呼出气一氧化氮测定在指导慢性阻塞性肺疾病急性加重患者使用全身激素的价值  

Value of exhaled nitric oxide measurement in guiding the use of systemic glucocorticoid in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：罗红辉[1] 刘育良 古晓龙 黄聪 罗忆群 LUO Honghui;LIU Yuliang;GU Xiaolong;HUANG Cong;LUO Yiqun(Department of General Medicine Meizhou People’s Hospital,Meizhou 514031,China)

机构地区：[1]梅州市人民医院全科医学科,广东梅州514031

出　　处：《广州医药》2023年第10期58-62,共5页Guangzhou Medical Journal

基　　金：梅州市社会发展科技计划项目(2019B017)。

摘　　要：目的探析慢性阻塞性肺疾病急性加重(AECOPD)患者在全身糖皮质激素(激素)使用过程中检测呼出气一氧化氮(FeNO)的价值。方法于2019年1月—2021年12月梅州市人民医院采集病例展开随机对照研究,实施对象为58例AECOPD患者,均检测FeNO水平,根据FeNO水平是否>25 ppb,分组为FeNO高水平组和FeNO低水平组,根据是否接受全身激素治疗分为治疗组和对照组,对照组予以常规治疗,治疗组实行常规+全身激素治疗;检测治疗前后FeNO、肺功能指标水平变化,判定COPD评估测试(CAT)评分,对比组间差异。结果FeNO高水平组全身激素治疗后(治疗组)FeNO降低(P<0.05),高水平组常规治疗后(对照组)FeNO前后比较差异无统计学意义(P>0.05),低水平组中治疗组和对照组治疗前后FeNO比较差异无统计学意义(P>0.05);FeNO高水平组治疗后第一秒用力呼气容积(FEV1)、第一秒用力呼气量占用力肺活量比值(FEV1/FVC)均升高,且治疗组升高程度较对照组更大(均P<0.05),FeNO低水平组治疗后FEV1、FEV1/FVC均升高(均P<0.05),但治疗组与对照组相比无差异(P>0.05);FeNO高水平组、低水平组治疗后CAT评分较治疗前均下降(均P<0.05),FeNO高水平组下降更明显。结论AECOPD患者实施FeNO测定,其水平变化在一定程度上可反映气道炎症,并预测激素治疗反应,指导合理有效地应用全身激素,避免出现激素过度使用情况。Objective To explore the value of detecting exhaled nitric oxide(FeNO)during systemic glucocorticoid use in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A randomized controlled study was conducted from January 2019 to December 2021 at the People's Hospital of Meizhou City.The subjects were 58 AECOPD patients,all of whom were tested for FeNO levels.Based on whether the FeNO levels were25 ppb,they were divided into a high level FeNO group and a low level FeNO group.They were divided into a treatment group and a control group based on whether they received systemic glucocorticoid therapy.The control group received routine treatment,while the treatment group received routine and systemic glucocorticoid therapy.Changes in FeNO and lung function indicators before and after treatment were detected,COPD assessment test(CAT)scores were determined,and differences between groups were compared.Results After systemic glucocorticoid therapy,the high level group of FeNO showed a decrease in FeNO(P0.05),while the high level group showed no statistically significant difference in FeNO before and after routine treatment(P0.05).The low level group showed no statistically significant difference in FeNO between the treatment group and the control group before and after treatment(P0.05).The first second forced expiratory volume(FEV1)and the ratio of first second forced expiratory volume to forced vital capacity(FEV1/FVC)in the high level group of FeNO significantly increased after treatment,and the degree of increase in the treatment group was greater than that in the control group(all P0.05).The FEV1 and FEV1/FVC in low level group of FeNO significantly increased after treatment(all P0.05),but the difference between the treatment group and the control group was not significant(P0.05).The CAT scores of the high and low levels of FeNO groups decreased after treatment compared to before treatment(all P0.05),and the decrease was more significant in the high level FeNO group.Conclusions The imp

关 键 词：呼出气一氧化氮测定 慢性阻塞性肺疾病 急性加重 全身激素 

分 类 号：R563.9[医药卫生—呼吸系统]