呼出气一氧化氮和肺泡一氧化氮在哮喘-慢性阻塞性肺疾病重叠诊断中的应用价值  

Diagnostic value of Fe NO and Ca NO in asthma-chronic obstructive pulmonary disease overlap

作　　者：范龙梅 张威[2] 张明月[2] 汪建新[2] Fan Longmei;Zhang Wei;Zhang Mingyue;Wang Jianxin(Department of Internal Medicine,Beijing Yangfangdian Hospital,Beijing 100036,China)

机构地区：[1]北京市羊坊店医院内科,100036 [2]解放军总医院第一医学中心呼吸与危重症科

出　　处：《北京医学》2022年第9期799-803,共5页Beijing Medical Journal

摘　　要：目的探讨炎症标志物呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和肺泡一氧化氮(concentration of alveolar nitric oxide,CaNO)区分哮喘-慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)重叠(asthma-COPD overlap,ACO)与COPD的诊断价值,为ACO的诊断及治疗寻求有效的生物指标。方法选取2019年3月至2020年5月解放军总医院第一医学中心呼吸科收治的单纯COPD患者30例为COPD组,ACO患者30例为ACO组。对比两组外周血嗜酸性粒细胞百分比、肺功能、FeNO值和CaNO值的差异。以ROC曲线评估FeNO、CaNO区分ACO与COPD的诊断价值。结果ACO组FeNO值、CaNO值和外周血嗜酸性粒细胞百分比显著高于COPD组[35.00(22.50,55.25)×10^(9)mol/L比17.50(11.00,32.75)×10^(9)mol/L,4.00(2.18,7.58)×10^(9)mol/L比2.30(1.50,3.95)×10^(9)mol/L,(5.35±1.86)%比(3.81±1.13)%],FEV1%pred、FVC%pred和FEV1/FVC%pred显著低于COPD组[(55.30±14.19)%比(76.05±16.08)%,(94.97±15.33)%比(108.75±11.82)%,(47.68±12.09)%比(56.57±7.69)%],差异均有统计学意义(P<0.05)。两组RV/TLC%pred和DLCO%pred比较,差异均无统计学意义(P>0.05)。ACO组小气道功能障碍发生率与COPD组比较,差异无统计学意义(P>0.05)。吸入支气管扩张剂后,ACO组FEV1改善率显著高于COPD组[19.70(15.69,26.25)%比10.10(5.04,12.80)%],差异有统计学意义(P<0.05)。FeNO区分ACO与COPD的最佳截断值为17.5×10^(9)mol/L,灵敏度为90.0%,特异性为50.0%,AUC为0.772(95%CI:0.656~0.888);CaNO区分ACO与COPD的最佳截断值为5.55×10^(9)mol/L,灵敏度为40.0%,特异性为90.0%,AUC为0.676(95%CI:0.539~0.813);FeNO联合CaNO时,阳性似然比及AUC较单独指标检测时均有提升。结论炎症标志物FeNO、CaNO可作为区分ACO与COPD的生物指标,且二者联合区分效能更高。Objective To investigate the diagnostic value of fractional exhaled nitric oxide(FeNO)and concentration of alveolar nitric oxide(CaNO)in distinguishing asthma-chronic obstructive pulmonary disease overlap(ACO)from chronic obstructive pulmonary disease(COPD),and to seek effective biological indicators for ACO diagnosis and treatment.Methods A total of 30 patients with simple COPD admitted to the Department of Respiratory,the First Medical Center of PLA General Hospital from March 2019 to May 2020 were selected as the COPD group,and 30 patients with ACO were included in the ACO group.The percentage of peripheral blood eosinophils,lung function,FeNO and CaNO were compared between the two groups.ROC curve was used to evaluate the diagnostic value of FeNO and CaNO in distinguishing ACO from COPD.Results The FeNO value,CaNO value and percentage of peripheral blood eosinophils in ACO group were significantly higher than those in COPD group[35.00(22.50,55.25)×10^(9)mol/L vs.17.50(11.00,32.75)×10^(9)mol/L,4.00(2.18,7.58)×10^(9)mol/L vs.2.30(1.50,3.95)×10^(9)mol/L,(5.35±1.86)%vs.(3.81±1.13)%],FEV_(1)%pred,FVC%pred and FEV_(1)/FVC%pred were significantly lower than those in COPD group[(55.30±14.19)%vs.(76.05±16.08)%,(94.97±15.33)%vs.(108.75±11.82)%,(47.68±12.09)%vs.(56.57±7.69)%],and the differences were statistically significant(P<0.05).There were no significant differences in RV/TLC%perd and DLCO%pred between the two groups(P>0.05).There was no significant difference in small airway dysfunction between ACO group and COPD group(P>0.05).After bronchodilator inhalation,the improvement rate of FEV_(1) in ACO group was significantly higher than that in COPD group[19.70(15.69,26.25)%vs.10.10(5.04,12.80)%],and the difference was statistically significant(P<0.05).The cut-off value of FeNO for distinguishing ACO from COPD was 17.5×10^(9)mol/L,with the sensitivity of 90.0%,and the specificity of 50.0%,and the AUC was 0.772(95%CI:0.656-0.888).The cut-off value of CaNO for distinguishing ACO from COPD was 5.55×10^(9)mol

关 键 词：哮喘-慢性阻塞性肺疾病重叠 慢性阻塞性肺疾病 呼出气一氧化氮 肺泡一氧化氮 

分 类 号：R562.25[医药卫生—呼吸系统] R563.9[医药卫生—内科学]