呼出气一氧化氮和支气管舒张剂反应的联合使用在儿童过敏性哮喘控制失败中的预测作用
2017/07/12
摘要
背景和目的：识别哮喘发作风险患者对以后的哮喘护理和改善预后是很重要的。本研究的目的在于观察支气管舒张剂反应和呼出气一氧化氮的联合使用在儿童过敏性哮喘中的预测作用是否优于单一方法测定。
方法：本研究包括了201例8-16年间断或轻度持续的过敏性哮喘儿童。这些哮喘儿童不接受控制药物治疗，2年进行10次以上的肺功能测试（支气管舒张剂反应和呼出气一氧化氮）。完成监测后，观察哮喘控制失败情况1年。
结果：监测期间，受试者中59%的哮喘患者至少有一次支气管舒张剂反应阳性（FEV1增加率≥12%）和77%的哮喘患者至少有一次呼出气一氧化氮值高于35ppb。当进行连续变量分析时，支气管舒张剂反应（风险比率1.21;95%CI:1.04-1.41;P = 0.014））和呼出气一氧化氮(风险比率1.27; 95%CI:1.09-1.49;P = 0.003)均与哮喘控制失败的风险相关。与支气管舒张剂反应阳性(风险比率3.19;95% CI: 1.05-9.64)或呼出气一氧化氮高于35ppb(风险比率4.70; 95%CI:1.68-13.11)的患者相比，两者都有的患者（风险比率7.08;95%CI:2.57-19.49)哮喘控制失败的风险更高。
结论：本研究表明，支气管舒张剂反应和呼出气一氧化氮的联合使用可以纠正单一检测方法带来的预测风险。
Combined use of fractional exhaled nitric oxide and bronchodilator response in predicting future loss of asthma control among children with atopic asthma.
Kim JK1, Jung JY1, Kim H2, Eom SY2, Hahn YS1
Abstract
BACKGROUND AND OBJECTIVE:Recognition of patients at risk of asthma exacerbation is important for future asthma care and improved outcome. The aim of the present study was to see whether measurements of bronchodilator response (BDR) and fractional exhaled nitric oxide (FeNO) in combination provide prognostic information superior to either measurement alone in children with atopic asthma.
METHODS:A total of 201 atopic children aged 8-16 years with intermittent or mild persistent asthma were included. Pulmonary function tests including BDR and FeNO were serially monitored 10 times or more over 2 years when subjects were not receiving controller medications. After completion of monitoring, 1-year observation for a loss of asthma control was performed.
RESULTS:During the monitoring period, positive BDRs (≥12% in forced expiratory volume in 1 s (FEV1 ) from pre-bronchodilator value) and FeNO higher than 35 parts per billion (ppb) were observed at least once in 59% and 77% of participants. When analysed as continuous variables, both BDR (hazard ratio (HR): 1.21; 95% CI: 1.04-1.41; P = 0.014) and FeNO (HR: 1.27; 95% CI: 1.09-1.49; P = 0.003) were associated with increased risks for a control loss. Compared with patients showing either positive BDRs (HR: 3.19; 95% CI: 1.05-9.64) or FeNO higher than 35 ppb (HR: 4.70; 95% CI: 1.68-13.11), patients with both findings (HR: 7.08; 95% CI: 2.57-19.49) had greater risks for a control loss.
CONCLUSIONS:These data support that combined use of BDR and FeNO measurements can modify predictive risk obtained from either measurement alone.
背景和目的：识别哮喘发作风险患者对以后的哮喘护理和改善预后是很重要的。本研究的目的在于观察支气管舒张剂反应和呼出气一氧化氮的联合使用在儿童过敏性哮喘中的预测作用是否优于单一方法测定。
方法：本研究包括了201例8-16年间断或轻度持续的过敏性哮喘儿童。这些哮喘儿童不接受控制药物治疗，2年进行10次以上的肺功能测试（支气管舒张剂反应和呼出气一氧化氮）。完成监测后，观察哮喘控制失败情况1年。
结果：监测期间，受试者中59%的哮喘患者至少有一次支气管舒张剂反应阳性（FEV1增加率≥12%）和77%的哮喘患者至少有一次呼出气一氧化氮值高于35ppb。当进行连续变量分析时，支气管舒张剂反应（风险比率1.21;95%CI:1.04-1.41;P = 0.014））和呼出气一氧化氮(风险比率1.27; 95%CI:1.09-1.49;P = 0.003)均与哮喘控制失败的风险相关。与支气管舒张剂反应阳性(风险比率3.19;95% CI: 1.05-9.64)或呼出气一氧化氮高于35ppb(风险比率4.70; 95%CI:1.68-13.11)的患者相比，两者都有的患者（风险比率7.08;95%CI:2.57-19.49)哮喘控制失败的风险更高。
结论：本研究表明，支气管舒张剂反应和呼出气一氧化氮的联合使用可以纠正单一检测方法带来的预测风险。
(中日友好医院医院呼吸与危重症医学科王瑞茵摘译 林江涛审校)
（Respirology. 2017 Apr;22(3):466-472.）
Combined use of fractional exhaled nitric oxide and bronchodilator response in predicting future loss of asthma control among children with atopic asthma.
Kim JK1, Jung JY1, Kim H2, Eom SY2, Hahn YS1
Abstract
BACKGROUND AND OBJECTIVE:Recognition of patients at risk of asthma exacerbation is important for future asthma care and improved outcome. The aim of the present study was to see whether measurements of bronchodilator response (BDR) and fractional exhaled nitric oxide (FeNO) in combination provide prognostic information superior to either measurement alone in children with atopic asthma.
METHODS:A total of 201 atopic children aged 8-16 years with intermittent or mild persistent asthma were included. Pulmonary function tests including BDR and FeNO were serially monitored 10 times or more over 2 years when subjects were not receiving controller medications. After completion of monitoring, 1-year observation for a loss of asthma control was performed.
RESULTS:During the monitoring period, positive BDRs (≥12% in forced expiratory volume in 1 s (FEV1 ) from pre-bronchodilator value) and FeNO higher than 35 parts per billion (ppb) were observed at least once in 59% and 77% of participants. When analysed as continuous variables, both BDR (hazard ratio (HR): 1.21; 95% CI: 1.04-1.41; P = 0.014) and FeNO (HR: 1.27; 95% CI: 1.09-1.49; P = 0.003) were associated with increased risks for a control loss. Compared with patients showing either positive BDRs (HR: 3.19; 95% CI: 1.05-9.64) or FeNO higher than 35 ppb (HR: 4.70; 95% CI: 1.68-13.11), patients with both findings (HR: 7.08; 95% CI: 2.57-19.49) had greater risks for a control loss.
CONCLUSIONS:These data support that combined use of BDR and FeNO measurements can modify predictive risk obtained from either measurement alone.
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