不同严重程度哮喘患者呼出一氧化氮的差流分析（Differential Flow Analysis）
2007/06/27
目前大多数哮喘患者病情都能够得到控制，但仍有一些哮喘患者病情未得到有效控制。为了帮助临床医生对哮喘进行病情监测，提高疗效，Caterina Brindicci等对56名不同严重程度哮喘患者(轻度10人;中度稳态17人;中度恶化11人;重度18人。其中有7人口服糖皮质激素)进行对照研究，测定其呼出一氧化氮（NO）的不同流速从而反应中心和周围气道的炎症程度，加以量化，并重复测量评估该方法。结果显示轻度哮喘患者组支气管一氧化氮(JNO)的流速(2,363±330 pL/s) 高于中度稳定哮喘患者组(1,300±59 pL/s, p < 0.0005)、吸入糖皮质激素治疗(ICS)的重度哮喘患者组（1,015 ± 67 pL/s, p < 0.0005）以及健康对照组(721±22 pL/s, p < 0.0001)。轻度哮喘患者组JNO的值与同时给予口服和吸入糖皮质激素治疗的重度哮喘患者组间无显著性差异(2,225±246 pL/s)。有恶化的患者与其它各组相比有一个较高的JNO(3,475±368.9 pL/s, p < 0.05)。与其它各组相比，口服糖皮质激素治疗的重度哮喘患者组的肺泡NO值较高(3.0±0.1 parts per billion [ppb], p < 0.0001)，但与中度恶化组相比无显著差异(2.8±0.3 ppb)。不同组间的NO弥散水平无差异。所有的测量方法具有高度可重复性，忽略日间和昼夜变异所引起的差异。从而得出结论：呼出NO的差流分析有助于判断哮喘患者气道炎症的发生部位，还可以用于评估周围气道炎症的疗效。
Key Words: asthma·different flow rates·exhaled nitric oxide·inflammation·small airways
（于娜 沈阳,中国医科大学附属一院呼吸科 110001 摘译 ）
(Chest. 2007;131:1353-1362 )
Key Words: asthma·different flow rates·exhaled nitric oxide·inflammation·small airways
Differential Flow Analysis of Exhaled Nitric Oxide in Patients With Asthma of Differing Severity
Caterina Brindicci, MD; Kazuhiro Ito, PhD; Peter J. Barnes, DM, DSc, FCCP and Sergei A. Kharitonov, MD, PhD
Abstract 摘要
Background: The majority of asthmatic patients achieve control of their illness; others do not. It is therefore crucial to validate/develop strategies that help the clinician monitor the disease, improving the response to treatment.
Methods: We have quantified the inflammation in central and peripheral airways by measuring exhaled nitric oxide (NO) at multiple exhalation flows in 56 asthmatics at different levels of severity (mild, n = 10; moderate stable, n=17; moderate during exacerbation, n=11; severe, n=18, 7 of whom were receiving oral corticosteroids) and 18 healthy control subjects. The reproducibility of the measurement was also assessed.
Results: Bronchial NO (JNO) in patients with mild asthma (2,363±330 pL/s) [mean±SD] was higher than in patients with moderate stable asthma (1,300±59 pL/s, p < 0.0005), in patients with severe asthma receiving inhaled corticosteroids (ICS) [1,015±67 pL/s, p < 0.0005], and healthy control subjects (721±22 pL/s, p < 0.0001). There were no differences between JNO in patients with mild asthma compared to patients with severe asthma receiving ICS and oral corticosteroids (2,225±246 pL/s). Patients with exacerbations showed a higher JNO (3,475 ± 368.9 pL/s, p < 0.05) compared to the other groups. Alveolar NO was higher in patients with severe asthma receiving oral corticosteroids (3.0±0.1 parts per billion [ppb], p < 0.0001) than in the other groups but was not significantly higher than in patients with moderate asthma during exacerbation (2.8±0.3 ppb). No differences were seen in NO diffusion levels between the different asthma groups. All the measurements were highly reproducible and free of day-to-day and diurnal variations.
Conclusions: Differential flow analysis of exhaled NO provides additional information about the site of inflammation in asthma and may be useful in assessing the response of peripheral inflammation to therapy.
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高渗盐水诱导痰法在运动诱发型支气管痉挛患者中的安全性评估
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