FeNO水平及最大中期呼气流量对哮喘患者小气道功能障碍的评估作用  

The Effect of FeNO Level and Maximal Mid-expiratory Flow on Evaluating Small Airway Dysfunction in Asthmatic Patients

作　　者：毛正道[1] 史彩雯 刘志光[1] 施宇佳[1] 张倩[1] MAO Zheng-dao;SHI Cai-wen;LIU Zhi-guang;SHI Yu-jia;ZHANG Qian(Department of Respiratory and Critical Care Medicine,The Affiliated Changzhou No.2 Pepole’s Hospital of Nanjing Medical University,Changzhou 213003,China)

机构地区：[1]南京医科大学附属常州市第二人民医院呼吸与危重症医学科,江苏常州213003

出　　处：《中国医药指南》2020年第20期1-3,共3页Guide of China Medicine

基　　金：江苏省六大人才高峰项目(WSN092);江苏省“333”高层次人才项目(BRA2016119);常州市高层次卫生人才培养工程(2016CZLJ017);常州市科技项目(CJ20179031)。

摘　　要：目的分析哮喘患者呼出气一氧化氮(FeNO)水平及最大中期呼气流量(MMEF)对哮喘患者小气道功能障碍的评估作用。方法选择我院2015年6月至2017年6月呼吸科门诊36例哮喘小气道功能异常患者,分别测定FeNO值、嗜酸性粒细胞相对值(Eos%)和肺功能,分析小气道功能异常哮喘患者FeNO与Eos%、第一秒用力肺活量占预计值的百分比(FEV1%)、MMEF的相关性及FeNO、MMEF水平诊断哮喘小气道功能异常的预测价值。结果小气道功能异常哮喘患者FeNO与Eos%、FEV1%、MMEF均呈正相关(r值分别为0.369、0.344、0.429,P值分别为0.027、0.040、0.009);ROC曲线下的面积(AUC)评价哮喘小气道功能异常结果显示FeNO联合MMEF诊断哮喘小气道功能异常的ROC-AUC值最大(AUC为0.899),表明FeNO联合MMEF诊断哮喘小气道功能异常的价值最高,此外FeNO亦可单独作为诊断哮喘小气道功能异常价值较高的指标(AUC值为0.796),最佳界值为48ppb,以FeNO超过48ppb为标准诊断小气道功能异常并与"金标准"比较,得到的敏感度和特异度分别为89.47%(17/19)、76.47%(13/17)。结论FeNO水平是小气道功能异常的敏感特异性指标,FeNO水平联合MMEF指标能更好地评估哮喘患者的小气道功能,为临床早期诊断和治疗提供一定的依据。Objective To analyze the effect of fractional exhaled nitric oxide(FeNO)level and maximal mid-expiratory flow(MMEF)of asthmatic patients on evaluating small airway dysfunction in asthmatic patients.Methods 36 asthmatic patients with small airway dysfunction were recruited from our outpatient department of respiratory medicine between June 2015 and June 2017.The values of FeNO,eosinophilic relative value(Eos%)and lung function were measured respectively.The correlation between FeNO and Eos%,the percentage of predicted forced expiratory volume in 1 second(FEV1%)and MMEF in asthmatic patients were analyzed.And the values of FeNO and MMEF levels on evaluating small airway dysfunction in asthma were conducted as well.Results There was a positive correlation between FeNO and Eos%,FEV,%and MMEF in asthmatic patients with small airway dysfunction(r=0.369,0.344 and 0.429,respectively;P=0.027,0.040 and 0.009,respectively).The result of the area under the ROC curve(AUC)of evaluating asthmatic airway dysfunction showed that applying FeNO combined with MMEF(AUC=0.899)was the best diagnostic value.In addition,FeNO can also be used as a good marker for the diagnosis of asthmatic small airway dysfunction(AUC=0.796).Using the cutoff value,48 ppb of FeNO,the sensitivity and specificity were89.47%and 76.47%,respectively,when compared with’gold standard’.Conclusion FeNO level is a sensitive and specific marker for the diagnosing small airway dysfunction FeNO level combined with MMEF can better evaluate the small airway function,and have the potential for early diagnosis and treatment of asthmatic patients.

关 键 词：哮喘 小气道功能障碍 呼出气一氧化氮 最大中期呼气流量 

分 类 号：R562.25[医药卫生—呼吸系统]