呼出气一氧化氮检测对咳嗽变异性哮喘的诊断价值  

The value of fractional exhaled nitric oxide in the diagnosis of cough variant asthma

作　　者：鲍鲁红[1] 高玮[2] 郭海英[1] 周新[1] 

机构地区：[1]上海交通大学附属第一人民医院呼吸科,200080 [2]上海交通大学附属第一人民医院医务处,200080

出　　处：《国际呼吸杂志》2016年第16期1201-1204,共4页International Journal of Respiration

摘　　要：目的 探讨呼出气一氧化氮（fractional exhaled nitric oxide，FeNO）检测在咳嗽变异性哮喘（cough variant asthma，CVA）诊断中的应用价值。 方法 回顾性研究2015年1月至2015年12月我院呼吸科门诊及住院因慢性咳嗽同时行支气管激发试验（bronchial provocation test，BPT）检查及FeNO检测的患者共989例。以BPH阳性作为诊断CVA的金标准，记录患者病史及FeNO水平；绘制受试者工作特征（ROC）曲线，探讨诊断CVA的FeNO阈值。 结果989例被纳入研究的患者中，120例BPH阳性者诊断为哮喘组，869例BPH阴性者诊断为非哮喘组。哮喘组患者FeNO水平（61.28±41.24）ppb明显高于非哮喘组（25.43±24.87）ppb，p〈0.01。诊断CVA的FeNO阈值为30.00ppb，ROC曲线下面积为0.804，其约登指数为0.5052，灵敏度为72.50%，特异度为78.02%，阳性预测值为31.29%，阴性预测值为95.36%，准确度为77.35%。 结论 FeNO检测诊断CVA具有较高的特异度和阴性预测值，且安全性好，在临床上有较高的诊断价值。Objective To discuss the value of fractional exhaled nitric oxide in the diagnosis of cough variant asthma. Methods Nine hundred and eighty-nine cases of chronic cough from outpatient department and inpatient department from Jan.2015 to Dec.2015 were studied retrospectively. Bronchial provocation test and detection of fractional exhaled nitric oxide were performed in all the patients. Bronchial provocation test was taken as the gold standard and medical histories and data of fractional exhaled nitric oxide of all the patients were recorded. Receiver operating characteristic curve was used to determine the cutoff value of fractional exhaled nitric oxide for diagnosing cough variant asthma. Results One hundred and twenty patients with a positive bronchial provocation test were diagnosed as cough variant asthma while eight hundred and sixty-nine cases of chronic cough with negative results in bronchial provocation test were diagnosed as non-asthma. ①Fractional exhaled nitric oxide levels in asthmatic patients were significantly higher than those in non-asthmatic patients [（61.28±41.24）ppb vs （25.43±24.87）ppb, p〈0.01]. ②Cutoff value of fractional exhaled nitric oxide for diagnosing cough variant asthma was 30.00 ppb, with area under curve of 0.804, Youden＇s index of 0.5052 and sensitivity of 72.50% and specificity of 78.02%. Positive predictive value, negative predictive value and accuracy were 31.29%, 95.36% and 77.35%, respectively. Conclusions Fractional exhaled nitric oxide has a higher specificity and a higher negative predictive value for diagnosing cough variant asthma. Also it is safe and has the value of clinical practical applications.

关 键 词：呼出气一氧化氮 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]