花粉季节在青年人中筛查哮喘的工具——便携式一氧化氮呼气装置
2008/06/06
呼气一氧化氮浓度（FeNO）对哮喘患者的随访很有价值。但是，其作为筛查工具是否有效仍未明确。就此，Konstantinos Kostikas等人将一份曾经用于筛查哮喘相关性呼吸症状的欧洲呼吸健康调查问卷进行修改，选择了961名大学生进行问卷调查。选择没有呼吸系统症状者作为健康对照（70例）。问卷中至少有一个问题选择了肯定答案的受试者（149例）都应用便携式NO分析仪测出了FeNO，并且都进行了肺量测定，然后由不知晓受试者FeNO的专业医生进行评估。结果有63例诊断哮喘，57例诊断过敏性鼻炎。哮喘患者的FeNO值相较对照组明显要高（p < 0.0001），但与过敏性鼻炎组比没有明显差异（p = 0.28）。FeNO > 19 ppb时，诊断哮喘的特异性为85.2%，敏感性为54.2%（曲线下面积AUC为0.723）。不吸烟者的FeNO诊断效果要比吸烟者好(AUC, 0.805)，但无论是否吸烟，在FeNO > 25 ppb时，特异性都会> 90%。尽管如此，FeNO指标用于区分哮喘和过敏性鼻炎效果仍不理想。
这项研究指出，便携式分析仪测得的FeNO，对于在青年人筛查哮喘是很效的。但是同时过敏性鼻炎和吸烟者作为显著的干扰因素不能忽视。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘择）
(Chest. 2008; 133:906-913)
Portable Exhaled Nitric Oxide as a Screening Tool for Asthma in Young Adults During Pollen Season*
Konstantinos Kostikas, MD; Andriana I. Papaioannou, MD; Kalliopi Tanou, MD; Angela Koutsokera, MD; Maria Papala, MD and Konstantinos I. Gourgoulianis, MD
Abstract
Background: The fraction of exhaled NO (FeNO) is valuable for the follow-up of asthmatic patients. However, its usefulness as a screening tool for asthma is not established.
Methods: We screened a population of 961 university students with a modified European Community Respiratory Health Survey questionnaire that has been previously used for the screening of respiratory symptoms related to asthma. All subjects with a positive answer to at least one question (n = 149) were submitted to FeNO measurement with a portable nitric oxide analyzer. Subsequently, they were submitted to spirometry and evaluated by a physician blinded to FeNO measurements. Seventy students with no respiratory symptoms served as control subjects.
Results: Asthma was diagnosed in 63 subjects, and allergic rhinitis was diagnosed in 57 subjects. Asthmatics presented higher FeNO values than control subjects (median, 20 parts per billion [ppb]; interquartile range, 14 to 31 ppb; vs median, 11 ppb; interquartile range, 7 to 13 ppb, respectively; p < 0.0001), whereas they did not differ from patients with allergic rhinitis (median, 17 ppb; interquartile range, 12 to 23 ppb; p = 0.28). FeNO values > 19 ppb presented 85.2% specificity and 52.4% sensitivity for the diagnosis of asthma (area under the curve [AUC], 0.723). The diagnostic performance of FeNO was better in nonsmokers (AUC, 0.805), yet FeNO values > 25 ppb were characterized by specificity > 90% for the diagnosis of asthma both in smokers and in nonsmokers. However, FeNO was not a good marker for the differentiation between asthma and allergic rhinitis.
Conclusions: FeNO measurement with a portable analyzer is useful for the screening for asthma in young adults. Significant confounding factors are allergic rhinitis and current smoking.
Key Words: allergic rhinitis • asthma • exhaled nitric oxide • screening • smoking
(Chest. 2008; 133:906-913)
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