呼出气一氧化氮联合相关因素对咳嗽变异性哮喘的诊断价值评价  

Exhaled nitric oxide combined with relevant factors in the diagnosis of cough variant asthma

作　　者：倪瑾华[1] 程齐俭[1] 冯耘[1] 曹蓓[1] 陈聆[1] 万欢英[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸科,上海200025

出　　处：《诊断学理论与实践》2014年第6期606-609,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的 :评价呼出气一氧化氮(Fe NO)检测单独或联合咳嗽变异性哮喘(cough variant asthma,CVA)相关因素对诊断CVA的有效性和准确性。方法:连续纳入2010年8月至2011年10月本院呼吸科门诊因慢性咳嗽行支气管激发试验检查的患者297例,记录病史并测定呼出气Fe NO水平,以支气管激发试验阳性作为CVA诊断的金标准,绘制ROC曲线,探讨诊断CVA的Fe NO临界点。建立Logisitic回归模型,通过分析筛选与CVA相关的因素,根据ROC曲线评价Fe NO联合其他相关因素对CVA的诊断价值。结果:145例患者支气管激发试验阳性并排除其他疾病被诊断为CVA(哮喘组),152例支气管激发试验阴性患者诊断为非哮喘的慢性咳嗽(非哮喘组)。1哮喘组患者Fe NO水平明显高于非哮喘组[(45.33±38.86)ppb比(26.28±23.86)ppb,P<0.05]。2诊断CVA的Fe NO最佳临界点为36.6 ppb,受试者工作特征曲线下面积为0.618,其约登指数为0.195,灵敏度为40.7%,特异度为78.8%。支气管激发阳性者中Fe NO大于36.6 ppb占37.24%,阴性者中Fe NO大于36.6 ppb占19.73%;3并发鼻炎、过敏史和Fe NO升高与咳嗽变异性哮喘相关(OR=4.334、4.165、2.292,P<0.05)。鼻炎、过敏史及Fe NO检测联合诊断CVA的灵敏度为67.6%,特异度为65.5%。结论:Fe NO检测对CVA的诊断具有较高的特异度,但灵敏度低;联合鼻炎和过敏史后,诊断的灵敏度升高。Objective： To evaluate the validity and accuracy of fractional exhaled nitric oxide （FeNO） alone or in combination with relevant factors for the diagnosis of cough variant asthma （CVA）. Methods： Two hundred and ninety- seven cases of chronic cough from outpatient department were enrolled. Bronchial provocation test and detection of FeNO were performed in consecutive patients, and medical history was recorded. Bronchial histamine provocation test was taken as the gold standard, ROC curve was used to determine the cutoff value of FeNO for diagnosing CVA. Logistic regression model was established, and through the construction of predicted probability analysis of indicators, the diagnostic value of FeNO alone and in combination with symptoms and history of CVA was evaluated by the ROC curve. Results： One hun- dred and forty-five patients with a positive bronchial provocation test were diagnosed as cough variant asthma after exclu- sion of other diseases. One hundred and fifty-two cases of chronic cough with negative result in provocation test were dia- gnosed as non-asthma. ① FeNO levels in asthmatic patients were significantly higher than that in non-asthma group [（45.33±38.86） ppb vs （26.28±23.86） ppb, P〈0.05]. ② Cutoff value of FeNO for diagnosing of CVA was 36.6 ppb, with AUC of 0.618 , Youden index of 0.195 and sensitivity of 40.7%, specificity of 78.8%. In patients with positive bronchial provocation, 37.24% had FeNO level greater than 36.6 ppb. In the others with negative bronchial provocation, 19.73% had FeNO level greater than 36.6ppb; ③ Concurrent rhinitis, allergy and high FeNO were associated with cough variant asthma（OR=4.334, 4.165, 2.292, P〈0.05）. For diagnosing CAV, high FeNO combined with rhinitis and allergy showed a sensitivity of 67.6% and specificity of 65.5%. Conclusions： For diagnosing cough variant asthma, FeNO alone has a high specificity but low sensitivity, when combined with rhinitis and history of allergy, the sensitivity of FeNO for CVA is in-creas

关 键 词：呼出气一氧化氮(Fe NO) 咳嗽变异性哮喘 支气管激发试验 

分 类 号：R562.25[医药卫生—呼吸系统]