持续性鼻炎的诊断分类及其与呼出一氧化氮和哮喘的关系*
2007/06/27
持续性鼻炎（persistent rhinitis）按临床诊断分类主要分为变态反应性鼻炎（allergic rhinitis，AR）、慢性鼻窦炎(chronic rhinosinusitis， CRS)和非变应性鼻炎(nonallergic rhinitis， NAR)。我们知道,鼻炎和哮喘是一类综合症的不同表现, 那些具有持续性鼻炎、下呼吸道炎性改变和症状以及符合哮喘标准的肺功能异常表现的患者更应该与变态反应性鼻炎 (AR)和慢性鼻窦炎(CRS)结合在一起考虑，而不是非变应性鼻炎(NAR)。为了研究持续性鼻炎的诊断分类与哮喘等之间的关系, Giovanni Rolla等学者从590名近1年内有鼻炎症状的患者中选出108名患者进行研究，入选标准需鼻炎症状持续4 周以上。以是否有哮喘症状，支气管舒张试验阳性，有或无乙酰胆碱高反应性来诊断是否患有哮喘。以50mL/s单次呼气法测呼出一氧化氮(FENO)的值。结果,39%的患者诊断为AR，21%的诊断为NAR，40%诊断为CRS。AR组(33%)和CRS组(42%)的哮喘患病率与NAR组(8.7%)相比显著增高。AR组和CRS组的FENO与NAR组相比显著增高。哮喘患者的FENO值与非哮喘患者相比显著增高。
从而得出结论:持续性鼻炎的分类诊断有助于预测下呼吸道炎症反应(表现为FENO值
从而得出结论:持续性鼻炎的分类诊断有助于预测下呼吸道炎症反应(表现为FENO值
增高)和哮喘的患病率：AR和CRS患者相较NAR患者有较高的FENO值和哮喘患病率。
（于娜 沈阳中国医科大学附属一院呼吸科 110001 摘译）
( Chest. 2007;131:1345-1352)
Key Words: allergy·asthma·chronic rhinosinusitis·exhaled breath analysis·exhaled nitric oxide·rhinitis
Diagnostic Classification of Persistent Rhinitis and Its Relationship to Exhaled Nitric Oxide and Asthma
A Clinical Study of a Consecutive Series of Patients
Giovanni Rolla, MD, FCCP; Giuseppe Guida, MD; Enrico Heffler, MD; Iuliana Badiu, MD; Luisa Bommarito, MD; Antonella De Stefani, MD; Antonio Usai, MD; Domenico Cosseddu, MD; Franco Nebiolo, MD and Caterina Bucca, MD
Abstract摘要
Background: Rhinitis and asthma represent the manifestation of one syndrome. Our hypothesis is that in patients with symptoms of persistent rhinitis, lower airway inflammation, lower respiratory symptoms, and lung function abnormalities compatible with asthma are more frequently associated with the diagnosis of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) than with nonallergic rhinitis (NAR).
Methods: One hundred eight of 590 consecutive patients referred in 1 year for rhinitis were enrolled on the basis of nasal symptoms lasting>4 weeks. Asthma was diagnosed on the basis of symptoms and a positive bronchodilation testing result and/or methacholine hyperresponsiveness. Exhaled nitric oxide (FENO) was measured with the single exhalation method at. 50mL/s
Results: AR was diagnosed in 39%, NAR in 21%, and CRS in 40%. The prevalence of asthma was significantly higher in AR patients (33%) and CRS patients (42%) than in NAR patients (8.7%) [p=0.036 and p=0.005, respectively]. FENO was significantly higher in patients with AR and CRS compared to patients with NAR (44.3 parts per billion [ppb]; 95% confidence interval [CI], 34 to 54 ppb; and 53 ppb; 95% CI, 42 to 64 ppb; vs 22 ppb; 95% CI, 18 to 27 ppb; p=0.002 and p=0.001, respectively). Patients with asthma had FENO values significantly higher than patients without asthma (64 ppb; 95% CI, 51 to 77 ppb; vs 33.3 ppb; 95% CI, 28 to 39 ppb; p<0.001).
Conclusions: The diagnostic classification of persistent rhinitis helps to predict lower airway inflammation (increased FENO) and prevalence of asthma: AR and CRS are associated with higher mean FENO values and higher prevalence of asthma than NAR.
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哮喘患者呼吸道热量和湿气流失与嗜酸性粒细胞炎症有关
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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
