呼出气一氧化氮监测对支气管哮喘的诊断及治疗评估价值研究  

Value of Fractional Exhaled Nitric Oxide in Asthma Diagnosis and Treatment

作　　者：陈凤佳[1] 严英硕[1] 周燕斌[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广东省广州市510080

出　　处：《中国全科医学》2014年第29期3430-3434,共5页Chinese General Practice

基　　金：2012年广东省自然科学基金资助项目(S2010010008393)

摘　　要：目的评估呼出气一氧化氮(FeNO)诊断支气管哮喘的准确性及其对支气管哮喘治疗效果的评估价值。方法连续入选2013年7月—2014年2月广州中山大学附属第一医院呼吸科门诊有咳嗽、气促、胸闷、喘息等临床表现疑似支气管哮喘的患者266例,借助FeNO分析仪进行检查,以传统肺功能检测(支气管激发试验或舒张试验)作为支气管哮喘诊断的金标准,绘制FeNO诊断支气管哮喘的ROC曲线,并确定其最佳截点。将第1秒用力呼气末容积(FEV1)下降20%的激发浓度(PC20)与FeNO进行相关性分析。对确诊支气管哮喘患者给予为期12周的布地奈德(200μg/次,2次/d)吸入治疗,检测治疗前后FeNO及肺功能变化,评估FeNO对支气管哮喘治疗效果的评估价值。结果 266例疑似支气管哮喘患者中最终确诊127例,规范使用治疗药物者35例。支气管哮喘组FeNO水平高于非支气管哮喘组〔(65.66±33.68)μg/L和(29.49±20.56)μg/L,t=7.89,P<0.05〕;激发试验阳性患者FeNO与PC20呈负相关(r=-0.599,P<0.05);FeNO诊断支气管哮喘的ROC曲线下面积为0.861,最佳截点为46.5μg/L;以FeNO为46.5μg/L诊断支气管哮喘的灵敏度为70.1%,特异度为93.9%,阳性预测值为93.2%,阴性预测值为72.7%。治疗12周后FeNO及第1秒用力呼气末容积占预计值百分比(FEV1%)较治疗前改善〔(46.36±23.18)μg/L和(85.12±38.19)μg/L,t=9.45,P<0.05;(84.89±12.68)和(75.46±13.75),t=4.79,P<0.05〕。结论在支气管哮喘初筛或诊断中,FeNO具有较高的灵敏度和特异度,持续监测FeNO有助于支气管哮喘治疗效果的评估和管理。Objective To evaluate the value of fractional exhaled nitric oxide（ FeNO） in diagnosis of asthma and its therapeutic reactions. Methods From July 2013 to February 2014,in Respiratory Medicine of the First Affiliated Hospital of Sun Yet- sen University,266 suspected bronchial asthma（ BA） patients underwent examinations with FeNO analyzer. Taking traditional pulmonary function testing as diagnostic gold standard,we drew ROC curve of FeNO diagnosing BA and determined its cut- off point. The correlation between PC20 stimulated by FEV1 decreasing by 20% and FeNO was analyzed. The diagnosed patients were given budesonide inhalation therapy,200 μg /time,twice /d,12 wk. The changes of FeNO and lung function before and after treatment were detected and the role of FeNO in BA treatment evaluated. Results In 266 suspected BA patients,127 were diagnosed at last,35 took medicine normatively. FeNO level was higher in BA group than in non- BA group 〔（ 65. 66± 33. 68） μg /L vs.（ 29. 49 ± 20. 56） μg /L,t = 7. 89,P 0. 05〕. FeNO was negatively correlated with PC20 in patients with positive provocative test（ r =- 0. 599,P 0. 05）. The area under ROC curve of FeNO diagnosing BA was 0. 861,the best cut- off point was 46. 5 μg /L. The sensitivity of FeNO = 46. 5 μg /L diagnosing BA was 70. 1%,specificity 93. 9%,positive predictive value 93. 2%,negative predictive value 72. 7%. FeNO and FEV1% were better after treatment 〔（ 46. 36 ±23. 18） μg /L vs.（ 85. 12 ± 38. 19） μg /L,t = 9. 45,P 0. 05;（ 84. 89 ± 12. 68） vs.（ 75. 46 ± 13. 75）,t = 4. 79,P 0. 05〕. Conclusion In BA screening and diagnosis,FeNO is of high sensitivity and specificity. Continuous FeNO monitoring contributes to BA＇s evaluation of treatment and management.

关 键 词：一氧化氮 支气管哮喘 诊断 ROC曲线 

分 类 号：R562.25[医药卫生—呼吸系统]