呼出气一氧化氮增高可预测亚急性咳嗽患者吸入激素治疗的反应性  

High fractional exhaled nitric oxide may predict response to inhaled corticosteroid therapy in patients with subacute cough

作　　者：叶艳梅[1] 王燕红[1] 倪丽[1] 梁健鹏[1] 郁伟伟[1] 吴月仙[1] 赵文驱 熊婧[1] 姚利红[1] 蔡绍曦[1] 赵海金[1] 

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科,慢性气道疾病实验室,广东广州510515

出　　处：《南方医科大学学报》2016年第7期932-935,共4页Journal of Southern Medical University

基　　金：国家自然科学基金(81270089;81470228);广东省自然科学基金(2015A030313236);广东省科技计划项目(2016A020215117);南方医院院长基金(2013C028)~~

摘　　要：目的评估亚急性咳嗽患者呼出气一氧化氮（FENO）表达水平及其指导吸入糖皮质激素（ICS）治疗的作用。方法收集门诊2015年2~10月超过3周主诉为咳嗽的病人100例,包括亚急性咳嗽52例,慢性咳嗽48例,排除肺部感染,3~8周之间的咳嗽定义亚急性咳嗽,超过8周定义慢性咳嗽。评估病人症状、FENO值、肺量计以及治疗反应性。结果以中位数（四分位数）判断,所有纳入对象的FENO值为19（12~30）ppb;亚急性咳嗽为16（9.5~29.8）ppb,慢性咳嗽为20.5（15.0~33.0）ppb,两者具有显著差别（Z=-2.245,P=0.025）;其中亚急性咳嗽有15例（28.8%）的FENO≥25 ppb,慢性咳嗽20例（41.6%）,两者占比无显著差异（χ^2=1.801,P=0.179）。以FENO≥25 ppb作为ICS治疗的临界值,35名患者中31人2周后咳嗽明显缓解,4人对ICS反应不佳。亚急性咳嗽（14/15,93.3%）和慢性咳嗽组（17/20,85.0%）ICS治疗反应良好,两者未见统计学差异（χ^2=0.588,P=0.443）。亚急性咳嗽组中,咳嗽变异性哮喘或嗜酸性粒细胞支气管炎组的FENO水平高于感染后咳嗽组。在病因分析中,咳嗽变异性哮喘或嗜酸性粒细胞支气管炎在亚急性咳嗽和慢性咳嗽中分别为23例（44.2%）和21例（43.8%）,两者无显著差异（χ^2=0.002,P=0.961）。结论FENO可能成为亚急性咳嗽病因分析及ICS治疗反应性判断的重要标志。Objective To evaluate fractional exhaled nitric oxide（FENO） level in patients with subacute cough and its value in predicting the patients＇ response to inhaled corticosteroids（ICS） treatment.Methods A total of 100 patients with persistent cough lasting more than 3 weeks were enrolled,including 52 patients with subacute cough and 48 with chronic cough.FENO,spirometry,and responses to ICS therapy of the patients were evaluated.Results The recruited patients had a median（interquartile ranges） FENO level of 19 ppb（12-30 ppb）.Patients with chronic cough had a significantly higher median FENO level than those with subacute cough（20.5 vs 16 ppb; Z=-2.245,P=0.025）.A FENO level ≥25 ppb was recorded in 15（28.8%） patients with subacute cough,as compared with 20（41.6%） in patients with chronic cough（χ2=1.801,P=0.179）.With a FENO ≥25 ppb as the critical value to justify ICS treatment,15 patients with subacute cough received ICS and 14（93.3%） of them showed obvious relief of cough after 2 weeks of therapy,a response rate similar to that of 85.0%（17/20） in patients with chronic cough receiving the treatment（χ2=0.588,P=0.443）.In patients with subacute cough,those with cough variant asthma（CVA） or eosinophilic bronchitis（EB） had a significantly higher median FENO level than those with postinfectious cough [（16（11-31）ppb vs 11（8-19） ppb,P〈0.01].In the etiological analysis,CVA or EB was identified in 23（44.2%） of the patients with subacute cough,as compared 21（43.8%） in patients with chronic cough（χ2=0.002,P=0.961）.Conclusion FENO may be an important indicator for etiological diagnosis of subacute cough and for predicting the response to ICS treatment.

关 键 词：呼出气一氧化氮 亚急性咳嗽 慢性咳嗽 咳嗽变异性哮喘 激素反应性 

分 类 号：R56[医药卫生—呼吸系统]