气道直径的变化是呼出气一氧化氮评估哮喘控制能力的主要决定因素
2017/09/29
摘要
气道口径的变化减弱了呼出的一氧化氮（FENO）的潜在价值并可能妨碍FeNO捕获哮喘控制的变化。在这里，我们的目的是评估1秒钟用力呼气量（FEV1）的变化,是否改变FENO反映哮喘控制的能力。
在对527例患者的1819对访问中，FeNO，控制哮喘（哮喘控制问卷（ACQ））及FEV1测量至少两次。其决定因素FENO–ACQ不一致概率通过Logistic回归进行分析评价。对FENO在捕获两次随访之间哮喘控制的恶化或改善有效性，进行分层ROC曲线分析评价。
当FEV1与FeNO变化同向时，FENO与ACQ的不一致倍率为3（P＜0.001）。曲线值下面积为0.765（95% CI 0.713–0.805）（改进；P＜0.001）和0.769（95% 0.706–0.810）（恶化；P＜0.001）或当FEV1和FeNO改变方向分别相反或相同时，曲线值下面积为0.590（95% 0.531–0.653）（改进；P = 0.001）和0.498（95% 0.416–0.567）（恶化；p=0.482）。
但哮喘控制变化时，FEV1与FeNO变化伴随方式决定其捕捉到哮喘控制变化的能力：平行或相反的FEV1和FeNO的变化，增加或减少这种捕捉哮喘控制的变化能力。
Airway calibre variation is a major determinant of exhaled nitric oxide’s ability to capture asthma control
Alain Michils, Amaryllis Haccuria, Sebastien Michiels and Alain Van Muylem
ABSTRACT
Changes in airway calibre have the potential to modify exhaled nitric oxide fraction (FENO)values and could hamper how FENO captures changes in asthma control. Here, our objective was to assess whether forced expiratory volume in 1 s (FEV1) variations alter the ability of FENO to reflect asthma control.
FENO, asthma control (Asthma Control Questionnaire (ACQ)) and FEV1 were measured at least two times in 527 patients during 1819 pairs of visits. Determinants of FENO–ACQ discordance probability were evaluated through a logistic regression analysis. The effectiveness of FENO at capturing either asthma control worsening or improvement between two visits was then assessed by undertaking a stratified receiver operating characteristic curves analysis.
When FEV1 and FENO change in the same direction, the odds of FENO–ACQ being discordant are multiplied by 3 (p<0.001). The area under the curve values were 0.765 (95% CI 0.713–0.805) (improvement; p<0.001) and 0.769 (95% 0.706–0.810) (worsening; p<0.001) or 0.590 (95% 0.531–0.653) (improvement; p=0.001) and 0.498 (95% 0.416–0.567) (worsening; p=0.482) when FEV1 and FENO changed in the opposite or same direction, respectively.
The manner in which FENO and FEV1 vary concomitantly when asthma control changes determines the ability of FENO to capture this change: parallel or opposite changes in FEV1 and FENO either decrease or increase this ability to capture asthma control changes.
气道口径的变化减弱了呼出的一氧化氮（FENO）的潜在价值并可能妨碍FeNO捕获哮喘控制的变化。在这里，我们的目的是评估1秒钟用力呼气量（FEV1）的变化,是否改变FENO反映哮喘控制的能力。
在对527例患者的1819对访问中，FeNO，控制哮喘（哮喘控制问卷（ACQ））及FEV1测量至少两次。其决定因素FENO–ACQ不一致概率通过Logistic回归进行分析评价。对FENO在捕获两次随访之间哮喘控制的恶化或改善有效性，进行分层ROC曲线分析评价。
当FEV1与FeNO变化同向时，FENO与ACQ的不一致倍率为3（P＜0.001）。曲线值下面积为0.765（95% CI 0.713–0.805）（改进；P＜0.001）和0.769（95% 0.706–0.810）（恶化；P＜0.001）或当FEV1和FeNO改变方向分别相反或相同时，曲线值下面积为0.590（95% 0.531–0.653）（改进；P = 0.001）和0.498（95% 0.416–0.567）（恶化；p=0.482）。
但哮喘控制变化时，FEV1与FeNO变化伴随方式决定其捕捉到哮喘控制变化的能力：平行或相反的FEV1和FeNO的变化，增加或减少这种捕捉哮喘控制的变化能力。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Eur Respir J 2017;50:1700392 doi.10.1183/13993003.00392-2017 May 17 2017）
（Eur Respir J 2017;50:1700392 doi.10.1183/13993003.00392-2017 May 17 2017）
Airway calibre variation is a major determinant of exhaled nitric oxide’s ability to capture asthma control
Alain Michils, Amaryllis Haccuria, Sebastien Michiels and Alain Van Muylem
ABSTRACT
Changes in airway calibre have the potential to modify exhaled nitric oxide fraction (FENO)values and could hamper how FENO captures changes in asthma control. Here, our objective was to assess whether forced expiratory volume in 1 s (FEV1) variations alter the ability of FENO to reflect asthma control.
FENO, asthma control (Asthma Control Questionnaire (ACQ)) and FEV1 were measured at least two times in 527 patients during 1819 pairs of visits. Determinants of FENO–ACQ discordance probability were evaluated through a logistic regression analysis. The effectiveness of FENO at capturing either asthma control worsening or improvement between two visits was then assessed by undertaking a stratified receiver operating characteristic curves analysis.
When FEV1 and FENO change in the same direction, the odds of FENO–ACQ being discordant are multiplied by 3 (p<0.001). The area under the curve values were 0.765 (95% CI 0.713–0.805) (improvement; p<0.001) and 0.769 (95% 0.706–0.810) (worsening; p<0.001) or 0.590 (95% 0.531–0.653) (improvement; p=0.001) and 0.498 (95% 0.416–0.567) (worsening; p=0.482) when FEV1 and FENO changed in the opposite or same direction, respectively.
The manner in which FENO and FEV1 vary concomitantly when asthma control changes determines the ability of FENO to capture this change: parallel or opposite changes in FEV1 and FENO either decrease or increase this ability to capture asthma control changes.
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