气道直径变化是决定呼出气一氧化氮（FENO）反应哮喘控制状态的重要因素
2017/12/29
摘要
背景：气道直径的变化有可能改变呼出气一氧化氮分数 (FENO) 的值, 并可能影响FENO 反应哮喘控制状态。本研究的主要目的为评估FEV1的变化是否会影响FENO反应哮喘控制状态。
方法：在1819位2次访视的患者中，选择527位患者为研究对象，至少2次测量FENO，FEV1和以哮喘控制问卷 (ACQ)评估的哮喘控制状态。通过logistic回归模型分析影响FENO和ACQ不一致的决定因素。通过分层的受试者测定特征曲线（ROC）评估FENO在反应两次访视前后哮喘控制恶化或改善方面的有效性。
结果：当 FEV1 和 FENO 在同方向变化时, FENO–ACQ的不一致概率扩大了3倍 (p<0.001)。当 FEV1 和 FENO反向变化时，ROC曲线下面积为 0.765 (95% CI 0.713–0.805) (改善; p< 0.001) 和 0.769 (95% CI 0.706–0.810) (恶化; p <0.001)。当 FEV1 和 FENO同向变化时，ROC曲线下面积为0.590 (95% CI 0.531–0.653) (改善; p = 0.001) 和 0.498 (95% CI 0.416–0.567) (恶化; p = 0.482)。
结论：当哮喘控制状态改变时，FENO和FEV1都随之改变，以此决定了FENO反应这种改变的能力：FENO和FEV1的平行或反向变化可降低或增加FENO反应哮喘控制状态的能力。
Airway calibre variation is a major determinant of exhaled nitric oxide's ability to capture asthma control
Alain Michils, Amaryllis Haccuria, Sebastien Michiels,et al
Abstract
Groundback：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.
Method：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.
Results: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.
Conclusions：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.
背景：气道直径的变化有可能改变呼出气一氧化氮分数 (FENO) 的值, 并可能影响FENO 反应哮喘控制状态。本研究的主要目的为评估FEV1的变化是否会影响FENO反应哮喘控制状态。
方法：在1819位2次访视的患者中，选择527位患者为研究对象，至少2次测量FENO，FEV1和以哮喘控制问卷 (ACQ)评估的哮喘控制状态。通过logistic回归模型分析影响FENO和ACQ不一致的决定因素。通过分层的受试者测定特征曲线（ROC）评估FENO在反应两次访视前后哮喘控制恶化或改善方面的有效性。
结果：当 FEV1 和 FENO 在同方向变化时, FENO–ACQ的不一致概率扩大了3倍 (p<0.001)。当 FEV1 和 FENO反向变化时，ROC曲线下面积为 0.765 (95% CI 0.713–0.805) (改善; p< 0.001) 和 0.769 (95% CI 0.706–0.810) (恶化; p <0.001)。当 FEV1 和 FENO同向变化时，ROC曲线下面积为0.590 (95% CI 0.531–0.653) (改善; p = 0.001) 和 0.498 (95% CI 0.416–0.567) (恶化; p = 0.482)。
结论：当哮喘控制状态改变时，FENO和FEV1都随之改变，以此决定了FENO反应这种改变的能力：FENO和FEV1的平行或反向变化可降低或增加FENO反应哮喘控制状态的能力。
(复旦大学附属中山医院 呼吸科 胡湘麟 摘译 杨冬 审校)
(European Respiratory Journal 2017 50)
(European Respiratory Journal 2017 50)
Airway calibre variation is a major determinant of exhaled nitric oxide's ability to capture asthma control
Alain Michils, Amaryllis Haccuria, Sebastien Michiels,et al
Abstract
Groundback：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.
Method：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.
Results: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.
Conclusions：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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