呼出气一氧化氮判断哮喘急性加重期气流阻塞的能力
2018/07/09
摘要
目的：现已提出呼出气一氧化氮（FENO）水平作为哮喘中变应性炎症反应的非侵入性生物标志物。 临床实践中许多哮喘患者从未接受肺功能测定，并且最近的数据报告表明在内科医师诊断的哮喘患者中存在误诊的情况。 本研究的目的是评估FENO水平在哮喘患者中区分是否气流阻塞的能力。
方法：试验成员为频发加重的哮喘患者（在过去的12个月里出现2次及以上因哮喘急性加重而急诊就诊或住院治疗）。所有患者均接受诊断性评估，包括肺功能检查，FENO检测和血清IgE以及嗜酸性粒细胞的检验。 并且如所示进行连续肺功能检测和乙酰甲胆碱激发试验。 FEV1 / FVC比值降低（<70％和/或<正常值下限）或乙酰甲胆碱激发试验阳性便可诊断气道阻塞。
结果：在222例哮喘患者中，136例患者存在气道阻塞（86例无气道阻塞）。81.6％的气道阻塞患者和66.2％的非气道阻塞患者参与了FENO检测。 在气道阻塞患者中及非气道阻塞患者中平均中位FENO值没有显着差异（40.8对30.4ppb，P = 0.10）。同样，在两者之间血清IgE水平和血嗜酸性粒细胞数也没有差异。
结论：此次试验分析表明，在哮喘患者中，FENO水平并不能够区分是否存在气道阻塞。合并哮喘症状的患者FENO水平可能高于所建议的20-25ppb切割点。哮喘患者应该考虑其他的客观证据以诊断气道阻塞，而不是FENO水平。
Ability of Exhaled Nitric Oxide to Discriminate for Airflow Obstruction Among Frequent Exacerbators of Clinically Diagnosed Asthma
L Jalota L, Allison DR, Prajapati V, Vempilly JJ, Jain VV.
Abstract
Objective:Fraction of exhaled nitric oxide (FENO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. Many asthmatics in clinical practice have never had spirometry and recent data report misdiagnoses in patients with physician diagnosed (PD) asthma. The aim of this study was to assess the ability of FENO to discriminate between those with and without airflow obstruction (AO) among patients with PD-asthma.
Methods：Frequent exacerbators of PD-asthma (with 2 or more asthma exacerbations leading to emergency room visit or hospitalization within last 12 months) were enrolled. All patients underwent diagnostic evaluations including spirometry, FENO testing and serum immunoglobulin (IgE) and eosinophils. Serial spirometry and methacholine challenge testing (MCT) were performed as indicated. AO was defined by a decreased FEV1/FVC ratio (< 70% and/or < LLN), or a positive MCT.
Results：Of the 222 patients with PD-asthma, AO was found in 136 (vs. 86 without AO). 81.6% of patients with AO and 66.2% without AO completed FENO testing. There was no significant difference in the mean FENO levels among patients with or without AO (40.8 vs. 30.4 ppb, P = 0.10). Likewise, there was no difference in the serum IgE levels and serum eosinophils.
Conclusions:Our analyses suggest that FENO levels do not help discriminate between those with and without AO in patients with PD-asthma. Patients who experience symptoms of asthma may have elevated FENO levels above the suggested cut points of 20–25 ppb. Objective confirmation of AO should be considered in all patients with PD-asthma, irrespective of FENO levels.
目的：现已提出呼出气一氧化氮（FENO）水平作为哮喘中变应性炎症反应的非侵入性生物标志物。 临床实践中许多哮喘患者从未接受肺功能测定，并且最近的数据报告表明在内科医师诊断的哮喘患者中存在误诊的情况。 本研究的目的是评估FENO水平在哮喘患者中区分是否气流阻塞的能力。
方法：试验成员为频发加重的哮喘患者（在过去的12个月里出现2次及以上因哮喘急性加重而急诊就诊或住院治疗）。所有患者均接受诊断性评估，包括肺功能检查，FENO检测和血清IgE以及嗜酸性粒细胞的检验。 并且如所示进行连续肺功能检测和乙酰甲胆碱激发试验。 FEV1 / FVC比值降低（<70％和/或<正常值下限）或乙酰甲胆碱激发试验阳性便可诊断气道阻塞。
结果：在222例哮喘患者中，136例患者存在气道阻塞（86例无气道阻塞）。81.6％的气道阻塞患者和66.2％的非气道阻塞患者参与了FENO检测。 在气道阻塞患者中及非气道阻塞患者中平均中位FENO值没有显着差异（40.8对30.4ppb，P = 0.10）。同样，在两者之间血清IgE水平和血嗜酸性粒细胞数也没有差异。
结论：此次试验分析表明，在哮喘患者中，FENO水平并不能够区分是否存在气道阻塞。合并哮喘症状的患者FENO水平可能高于所建议的20-25ppb切割点。哮喘患者应该考虑其他的客观证据以诊断气道阻塞，而不是FENO水平。
（中日友好医院呼吸与危重症医学科 张 鑫 摘译 林江涛 审校）
（Lung:2018 Jun 18.10.）
（Lung:2018 Jun 18.10.）
Ability of Exhaled Nitric Oxide to Discriminate for Airflow Obstruction Among Frequent Exacerbators of Clinically Diagnosed Asthma
L Jalota L, Allison DR, Prajapati V, Vempilly JJ, Jain VV.
Abstract
Objective:Fraction of exhaled nitric oxide (FENO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. Many asthmatics in clinical practice have never had spirometry and recent data report misdiagnoses in patients with physician diagnosed (PD) asthma. The aim of this study was to assess the ability of FENO to discriminate between those with and without airflow obstruction (AO) among patients with PD-asthma.
Methods：Frequent exacerbators of PD-asthma (with 2 or more asthma exacerbations leading to emergency room visit or hospitalization within last 12 months) were enrolled. All patients underwent diagnostic evaluations including spirometry, FENO testing and serum immunoglobulin (IgE) and eosinophils. Serial spirometry and methacholine challenge testing (MCT) were performed as indicated. AO was defined by a decreased FEV1/FVC ratio (< 70% and/or < LLN), or a positive MCT.
Results：Of the 222 patients with PD-asthma, AO was found in 136 (vs. 86 without AO). 81.6% of patients with AO and 66.2% without AO completed FENO testing. There was no significant difference in the mean FENO levels among patients with or without AO (40.8 vs. 30.4 ppb, P = 0.10). Likewise, there was no difference in the serum IgE levels and serum eosinophils.
Conclusions:Our analyses suggest that FENO levels do not help discriminate between those with and without AO in patients with PD-asthma. Patients who experience symptoms of asthma may have elevated FENO levels above the suggested cut points of 20–25 ppb. Objective confirmation of AO should be considered in all patients with PD-asthma, irrespective of FENO levels.
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家务和职业清洁与肺功能衰退和气道阻塞相关
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预测哮喘急性发作未来风险的新型生物标志物-痰液与血清硫化氢比值
