呼出气一氧化氮与AECOPD临床指标的相关性分析  

Correlation Analysis between Clinical Indexes and Exhaled Nitric Oxide in Patients with Acute Attack of Chronic Obstructive Pulmonary Disease

作　　者：郝琳[1] HAO Lin(Department of Pneumology,Nanyang Second General Hospital,Nanyang Henan 473000,China)

机构地区：[1]南阳市第二人民医院呼吸科,河南南阳473000

出　　处：《河南医学高等专科学校学报》2022年第6期649-653,共5页Journal of Henan Medical College

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191456)。

摘　　要：目的探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期(AECOPD)患者临床指标的相关性及对糖皮质激素治疗反应性的评估价值。方法选择120例AECOPD患者,以25 ppb为切点将患者分为低FeNO组(76例)和高FeNO组(44例),并根据糖皮质激素治疗的反应性分为反应良好组(89例)与无反应组(31例)。收集性别、年龄、体质量指数(BMI)、基线呼吸困难指数评分(mMRC)、COPD患者自我评估测试问卷(CAT)、外周血降钙素原(PCT)、C反应蛋白(CRP)、B型脑钠肽(BNP)、总IgE、嗜酸性粒细胞(EOS)水平、动脉血气分析和肺功能指标。结果低FeNO组与高FeNO组之间的年龄、mMRC分级、CAT评分、PCT、EOS、氧分压(PaO_(2))、FEV_(1)占预计值百分数(FEV_(1)%pred)比较,差异有统计学意义(P<0.05)。基线FeNO水平与CAT评分呈正相关(r=0.663,P<0.05),与EOS呈正相关(r=0.795,P<0.05),而与其他指标均无相关性(P>0.05)。反应良好组与无反应组之间的年龄及基线EOS、IgE、二氧化碳分压(PaCO_(2))、FeNO比较,差异有统计学意义(P<0.05)。反应良好组与无反应组治疗后的IgE、PaO_(2)、PaCO_(2)、FEV_(1)%pred、第1秒用力呼气量占用力肺活量比值(FEV_(1)/FVC)、FeNO比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,基线及治疗后的FeNO均不是糖皮质激素治疗无反应的独立影响因素。结论FeNO可作为评估AECOPD患者气道炎症的辅助指标,但对评估患者使用激素治疗是否获益的价值有限。Objective To explore the correlation between exhaled nitric oxide(FeNO)and clinical indexes in patients with acute episode of chronic obstructive pulmonary disease(AECOPD),and to assess the value of responsiveness to glucocorticoid therapy.Methods 120 patients with AECOPD were selected and divided into low FeNO group(76 patients)and high FeNO group(44 patients)using a cut-off point of 25 ppb,and divided into good response group(89 patients)and non-response group(31 patients)based on responsiveness to glucocorticoid treatment.Gender,age,body mass index(BMI),baseline dyspnoea index score(mMRC),COPD patient self-assessment questionnaire(CAT),peripheral blood calcitonin(PCT),C-reactive protein(CRP),B-brain natriuretic peptide(BNP),total IgE,eosinophil(EOS)levels,and arterial blood gas analysis and lung function parameters were collected.Results The differences in age,mMRC classification,CAT score,PCT,EOS,partial pressure of oxygen(PaO_(2))and FEV_(1) as a percentage of predicted value(FEV_(1)%pred)between the low FeNO group and the high FeNO group were statistically significant(P<0.05).Baseline FeNO levels were positively correlated with CAT score(r=0.663,P<0.05)and with blood EOS(r=0.795,P<0.05),while there was no correlation with any other index(P>0.05).There were statistically significant differences in age,baseline EOS,IgE,partial pressure of carbon dioxide(PaCO_(2))and FeNO between the good response group and the non-response group(P<0.05).There were statistically significant differences in IgE,PaO_(2),PaCO_(2),FEV_(1)%pred,1st second exertional expiratory volume to exertional lung volume ratio(FEV_(1)/FVC)and FeNO after treatment between the good response and non-response groups(P<0.05).Multi-factor logistic regression analysis showed that neither baseline nor post-treatment FeNO was an independent influence on non-response to glucocorticoid treatment.Conclusion FeNO can be used as an auxiliary index to evaluate airway inflammation in patients with AECOPD,but is of limited value in assessing whether patients be

关 键 词：慢性阻塞性肺疾病急性加重期 呼出气一氧化氮 糖皮质激素反应性 

分 类 号：R563[医药卫生—呼吸系统]