呼出气一氧化氮联合激活蛋白A测定对哮喘-慢性阻塞性肺疾病重叠的诊断价值  

Value of Fractional Exhale Nitric Oxide and Activin-A in Diagnosis of Asthma-COPD Overlap

作　　者：赵爽[1] 徐建华[1] 王导新[2] 戚迪[2] ZHAO Shuang;XU Jianhua;WANG Daoxin;QI Di(Department of Respiratory Medicine,Chongqing Hechuan People′s Hospital,Chongqing 401520,China;Department of Respiratory and Critical Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆市合川区人民医院呼吸内科,重庆401520 [2]重庆医科大学附属第二医院呼吸与危重症医学科,重庆400010

出　　处：《医学综述》2020年第8期1608-1613,共6页Medical Recapitulate

基　　金：国家自然科学基金(81800083);重庆市卫生计生委医学科研项目(2016MSXM165)。

摘　　要：目的探讨呼出气一氧化氮(FeNO)联合血清激活蛋白A对哮喘-慢性阻塞性肺疾病重叠(ACO)的诊断价值。方法选取2017年1月至2018年6月重庆市合川区人民医院呼吸内科收治的40例支气管哮喘患者(哮喘组)、30例ACO患者(ACO组)、45例慢性阻塞性肺疾病(COPD)患者(COPD组)以及同期35名健康不吸烟志愿者(健康对照组)作为研究对象。所有入组对象于入院24 h内以及同期体检门诊抽取静脉血检测血清激活蛋白A,并进行FeNO水平及肺功能检测。比较哮喘组、ACO组、COPD组及健康对照组FeNO和血清激活蛋白A的差异,分析FeNO和血清激活蛋白A与第一秒用力呼气量(FEV 1)/用力肺活量(FVC)、FEV 1占预计值百分比的相关性。利用受试者工作特征曲线(ROC曲线)分析血清激活蛋白A、FeNO单独及联合检测诊断ACO的临床价值。结果①各组FeNO水平比较:与健康对照组相比,哮喘组及ACO组FeNO水平显著升高(P<0.001);COPD组FeNO水平较哮喘组及ACO组低(P<0.05);ACO组FeNO水平明显低于哮喘组(P<0.001)。②各组血清激活蛋白A比较。与健康对照组相比,哮喘组、ACO组及COPD组血清激活蛋白A水平均显著升高(P<0.001)。哮喘组血清激活蛋白A水平显著高于ACO组(P<0.001),ACO组血清激活蛋白A显著高于COPD组(P<0.001)。③ACO组FeNO值与激活蛋白A水平与肺功能相关性分析:ACO组FeNO值与FEV 1占预计值百分比、FEV 1/FVC值均无显著相关性(r=0.151,P=0.065;r=0.069,P=0.398)。激活蛋白A水平与FEV 1占预计值百分比、FEV 1/FVC值均无显著相关性(r=-0.155,P=0.058;r=-0.318,P=0.151)。④FeNO诊断COPD患者ACO的ROC曲线下面积为0.678(95%CI 0.549~0.807,P=0.009),以FeNO>23.650 ppb为折点鉴别诊断ACO的灵敏度为66.7%,特异度为62.2%,阳性预测值为52.6%,阴性预测值为73.7%;血清激活蛋白A诊断COPD患者ACO的ROC曲线下面积为0.885(95%CI 0.813~0.985,P<0.001),以激活蛋白A>204.065 ng/L为折点鉴别诊断ACO的灵敏度为96.7%,特异�Objective To evaluate the prognostic value of fractional exhale nitric oxide(FeNO)and activin-A in asthma-chronic obstructive pulmonary disease(COPD)overlap(ACO)patients.Methods A total of 150 patients of asthma(n=40),ACO(n=30),COPD(n=45)and healthy controls(n=35)admitted to the Department of Respiratory Medicine of Chongqing Hechuan People′s Hospital from Jan.2017 to Jun.2018 were included in the study.All patients were examined for activin-A by venous-blood sampling,as well as FeNO test and pulmonary function tests within 24 h of admission to the hospital or during health examination to analyze the differences in FeNO,serum activin A and pulmonary function among groups,and to detect the correlation of FeNO/serum activin A with forced expiratory volume in the first second(FEV 1)/forced vital capacity(FVC),FEV 1 percentage of the predicted value(FEV 1%).The clinical value of serum activin-A and FeNO in the diagnosis of ACO was analyzed by receiver operating characteristic(ROC)curve.Results①Comparison of FeNO between each group:compared with the healthy control,the asthma and ACO group maintained higher FeNO level(P<0.001);compared with asthma and ACO group,the COPD group maintained lower FeNO level(P<0.05);compared with the asthma group,the FeNO level of the ACO group was lower(P<0.001).②Comparison of activin-A between each group:compared with the healthy control,the asthma,ACO and COPD group maintained higher serum activin-A level(P<0.001);the serum activin-A level was higher in the asthma group than the ACO group(P<0.01),while it was significantly higher in the ACO group than the COPD group(P<0.001).③Correlation analysis between FeNO level and activin-A level and lung function examination in the ACO group:no statistically significant differences were found between FeNO level and FEV 1%and FEV 1/FVC(r=0.151,P=0.065;r=0.069,P=0.398).There were no significantly correlation between serum activin-A and FEV 1%and FEV 1/FVC in each group(r=-0.155,P=0.058;r=-0.318,P=0.151).④The area under curve(AUC)of FeNO fo

关 键 词：哮喘-慢性阻塞性肺疾病重叠 哮喘 慢性阻塞性肺疾病 呼出气一氧化氮 激活蛋白A 

分 类 号：R562.25[医药卫生—呼吸系统] R563[医药卫生—内科学]