呼出气一氧化氮检测在非典型支气管哮喘临床诊断中的应用  

Diagnostic value of fractional exhaled nitric oxide in non-typical bronchial asthma

作　　者：蒋雄斌[1] 黄茂[1] 殷凯生[1] 朱毅[1] 

机构地区：[1]南京医科大学第一附属医院呼吸内科,210029

出　　处：《中国医师进修杂志》2012年第31期17-19,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的评价呼出气一氧化氮（FeNO）检测在非典型支气管哮喘诊断中的应用价值。方法纳入有喘息、咳嗽、胸闷等疑似支气管哮喘患者95例。使用一氧化氮（NO）测定仪检测FeNO水平，检测过程严格按照美国胸科协会制定的指南进行。以临床表现和支气管舒张试验为支气管哮喘诊断的金标准，绘制受试者工作特征（ROC）曲线，结合ROC曲线明确FeNO的诊断临界点，以评价FeNO检测对非典型支气管哮喘的诊断价值。结果95例患者中，临床诊断为支气管哮喘44例，非支气管哮喘51例。支气管哮喘患者FeNO水平为（55．2±14．0）nmol／L），明显高于非支气管哮喘患者的（18．9±5．2）nmol/L，差异有统计学意义（P〈0．01）。支气管哮喘患者FeNO水平与第1秒用力呼气容积占预计值百分比元直线相关性（r=-0．162，P〉0．05）。ROC曲线下面积为0．858，最佳临界点为36nmol／L，以该点为阈值，诊断支气管哮喘的敏感度为80．2％，特异度为79．5％，阳性预测值为85．4％，阴性预测值为83．3％，准确度为85．9％。结论FeNO检测对非典型支气管哮喘的诊断具有较高的敏感度和特异度，如结合肺功能检查可提高诊断效率，防止漏诊及误诊。Objective To study the diagnostic value of fractional exhaled nitric oxide （FeNO） in non-typical bronchial asthma. Methods Ninety-five patients with unknown-cause respiratory symptoms including wheezing, cough and breathlessness were enrolled. FeNO was measured by nitric oxide analyzer. The clinical symptoms and bronchial bronchodilator test were defined as golden standard for asthma diagnosis. The diagnostic value of FeNO was assessed and the optimal operating point of FeNO test was determined by means of the receiver operating characteristic （ROC） curve. Results Among 95 patients, 44 cases were diagnosed as asthma, 51 cases were diagnosed as non-asthma. The level of FeNO of asthma patients were higher than that of non-asthma patients [ （55.2 ± 14.0） nmol/L vs. （ 18.9 ± 5.2） nmol/L,P 〈 0.01 ]. A non-linear correlation of FeNO with FEV1% was revealed in the cases with asthma （r = -0.162 ,P 〉 0.05）. Area under ROC curve was 0.858. The optimal diagnostic cut off point was 36 nrnol/L which was capable of differentiating asthma and non-asthma with sensitivity of 80.2% ,specificity of 79.5% ,positive predictive value of 85.4%, negative predictive value of 83.3% and accuracy of 85.9%. Conclusions FeNO test may be helpful in the diagnosis of non-typical asthma with high sensitivity and specificity, which can also improve the diagnostic effectiveness and avoid misdiagnosis,missed diagnosis when combined with lung function test.

关 键 词：哮喘 一氧化氮 诊断 支气管舒张试验 受试者工作特征曲线 

分 类 号：R562.25[医药卫生—呼吸系统]