呼出气一氧化氮与血嗜酸性粒细胞评估COPD糖皮质激素治疗的有效性研究  

Value of exhaled nitric oxide and eosinophils in evaluating the therapeutic effect of inhaled corticosteroids for COPD patients

作　　者：黄晓丽 陈倩[1] 黄小芳[1] HUANG Xiaoli;CHEN Qian;HUANG Xiaofang(Department of Respiratory Medicine,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China)

机构地区：[1]杭州市中医院呼吸内科

出　　处：《全科医学临床与教育》2019年第10期882-884,893,共4页Clinical Education of General Practice

摘　　要：目的探讨呼出气一氧化氮(FENO)及血嗜酸性粒细胞(EOS)测定对指导慢性阻塞性肺疾病(COPD)患者合理吸入型糖皮质激素(ICS)治疗的临床价值。方法回顾性选取120例稳定期COPD患者作为观察组,将ICS治疗4周后治疗有效的患者列为A组(78例)、治疗无效的患者列为B组(42例),另选取54例正常健康志愿者为对照组,比较各组对象的FENO、EOS水平,采用ROC曲线评价FENO、EOS值对COPD患者ICS治疗效果的预测价值。结果观察组治疗前FENO、EOS值均明显高于对照组,治疗后观察组FENO、EOS值均较治疗前明显下降,差异均有统计学意义(t分别=21.86、13.35,17.43、13.75,P均<0.05);治疗前,A组、B组间FENO、EOS值比较,差异无统计学意义(t分别=0.35、0.62,P均>0.05),治疗后,A组、B组的FENO、EOS值均明显低于治疗前(t分别=19.96、8.47、11.41、5.39,P均<0.05),且A组患者治疗后FENO、EOS值明显低于B组(t分别=8.36、3.41,P均<0.05)。经Pearson相关性分析显示,COPD患者治疗前的FENO水平与外周血EOS值呈正相关(r=0.53,P<0.05),治疗后FENO值和EOS值无相关性(r=0.18,P>0.05),治疗前FENO、EOS预测COPD患者ICS治疗效果的ROC曲线下面积(AUC)分别为0.72、0.63。结论 FENO、EOS对于COPD患者气道炎症的评估及指导治疗有一定的临床意义。Objective To investigate the value of exhaled nitric oxide(FENO)and eosinophil(EOS)in guiding rational inhaled corticosteroids(ICS)therapy in patients with chronic obstructive pulmonary disease(COPD). Methods Totally 120 patients with stable COPD were retrospectively selected as observation group.After 4 weeks of ICS treatment,78 patients with obvious improvement were enrolled as group A,42 patients without obvious therapeutic effect were enrolled as group B.At meanwhile,54 healthy volunteers were selected as control group.The levels of FENO and EOS among three groups were compared.The values of FENO and EOS in predicting the therapeutic effect of ICS for COPD were evaluated by ROC curve. Results The FENO and EOS values of the observation group before treatment were significantly higher than those of the control group,and the FENO and EOS values of the observation group after treatment were significantly lower than those before treatment(t =21.86,13.35,17.43,13.75,P<0.05).There was no significant difference in FENO and EOS values between group A and group B before treatment(t= 0.35,0.62,P>0.05).After treatment,the FENO and EOS values in group A and B were significantly lower than those before treatment(t= 19.96,8.47,11.41,5.39,P<0.05).And the FENO and EOS values in group A after treatment were significantly lower than those in group B(t= 8.36,3.41,P<0.05).Pearson correlation analysis result showed that FENO level before treatment was positively correlated with EOS value in peripheral blood(r=0.53,P<0.05).There was no correlation between FENO and EOS after treatment(r=0.18,P>0.05).The areas under ROC curve(AUC)of FENO and EOS before treatment for predicting ICS therapeutic effect in COPD patients were 0.72 and 0.63,respectively. Conclusion FENO and EOS have certain clinical significance in evaluating and guiding the treatment of airway inflammation in COPD patients.

关 键 词：慢性阻塞性肺疾病 呼出气一氧化氮 嗜酸性粒细胞 吸入型糖皮质激素 

分 类 号：R56[医药卫生—呼吸系统]