中央和外周气道一氧化氮测定在哮喘诊断中的应用  

The utility of central and peripheral airway nitric oxide in the diagnosis of asthma

作　　者：陈文丽 王少飞[1] 王艳飞[2] CHEN Wenli;WANG Shaofei;WANG Yanfei(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000,China;Department of Emergency,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000,China)

机构地区：[1]承德医学院附属医院呼吸与危重症医学科,河北承德067000 [2]承德医学院附属医院急诊科,河北承德067000

出　　处：《中国临床医生杂志》2024年第3期295-299,共5页Chinese Journal For Clinicians

基　　金：2018年度河北省医学科学研究重点课题计划(20181157)。

摘　　要：目的通过分析中央气道一氧化氮(FeNO)、外周气道一氧化氮(CaNO)和肺功能之间的关系,探讨FeNO和CaNO在哮喘诊断中的临床应用价值。方法以承德医学院附属医院2020年1月至2022年4月同时行FeNO、CaNO、肺功能检测的患者为研究对象,分为哮喘组、慢阻肺组和对照组,分析三组患者FeNO、CaNO与肺功能指标的关系,应用受试者操作特征曲线和配对设计资料χ^(2)检验分析FeNO和CaNO在哮喘诊断方面的价值。结果共纳入308例为研究对象,其中哮喘组患者130例,慢阻肺组患者102例,对照组患者76例。三组患者比较,哮喘组患者FeNO[(55.14±34.64)ppb]水平高于慢阻肺组患者[(19.56±7.93)ppb]和对照组患者[(18.93±7.93)ppb],组间差异有统计学意义(P<0.01),但后两组患者比较差异无统计学意义(P>0.05)。三组患者比较,CaNO和肺功能各指标组间差异均有统计学意义(P<0.05)。FeNO与CaNO呈正相关(r=0.363,P<0.001)。FeNO与年龄、25%肺活量时的最大呼气流速占预计值百分比(MEF25%pred)、用力呼气中期流速占预计值百分比(MMEF%pred)呈负相关。CaNO与第1秒用力呼气容积占预计值百分比、75%肺活量时的最大呼气流速占预计值百分比、50%肺活量时的最大呼气流速占预计值百分比、MEF25%pred、MMEF%pred呈负相关。FeNO和CaNO诊断哮喘的临界值分别为27.5ppb和10.6ppb。FeNO的受试者操作特征曲线下面积(0.896,95%CI 0.858~0.934)比CaNO(0.649,95%CI 0.586~0.712)大(P<0.05),且FeNO敏感性和特异性(0.800,0.888)较CaNO(0.577,0.719)高。结论FeNO和CaNO可与肺功能一起用于辅助诊断哮喘,但FeNO诊断价值更大,CaNO越高,小气道功能越差。Objective To explore the clinical application of FeNO and CaNO in asthma,through the study of the relationship among FeNO,CaNO and pulmonary function in patients.Method A retrospective analysis was performed for the outpatients of Affliated Hospital of Chengde Medical College,who completed the examinations of CaNO,FeNO and lung function from January 2020 to April 2022.According to the inclusion criteria and exclusion criteria,the subjects were divided into asthma group,COPD group,control group.The relationship between CaNO,FeNO(fractional concentration of exhaled nitric oxide)and lung function was compared among the three groups.The ROC curve and paired chi—square test were used to explore the value of CaNO and FeNO for asthma.Result 308 subjects were included,130 patients in asthma group,102 patients in COPD group and 76 patients in control group.The mean FeNO level in asthma group was(55.14±34.64)ppb,which was significantly higher than that in COPD group(19.56±7.93)ppb and control group(18.93±7.93)ppb(P<0.01).There was no significant difference on FeNO level between the COPD group and control group.There was significant difference on CaNO and lung function among the three groups(P<0.05).There was a positive correlation between CaNO and FeNO(r=0.363,P<0.001).FeNO were negatively correlated with age,MEF25%pred,MMEF%pred.CaNO were negatively correlated with FEV1%pred、MEF75%pred、MEF50%pred、MEF25%pred、MMEF%pred.The cutoff values of FeNO and CaNO for asthma diagnosis were 27.5ppb and 10.6ppb.The area under ROC curve of FeNO(0.896)was larger than CaNO(0.649).The sensitivity and specificity of FeNO(0.800,0.888)were higher than CaNO(0.577,0.719).There was significant difference between FeNO and bronchodilation test/CaNO in diagnosis of asthma.Conclusion FeNO and CaNO can be used together with lung function in the diagnosis of asthma.FeNO has greater diagnostic value than bronchodilation test/CaNO.The higher the CaNO is,the worse the small airway function is.

关 键 词：支气管哮喘 慢性阻塞性肺疾病 肺功能 呼出气一氧化氮 肺泡一氧化氮 

分 类 号：R741[医药卫生—神经病学与精神病学]