呼出气一氧化氮与小气道功能预测咳嗽变异性哮喘患者支气管高反应性  

Fractional exhaled nitric oxide and small airway function predict bronchial hyperresponsiveness in patients with chronic cough

作　　者：丁金盾 邱章伟 徐晓婷 戴元荣[1] DING Jin-dun;QIU Zhang-wei;XU Xiao-ting;DAI Yuan-rong(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325027,China)

机构地区：[1]温州医科大学附属第二医院呼吸与危重症医学科,浙江温州325027

出　　处：《临床肺科杂志》2022年第2期169-173,183,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的评估呼出气一氧化氮(FeNO)及小气道功能指标,预测慢性咳嗽患者支气管高反应性(BHR)的价值。方法回顾性分析2019年1月-2020年1月期间我院呼吸内科就诊的慢性咳嗽患者资料,将慢性咳嗽患者分为支气管激发试验(BPT)阳性组与BPT阴性组,评估FeNO、肺通气功能及脉冲振荡肺功能(IOS)对BHR的诊断价值。结果共222例慢性咳嗽患者纳入分析,其中BPT阳性106例,BPT阴性116例。BPT阳性组FeNO显著高于BPT阴性组,FEF25/50/75%pred、MMEF%pred、X5-X5pred显著低于BPT阴性组(均P<0.05)。FeNO诊断BHR的曲线下面积(AUC)为0.624,FEF25%pred、FEF50%pred、FEF75%pred及MMEF%pred的AUC分别为0.699、0.694、0.644、0.687,X5-X5pred的AUC为0.604。采用logistic回归对FeNO与小气道功能指标进行联合,发现FeNO联合MMEF%pred的模型诊断BHR的AUC最高为0.735(95%CI,0.657~0.804),较单用FeNO或单用MMEF%pred均有提升(P<0.05),而FeNO与X5-X5pred联合的模型不成立,同时应用该模型未见AUC显著提升。结论在慢性咳嗽患者中,FeNO、X5-X5pred、FEF25%pred、FEF50%pred、FEF75%pred及MMEF%pred均具有预测BHR的作用,FeNO联合MMEF%pred优于单独使用,肺功能小气道指标的BHR预测价值可能优于IOS。Objective To evaluate the value of fractional exhaled nitric oxide(FeNO)and small airway function in predicting bronchial hyperresponsiveness(BHR)in patients with chronic cough.Methods The data from patients with chronic cough were retrospectively analyzed,which had medical consultations from January 2019 to January 2020.They were divided by the result of bronchial provocation test(BPT).The diagnostic accuracy of FeNO,pulmonary function test and impulse oscillometry system(IOS)on BHR was evaluated.Results A total of 222 patients with chronic cough were included in the analysis,including 106 cases in the BPT positive group and 116 cases in the BPT negative group.The value of FeNO in the BPT positive group was significantly higher than that in the BPT negative group,and the value of FEF25/50/75%pred,MMEF%pred and X5-X5 pred were significantly lower than those in the BPT negative group.The AUCs of FeNO,FEF25%pred,FEF50%pred,FEF75%pred,MMEF%pred and X5-X5 pred were 0.624,0.699,0.694,0.644,0.687 and 0.604 respectively.Logistic regression analysis showed that the AUC of FeNO combined with MMEF%pred in diagnosing BHR was 0.735(95%CI,0.657-0.804),which was higher than either FeNO or MMEF%pred alone(P<0.05),but the model of FeNO combined with X5-X5 pred was not established,and there was no significant increase in AUC.Conclusion FeNO,FEF25%pred,FEF50%pred,FEF75%pred,MMEF%pred and X5-X5 pred can predict BHR in patients with chronic cough,and the combination of FeNO and MMEF%pred performs better.In comparison of lung function test with IOS in the assessment of small airway function,the former seems to have a better value in prediction of BHR.

关 键 词：咳嗽 支气管激发试验 呼出气一氧化氮 脉冲振荡技术 小气道功能 

分 类 号：R562.25[医药卫生—呼吸系统]