FeNO_(50)+CaNO联合检测对慢性阻塞性肺疾病急性加重期激素治疗的应用价值  

The Application Value of FeNO_(50)CaNo Combined Detection in Hormone Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：刘茜 张敏[1] 武莉莉[1] LIU Xi;ZHANG Min;WU Lili(Shenzhen Second People's Hospital,Guangdong Shenzhen 518035;Shenzhen University,Guangdong Shenzhen 518000)

机构地区：[1]深圳市第二人民医院,广东深圳518035 [2]深圳大学,广东深圳518000

出　　处：《深圳中西医结合杂志》2024年第7期13-18,I0003,共7页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市第二人民医院院级临床研究项目(20213357029)。

摘　　要：目的:探讨呼出气流速为50 mL·s^(-1)时呼出气一氧化氮(FeNO_(50))+肺泡呼出气一氧化氮(CaNO)联合检测对慢性阻塞性肺疾病急性加重期(AECOPD)患者使用糖皮质激素治疗的应用价值。方法:前瞻性地纳入2021年6月1日至2023年5月31日在深圳市第二人民医院呼吸与危重症医学科住院的AECOPD患者62例。根据入院时FeNO_(50)、CaNO水平分为4组(Ⅰ组:FeNO_(50)<25 ppb,CaNO≤5 ppb;Ⅱ组:FeNO_(50)≥25 ppb,CaNO≤5 ppb;Ⅲ组:FeNO_(50)<25 ppb,CaNO>5 ppb;Ⅳ组:FeNO_(50)≥25 ppb,CaNO>5 ppb)。对所有患者使用全身糖皮质激素治疗。分别记录入院时及出院时的FeNO_(50)水平、CaNO水平、外周血嗜酸性粒细胞(EOS)、肺功能[第1秒用力呼气容积(FEV1)]、慢性阻塞性肺疾病评估测试(CAT)评分。使用Pearson相关性分析EOS、FeNO_(50)、CaNO三者关系,比较4组间FEV1、CAT评分治疗前后的改善值变化情况;采用受试者工作特征曲线(ROC)分析FeNO_(50)、CaNO、EOS对治疗后肺功能改善的预测价值。结果:各组患者的年龄、性别、身体质量指数(BMI)、吸烟史及平素症状之间比较,差异无统计学意义(P>0.05)。Pearson分析提示入院时EOS与FeNO_(50)呈正相关(r=0.521,P<0.05);经过治疗,EOS改善值与FeNO_(50)改善值呈正相关(r=0.472,P<0.05)。经全身糖皮质激素治疗后,4组间FEV1改善值、CAT评分改善值差异均有统计学意义(P<0.001;P=0.002);Ⅳ组患者较其他三组FEV1改善值更明显,差异有统计学意义(P<0.05),Ⅲ组和Ⅳ组患者较其他两组CAT评分改善更明显,差异有统计学意义(P<0.05)。ROC曲线下面积未观察到EOS、FeNO_(50)、CaNO对AECOPD患者治疗后肺功能显著改善有明显预测价值。结论:FeNO_(50)+CaNO联合检测对AECOPD患者使用全身糖皮质激素疗效具有一定的预测作用,FeNO_(50)与CaNO均升高的患者经全身糖皮质激素治疗后肺功能的改善更明显,而CANO升高的患者治疗后症状的改善更明显,但有待扩大样本�Objective To explore the application value of combined detection of fractional exhaled nitric oxide at an exhaled airflow rate of 50 mL·s^(-1)(FeNO_(50))and alveolar exhaled nitric oxide(CaNO)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with glucocorticoids.Methods Prospective enrollment of 62 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine at Shenzhen Second People's Hospital from June 1,2021 to May 31,2023.They were categorized into four groups based on their FeNO_(50) and CaNO levels upon admission(Group Ⅰ:FeNO_(50)<25 ppb,CaNO≤5 ppb;Group Ⅱ:FeNO_(50)≥25 ppb,CaNO≤5 ppb;Group Ⅲ:FeNO_(50)<25 ppb,CaNO>5 ppb;Group Ⅳ:FeNO_(50)≥25 ppb,CaNO>5 ppb).All patients received treatment with systemic glucocorticoids.The levels of FeNO_(50),CaNO,peripheral blood eosinophils(EOS),pulmonary function[(forced expiratory volume in the first second(FEV1)],and chronic obstructive pulmonary disease assessment test(CAT)scores were measured at admission and discharge.Pearson correlation analysis was conducted to examine the relationship between EOS,FeNO_(50),and CaNO.The improvement in FEV1 and CAT scores before and after treatment was compared among the 4 groups.Furthermore,the predictive value of FeNO_(50),CaNO,and EOS on lung function improvement after treatment was assessed using receiver operating characteristic curve(ROC).Results There were no significant differences in age,sex,body mass index(BMI),smoking history and normal symptoms among all groups(P>0.05).Pearson analysis showed that there was a positive correlation between EOS and FeNO_(50)(r=0.521,P<0.05).After treatment,the improvement value of EOS was positively correlated with that of FeNO_(50)(r=0.472,P<0.05).After systemic glucocorticoid treatment,there were statistically significant differences in FEV1 improvement and CAT score improvement among the 4 groups(P<0.001;P=0.002).Compared with the other three groups,the improvement of FEV1 in group Ⅳ was more obvious,and the di

关 键 词：慢性阻塞性肺疾病急性加重期 呼出气一氧化氮 肺泡呼出气一氧化氮 联合检测 外周血嗜酸性粒细胞计数 

分 类 号：R563.9[医药卫生—呼吸系统]