难治性哮喘患者的呼出一氧化氮水平提示肺功能下降程度
2008/09/28
关键词：气道阻塞、哮喘、一氧化氮、疾病严重指数
一些哮喘患者即使在使用激素治疗后仍会出现进行性的肺功能下降。为了确定肺功能下降的危险因素，Van Veen等对难治性哮喘患者进行了一项研究。
研究在1998～1999年入选了136例不吸烟的难治性哮喘患者进行研究，并对其中98例患者进行5～6年的随访。测定各种基础的临床特征和炎症指标对支气管舒张剂后FEV1下降的预测效果，这些临床特征和炎症指标包括，哮喘发作次数和持续时间、过敏症、气道反应性、血和痰中的嗜酸性粒细胞数，以及呼出气一氧化氮含量（nitric oxide in exhaled air, FeNO)。研究发现，高FeNO (
20 ppb) 者FEV1的下降比低FeNO者多40.3 mL·yr–1 (95%CI, 7.3 mL·yr–1–73.2mL·yr–1) ，因此高FeNO (20 ppb)与FEV1的加速下降(25 mL·yr–1)有关，相对危险因素为1.9 (95% CI, 1.1–2.6)。而且在基础FEV180%预计值的患者中，这一相关性更强。高FeNO（20 ppb）者FEV1的下降为90%预计值，明显高于低FeNO（<20 ppb）者的下降（29%预计值），相对危险性为3.1 (95% CI, 1.7–3.4)。
20 ppb) 者FEV1的下降比低FeNO者多40.3 mL·yr–1 (95%CI, 7.3 mL·yr–1–73.2mL·yr–1) ，因此高FeNO (20 ppb)与FEV1的加速下降(25 mL·yr–1)有关，相对危险因素为1.9 (95% CI, 1.1–2.6)。而且在基础FEV180%预计值的患者中，这一相关性更强。高FeNO（20 ppb）者FEV1的下降为90%预计值，明显高于低FeNO（<20 ppb）者的下降（29%预计值），相对危险性为3.1 (95% CI, 1.7–3.4)。 通过研究，作者认为FeNO可以作为难治性哮喘患者肺功能加速下降的预测因子，尤其对那些FEV1仍然正常的患者。
(韩伟 青岛大学附属青岛市立医院东院呼吸科266071 摘译)
（Eur Respir J 2008; 32:344-349)
Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma
I. H. van Veen, A. ten Brinke, P. J. Sterk et al.
Keywords: Airway obstruction, asthma, nitric oxide, severity of illness index
A subset of patients with asthma is known to have progressive loss of lung function despite treatment with corticosteroids. The aim of the present study was to identify risk factors of decline in forced expiratory volume in one second (FEV1) in patients with difficult-to-treat asthma.
In total, 136 nonsmoking patients with difficult-to-treat asthma were recruited between 1998 and 1999. Follow-up assessment was performed 5–6 yrs later in 98 patients. The predictive effect of clinical characteristics and inflammatory markers were analysed at baseline (asthma onset and duration, atopy, airway hyperresponsiveness, blood and sputum eosinophils, and the fraction of nitric oxide in exhaled air (FeNO)) on subsequent decline in post-bronchodilator FEV1.
Patients with high FeNO (20 ppb) had an excess decline of 40.3 (95% confidence interval (CI) 7.3–73.2) mL·yr–1 compared to patients with low FeNO. FeNO 20 ppb was associated with a relative risk of 1.9 (95% CI, 1.1–2.6) of having an accelerated (25 mL·yr–1) decline in FEV1. In patients with baseline FEV1 80% of predicted, this relationship was even stronger: 90 versus 29% had accelerated decline in FEV1 (FeNO 20 ppb versus FeNO <20 ppb respectively; relative risk 3.1 (95% CI, 1.7–3.4).
20 ppb) had an excess decline of 40.3 (95% confidence interval (CI) 7.3–73.2) mL·yr–1 compared to patients with low FeNO. FeNO 20 ppb was associated with a relative risk of 1.9 (95% CI, 1.1–2.6) of having an accelerated (25 mL·yr–1) decline in FEV1. In patients with baseline FEV1 80% of predicted, this relationship was even stronger: 90 versus 29% had accelerated decline in FEV1 (FeNO 20 ppb versus FeNO <20 ppb respectively; relative risk 3.1 (95% CI, 1.7–3.4). Exhaled nitric oxide is a predictor of accelerated decline in lung function in patients with difficult-to-treat asthma, particularly if forced expiratory volume in one second is still normal.
Eur Respir J 2008; 32:344-349
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