%+MEF25%+MEF50%	0.602	0.123	0.477～0.727
FEV1%+MEF25%+MEF50%	0.594	0.156	0.468～0.720
FeNO+MEF25%+MEF50%	0.606	0.108	0.482～0.730

表1 入组时的哮喘患者不同指标ROC曲线

变　量	AUC	P值	95%CI
FeNO	0.474	0.695	0.337～0.611
FEV1%	0.609	0.098	0.479～0.739
MEF25%+MEF50%	0.598	0.138	0.473～0.724
FeNO+FEV1%	0.596	0.145	0.466～0.726
FeNO+FEV1%+MEF25%+MEF50%	0.602	0.123	0.477～0.727
FEV1%+MEF25%+MEF50%	0.594	0.156	0.468～0.720
FeNO+MEF25%+MEF50%	0.606	0.108	0.482～0.730

表2 不同控制状态的哮喘患者入组时FeNO和肺功能参数的比较

组　别		例数	FeNO	FEV1%	FEV₁/FVC%	MEF25%	MEF50%
未控制组ACT		58	64.95±52.20	88.46±21.27	75.16±14.79	64.17±36.89	70.35±29.24
控制组ACT		36	65.94±52.59	93.69±18.70	78.37±13.18	78.01±42.75	79.35±24.22
	P值		0.9332	0.2330	0.2952	0.1025	0.1253

表2 不同控制状态的哮喘患者入组时FeNO和肺功能参数的比较

组　别		例数	FeNO	FEV1%	FEV₁/FVC%	MEF25%	MEF50%
未控制组ACT		58	64.95±52.20	88.46±21.27	75.16±14.79	64.17±36.89	70.35±29.24
控制组ACT		36	65.94±52.59	93.69±18.70	78.37±13.18	78.01±42.75	79.35±24.22
	P值		0.9332	0.2330	0.2952	0.1025	0.1253

图2 A：入组时的哮喘患者FeNO和ACT的相关性分析；B：入组时的哮喘患者FeNO和IgE的相关性分析；C：入组时的哮喘患者FeNO和嗜酸性粒细胞计数的相关性分析；D：入组时的哮喘患者FeNO和FEV%的相关性分析

图3 A：所有入组时的哮喘患者的ACT和FEV1%的相关性分析；B：入组时的不合并过敏性鼻炎的哮喘患者ACT和FeNO的相关性分析

图4 A：入组时的哮喘患者和完成3个月随访的哮喘患者FeNO的水平比较；B：入组时的哮喘患者和完成1个月及3个月随访的哮喘患者ACT的水平比较

图5 完成3个月随访的哮喘患者ACT与FeNO的相关性分析

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Clinical significance of fractional exhaled nitric oxide in asthma patients

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Clinical significance of fractional exhaled nitric oxide in asthma patients