[1]刘国华,袁晓梅,张志强,等.呼出气一氧化氮在嗜酸性粒细胞表型支气管哮喘患者的诊断及吸入糖皮质激素治疗效果评价中的价值[J].新乡医学院学报,2017,34(9):836-839.[doi:10.7683/xxyxyxb.2017.09.015]
　LIU Guo-hua,YUAN Xiao-mei,ZHANG Zhi-qiang,et al.Value of fractional exhaled nitric oxide in diagnosing of eosinophils bronchial asthma and in appraising of therapeutic reaction of inhaled corticosteroids for eosinophils bronchial asthma[J].Journal of Xinxiang Medical University,2017,34(9):836-839.[doi:10.7683/xxyxyxb.2017.09.015]
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呼出气一氧化氮在嗜酸性粒细胞表型支气管哮喘患者的诊断及吸入糖皮质激素治疗效果评价中的价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年9
页码:
836-839
栏目:
临床研究
出版日期:
2017-09-05

文章信息/Info

Title:
Value of fractional exhaled nitric oxide in diagnosing of eosinophils bronchial asthma and in appraising of therapeutic reaction of inhaled corticosteroids for eosinophils bronchial asthma
作者:
刘国华; 袁晓梅; 张志强; 孙春霞; 郭悦鹏
（新乡医学院第一附属医院呼吸科，河南　新乡　453100）
Author(s):
LIU Guo-hua; YUAN Xiao-mei; ZHANG Zhi-qiang; SUN Chun-xia; GUO Yue-peng
（Department of Respiratory Medicine，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China）
关键词:
支气管哮喘; 呼出气一氧化氮; 哮喘控制测试; 诱导痰; 嗜酸性粒细胞
Keywords:
bronchial asthma; ractional exhaled nitric oxide; asthma control test; induced sputum; eosinophils
分类号:
R562.2
DOI:
10.7683/xxyxyxb.2017.09.015
文献标志码:
A
摘要:
目的　探讨呼出气一氧化氮（FeNO）在嗜酸性粒细胞（EOS）表型支气管哮喘的诊断及吸入糖皮质激素（ICS）治疗效果评价中的价值。方法　选择2015年4月至2016年2月新乡医学院第一附属医院收治的支气管哮喘患者62例为哮喘组，另选择体检健康者62例为对照组。哮喘组患者根据诱导痰细胞计数分为EOS哮喘组（n=31）和非EOS哮喘组（n=31），其中EOS哮喘组根据疾病严重程度又分为轻度哮喘组（n=7）、中度哮喘组（n=13）和重度哮喘组（n=11）。哮喘组患者给予常规治疗（多索茶碱0.2 g 静脉输液，每日2次；西替利嗪10 mg，每晚1次口服；孟鲁斯特10 mg，每晚1次口服；雾化吸入布地奈德2 mg和复方异丙托溴铵2.5 mL雾化溶液，每日2次），共7 d。分别于治疗前后检测患者的肺功能、哮喘控制测试（ACT）评分、FeNO水平及诱导痰EOS比例；对照组受试者检测FeNO水平。比较各组研究对象的FeNO水平及哮喘组患者的控制率，分析哮喘组FeNO水平与EOS比例的相关性。结果　治疗前，对照组和哮喘组受试者FeNO水平分别为（9.57±6.61）、（30.23±8.91）ppb，对照组受试者FeNO水平显著低于哮喘组（t=7.414，P<0.05）；EOS哮喘组和非EOS哮喘组患者FeNO水平分别为（59.62±29.04）、（18.20±11.33）ppb，非EOS哮喘组患者FeNO水平显著低于EOS哮喘组（t=6.568，P<0.05）。哮喘组患者的FeNO水平与EOS比例呈正相关（r=0.823，P<0.05）。非EOS哮喘组患者治疗前后FeNO水平比较差异无统计学意义（t=2.013，P>0.05）。EOS哮喘组患者治疗后FeNO水平低于治疗前（t=7.740，P<0.05）；其中轻、中、重度哮喘组患者治疗后FeNO水平均低于治疗前（P<0.05）。EOS哮喘组患者的控制率为67.7%（21/31），高于非EOS哮喘组患者的22.6%（7/31）（χ2=12.765，P<0.05）。轻、中、重度哮喘组患者的控制率分别为28.6%（2/7）、76.9%（10/13）、81.8%（9/11），轻度哮喘组患者的控制率低于中、重度哮喘组（χ2=6.418、7.103，P<0.05）；中度哮喘组与重度哮喘组患者的控制率比较差异无统计学意义（χ2=0.087，P>0.05）。结论　FeNO水平能反映EOS支气管哮喘患者气道炎症程度，可用于EOS表型支气管哮喘的诊断，对EOS支气管哮喘患者ICS治疗效果评价有一定临床价值。
Abstract:
Objective　To determine the diagnostic value of ractional exhaled nitric oxide（FeNO） in eosinophils（EOS） bronchial asthma and its significance in appraising of therapeutic reaction of inhaled corticosteroids（ICS） for EOS bronchial asthma.Methods　A total of sixty-two patients with bronchial asthma in the First Affiliated Hospital of Xinxiang Medical University from April 2015 to February 2016 were selected as asthma group；at the same time，sixty-two healthy people were recruited as control group.The patients in asthma group were divided into EOS asthma group（n=31） and non EOS asthma group（n=31） according to the induced sputum cell count；the patients in EOS asthma group were divided into mild（n=7），moderate（n=13） and sever asthma group（n=11） according to the severity of the disease.The patients in asthma group were given conventional therapy（doxofylline 0.2 g intravenous infusion，two times per day；oral cetirizine 10 mg，one time per night；oral montelukast 10 mg，one time per night；budesonide 2 mg and compound ipratropium bromide solution 2.5 mL by aerosol rebreathing method，two times per day） for seven days.The pulmonary function，asthma control test（ACT） score，FeNO level and the ratio of EOS of patients were detected before and after treatment；the FeNO levels of person in the control group were tested.The FeNO levels of subjects were compared in each group；the correlation between FeNO level and EOS ratio was analysed in asthmatic group；the controlling rates of patients in asthmatic group were compared.Results　Before treatment，the FeNO level in control group and asthma group was （9.57±6.61），（30.23±8.91）ppb respectively；the FeNO level in control group was significantly lower than that in asthma group（t=7.414，P<0.05）.Before treatment，the FeNO level of patients in EOS asthma group and non EOS asthma group was （59.62±29.04），（18.20±11.33）ppb respectively；the FeNO level in non EOS asthma group was lower than that in EOS asthma group（t=6.568，P<0.05）.In asthma group，the level of FeNO was positively correlated with EOS ratio（r=0.823，P<0.05）.There was no statistic difference in FeNO level of patients in non EOS asthma group before and after treatment（t=2.013，P>0.05）.The FeNO levels of patients in EOS asthma group after treatment were significantly lower than those before treatment（t=7.740，P<0.05）；the FeNO levels of patients in mild，moderate and sever asthma group after treatment were significantly lower than those before treatment（t=3.535，8.171，7.161；P<0.05）.The control rate of patients in EOS asthma group（67.7%，21/31） was significantly higher than that in the non EOS asthma group（22.6%，7/31）（χ2=12.765，P<0.05）.The control rate of patients in mild，moderate and sever asthma group was 28.6%（2/7），76.9%（10/13） and 81.8%（9/11） respectively；the control rate of patients in mild asthma group was significantly lower than that in moderate and sever asthma group （χ2=6.418，7.103;P<0.05）；there was no statistic difference in control rate of patients between moderate asthma group and sever asthma group（χ2=7.103，P>0.05）.Conclusion　FeNO level can reflect the degree of airway inflammation，and can be used for the diagnosis of EOS phenotype asthma，and also has certain clinical value in evaluating the therapeutic reaction of ICS for treatment of EOS asthma.

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更新日期/Last Update: 2017-09-05