哮喘联盟

   摘要
   背景：近期有研究证实，呼出气一氧化碳(FENO)与其他哮喘控制指标并不一致。本研究旨在阐述和验证新肺功能与肺部炎症的比值。
   方法：本研究为回顾性横断面研究，数据来源于1,529例（年龄4-24岁）伴有哮喘相关症状的儿童、青少年以及少部分（占研究人群的2%）青壮年的病历记录。本研究为首个分析以此种方式（在药物治疗之前）取得的下述结果的研究：FENO、肺活量测定、气道特异性阻力、过敏性疾病的诊断、变应原的致敏性（特异性IgE）。
   结果：本研究中哮喘诊断新指标的临界值如下：FVC/FENO = 0.17 L/ppb，FEV1/FENO= 0.15 L/ppb，FEF25-75%/ FENO= 0.16 L/ppb，FENO/FVC = 11.00 ppb/L，FENO/FEV1 = 12.53 ppb/L，FENO/FEF25-75% = 11.81 ppb/L。只有以上比值与哮喘的诊断密切相关，且这些比值彼此密切相关。以上比值在哮喘患者和健康受试者之间有显著差异，男性和女性之间亦如此。仅有FEF25-75%/FENO和FENO/FEF25-75% 的值是研究对象任何致敏反应的重要预测因子。本研究发现，FVC/FENO、FEV1/FENO及FEF25-75%/FENO的敏感性高于特异性，且阳性预测值高于阴性预测值；而FENO/FVC、FENO/FEV1及FENO/FEF25-75%则呈现镜像效果。但是，在使用新参数的情况下，阳性预测值和阴性预测值在诊断哮喘的准确性上缺乏说服力。
   结论：本研究提出的新指标¬即肺功能与肺部炎性标志物的比值，使得在肺活量测定和FENO测定的基础上诊断儿童、青少年哮喘成为可能。本研究提出的各项比值为哮喘诊断的常用参数提供了进一步的支持。
 

（杨冬 审校）
Respir Care. 2015 Dec 1.pii: respcare.04092. [Epub ahead of print]

 

Spirometry-Adjusted Fraction of Exhaled Nitric Oxide Allows Asthma Diagnosis in Children, Adolescents, and Young Adults.
 

Grzelewski T1, Stelmach W2, Stelmach R3, Janas A3, Grzelewska A4, Witkowski K5, Makandjou-Ola E6, Majak P7, Stelmach I8.

 

Abstract
BACKGROUND:Recently, it has been proved that fractional exhaled nitric oxide (FENO) results are in disagreement with other measurements of asthma control. The objective of this work is to present and validate new lung function/lung inflammation ratios.
METHODS:This is a retrospective, cross-sectional study in which we evaluated data from medical documentation of 1,529 pediatric and adolescent subjects and a small number (2% of the studied population) of young adults, who presented symptoms suggestive of asthma (age range 4-24 y). We are the first to analyze results obtained in this manner (before the introduction of controlled medication): FENO, spirometry, specific resistance of the airways, diagnosis of allergic diseases, and allergen sensitization (specific immunoglobulin E results).
RESULTS:Cut-off points for the new indicators allowed us to diagnose asthma in the study participants: for FVC/FENO ratio, 0.17 L/ppb; for FEV1/FENO ratio, 0.15 L/ppb; for forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%)/FENO ratio, 0.16 L/ppb; for FENO/FVC ratio, 11.00 ppb/L; for FENO/FEV1 ratio, 12.53 ppb/L; and for FENO/FEF25-75% ratio, 11.81 ppb/L. Only the ratios described above were closely correlated with the diagnosis of asthma and with one another. They significantly differed between subjects with asthma and healthy subjects as well as between females and males. Only FEF25-75%/FENO and FENO/FEF25-75% values were significant predictors of any sensitization in the studied subjects. We found higher sensitivity than specificity and higher positive predictive value than negative predictive value for FVC/FENO, FEV1/FENO, and FEF25-75%/FENO and found a mirror image for reverse parameters. However, the positive predictive values and negative predictive values were not clearly convincing with respect to diagnostic accuracy in the case of the new parameters proposed.
CONCLUSIONS:We propose new lung function/lung inflammation ratios by which it may become possible to diagnose asthma in children and adolescents on the basis of a subject's spirometry and FENO measurements. We believe that our ratios are only supportive of the universally used parameters in the process of diagnosing asthma.
 

Respir Care. 2015 Dec 1.pii: respcare.04092. [Epub ahead of print]