FeNO、外周血EOS计数及血清总IgE对支气管哮喘的联合诊断价值探讨  

Combined diagnostic value of fractional of exhaled nitric oxide,peripheral blood eosinophil count,and serum total immunoglobulin E in bronchial asthma

作　　者：缪晔红 沈莹莹 魏源 张秀琴[2] Miao Yehong;Shen Yingying;Wei Yuan;Zhang Xiuqin(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Nantong University,Nantong 226000,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]南通大学附属医院呼吸与危重症医学科,南通226000 [2]苏州大学附属第一医院呼吸与危重症医学科,苏州215006

出　　处：《国际呼吸杂志》2022年第8期583-588,共6页International Journal of Respiration

基　　金：苏州市科技计划项目(SS201813)。

摘　　要：目的探讨呼出气一氧化氮(FeNO)、外周血嗜酸粒细胞(EOS)计数及血清总免疫球蛋白E(IgE)对支气管哮喘(哮喘)的联合诊断价值。方法本研究为病例对照研究。采用非随机抽样法,选取2017年9月至2021年6月苏州大学附属第一医院哮喘专病门诊就诊的疑似哮喘患者120例,其中哮喘组80例,非哮喘组40例(慢性阻塞性肺疾病患者19例,慢性咳嗽患者21例)。对所有患者进行一般临床资料、危险因素调查、肺功能测定、FeNO测定、外周血EOS计数、血清总IgE测定。分析哮喘组及非哮喘组FeNO、外周血EOS计数、血清总IgE的表达水平差异,探讨三者对哮喘的单独诊断价值及联合诊断价值。采用SPSS 24软件及MedCalc软件进行统计分析,使用Graphpad Prism 6软件作图。结果哮喘组中FeNO、外周血EOS计数及血清总IgE水平明显高于非哮喘组,差异均有统计学意义(Z值分别为-6.15、-4.93、-4.68,P值均<0.01)。FeNO、外周血EOS计数及血清总IgE均能从疑似哮喘患者中鉴别诊断哮喘。通过绘制受试者工作特征曲线发现,FeNO的曲线下面积(AUC)为0.85(95%CI:0.78~0.91,P<0.001)。外周血EOS计数的AUC为0.78(95%CI:0.70~0.86,P<0.001)。血清总IgE的AUC为0.76(95%CI:0.68~0.85,P<0.001)。FeNO、外周血EOS、血清总IgE联合应用可以提高诊断效能,AUC为0.86(95%CI:0.80~0.92,P<0.001)。结论FeNO、外周血EOS计数、血清总IgE在哮喘的临床应用中具有重要的价值。与支气管激发试验或舒张试验相比,这3个生物学指标较普遍、廉价、安全,三者联合应用可以提高诊断效能。Objective To investigate the combined diagnostic value of fractional of exhaled nitric oxide(FeNO),peripheral blood eosinophil(EOS)count,and serum total immunoglobulin E(IgE)in bronchial asthma(asthma).Methods This study was a case-control study.Non-random sampling method was used.A total of 120 out-patients with suspected asthma were selected in the First Affiliated Hospital of Soochow University from September 2017 to June 2021,including 80 in asthma group and 40 in non-asthma group(19 patients with chronic obstructive pulmonary disease and 21 patients with chronic cough).General clinical data,risk factor investigation,lung function measurement,FeNO measurement,peripheral blood EOS count,and total serum IgE measurement were performed in all patients.The differences of FeNO and EOS count in peripheral blood and total IgE expression in serum between asthmatic and non-asthmatic groups were analyzed to explore the diagnostic value of the three alone and combined for asthma.SPSS 24 software and MedCalc software were used for statistical analysis,and Graphpad Prism 6 software was used for plotting.Results FeNO,peripheral blood EOS,and total IgE levels in asthmatic group were significantly higher than those in non-asthmatic group,and the differences were statistically significant(Z values were-6.15,-4.93,and-4.68,respectively,all P<0.01).FeNO,peripheral blood EOS count,and total serum IgE can be used to differentiate asthma from suspected asthma patients.The area under curve(AUC)of FeNO was 0.85(95%CI:0.78-0.91,P<0.001).The AUC of the EOS count of peripheral blood was 0.78(95%CI:0.70-0.86,P<0.001).The AUC of the serum total IgE curve was 0.76(95%CI:0.68-0.85,P<0.001).When FeNO combined with the EOS count of peripheral blood and the serum total IgE,the AUC was 0.86(95%CI:0.80-0.92,P<0.001),which means the combined method can improve the diagnosis effectiveness.Conclusions FeNO,peripheral blood EOS count,and total serum IgE have important clinical value in asthma diagnosis.Compared with bronchial provocation test or rel

关 键 词：哮喘 诊断 呼出气一氧化氮 外周血嗜酸粒细胞计数 血清总免疫球蛋白E 

分 类 号：R562.25[医药卫生—呼吸系统]