鼻一氧化氮测定在变应性鼻炎临床应用的Meta分析  

Clinical application of nasal nitric oxide detection in allergic rhinitis:a Meta-analysis

作　　者：刘哲[1] 于金壮 田杰[2] 史丽[1] LIU Zhe;YU Jin-zhuang;TIAN Jie;SHI Li(Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250000,China;Department of Otolaryngology-Head and Neck Surgery,Zibo Central Hospital,Zibo 255000,China)

机构地区：[1]山东省耳鼻喉医院,山东大学附属山东省耳鼻喉医院耳鼻喉头颈外科,济南250000 [2]淄博市中心医院耳鼻喉头颈外科,山东淄博255000

出　　处：《中华临床免疫和变态反应杂志》2021年第6期651-663,共13页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的通过Meta分析和回归分析对鼻一氧化氮(nasal nitric oxide,nNO)水平与变应性鼻炎(allergic rhinitis,AR)之间的关系进行系统回顾,为规范nNO检测在AR诊断中的应用提供依据。方法系统检索PubMed、Web of Science、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、维普(VIP)及万方等数据库。检索时间为2005年1月1日至2021年3月31日,纳入文献为确诊变应性鼻炎的临床病例对照研究。采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa scale,tNOS)对所纳入的研究进行方法学质量评价,通过Review Manager 5.3和Stata 16软件进行数据分析。结果最终纳入病例对照研究36篇(3012例AR患者和2409例对照组)。与对照组相比,AR患者nNO值显著升高(SMD:1.39,95%置信区间:1.07~1.71,P<0.01)。敏感性和亚组分析证实,该结果不受临床混杂因素(哮喘、吸烟史、年龄、地域种族等)的影响,对常年性和季节性疾病评价均有效。回归分析表明,测定时鼻气流流速越大,效应量越大。结论AR患者的nNO水平较正常人高,nNO组间差异大小与测试时鼻气流流速具有相关性,同时(吸气、呼气)测试流速也是异质性的来源,需要规范其检测标准以扩大临床应用。Objective The relationship between nasal Nitric Oxide(nNO)level and allergic rhinitis(AR)was reviewed basing on meta-analysis and meta-regression,providing a basis for standardized application in diagnosis of AR.Methods PubMed,Web of Science,Embase,Cochrane Library,CNKI,VIP and Wanfang Databases from January 1st,2005 to March 31st,2021 were searched,literatures related to clinical case-control studies of allergic rhinitis were included.The quality of literatures were evaluated according to Newcastle-Ottawa Scale.Meta-analysis was performed by using Stata 16 and Review Manager 5.3 software.Results Thirty-six case-control studies were selected for further analysis,in which a total of 3012 AR patients and 2409 controls enrolled.nNO values of AR patients were significantly higher than that of control group(SMD:1.39,95%CI:1.07-1.71,P<0.01).It was confirmed that the results were independent of clinical confounding factors(such as asthma,smoking history,age,regional ethnicity,etc.)and valid for both perennial and seasonal disease assessments,basing on results of sensitivity and subgroup analyses.The increasing nasal flow velocity was related to larger effect value,which was shown by result of regression analysis.Conclusion The nNO levels of AR patients were higher than that of controls and the difference was correlated with velocity of nasal inhalational airflow.Meanwhile,the velocity of both inhalational airflow and exhalant airflow were major influence factors of heterogeneity.Further studies for standardization of detection are necessary for broader clinical application.

关 键 词：鼻炎 变应性 一氧化氮 META分析 

分 类 号：R76[医药卫生—耳鼻咽喉科]