呼出气一氧化氮在评价年轻成人慢性咳嗽患者中的作用
2009/11/17
背景：支气管哮喘（A）在慢性咳嗽患者中较为常见。本试验旨在研究呼出气一氧化氮分数（FeNO）是否可用作在慢性咳嗽患者（CCP）中筛选哮喘患者的检查方法。
方法：该研究在540名平均年龄26.5岁（18～45岁）的非吸烟年轻CCP中开展。所有患者的静息肺活量均在正常范围内，胸片显示无明显异常。对所有患者进行了常见吸入性过敏原皮肤针刺试验、组胺支气管激发试验和FeNO检测。另入选100名健康、非吸烟、无过敏症者作为对照组（HC）。
结果：有178名CCP（32.96%）诊断为哮喘（A），其它常见诊断疾病包括鼻-鼻窦炎（R）和胃食管反流（GERD）。哮喘患者（86 ppb; 95% CI 72-94,5 ppb）的FeNO浓度中位数显著高于鼻-鼻窦炎患者（37 ppb; 95% CI 35,6-42,9 ppb; p < 0.0001）、GERD患者（14,8 ppb; 95%CI 13.3至16.2 ppb; p < 0.0001）和HC（13 ppb; 95%CI 11-15 ppb; p < 0.0001）。log(FeNO)与支气管反应性（以log(PC20)表示）显著相关（r = -0.529; 95%CI -0.616--0.429; p < 0.0001）。log(FeNO)与外周血嗜酸性粒细胞相关性更强（r = 0.757; 95%CI 0.717- 0.792）。受试者工作曲线（ROC）分析显示，CCP可通过检测FeNO来筛选哮喘患者。采用40ppb作为FeNO截断值，其特异性为82.6％，敏感性为88.3％。
结论：临床上， FeNO检测可用于在年轻成人慢性咳嗽患者中筛选哮喘患者。
（刘国梁 审校）
J Asthma. 2009 Sep;46(7):692-698.
Exhaled nitric oxide in evaluation of young adults with chronic cough.
Kowal K, Bodzenta-Lukaszyk A, Zukowski S.
BACKGROUND: Bronchial asthma (A) is frequently diagnosed in patients with chronic cough. The study was conducted to determine whether an evaluation of fractional exhaled nitric oxide (FeNO) concentration can be used as a screening test for asthma in young adults with chronic cough (CCP).
METHODS: The study was performed on 540 (mean age 26.5; range 18-45 years), nonsmoking young CCP. All patients had resting spirometry within normal limits and no abnormalities on chest radiographs. Skin prick tests with common aeroallergens, bronchial provocation challenge with histamine, and evaluation of FeNO concentration were performed in all patients. One hundred healthy, nonsmoking, nonatopic subjects were used as control subjects (HC).
RESULTS: Asthma (A) was diagnosed in 178 CCP (32.96%). Other frequent diagnoses included rhinitis/sinusitis (R) and gastroesophageal reflux (GERD). The median FeNO concentration in A (86 ppb; 95% CI 72 to 94,5 ppb) was significantly greater than in R (37 ppb; 95% CI 35,6 to 42,9 ppb; p < 0.0001), GERD (14,8 ppb; 95%CI 13.3 to 16.2 ppb; p < 0.0001), or in HC (13 ppb; 95%CI 11 to 15 ppb; p < 0.0001). Significant correlation was found between log(FeNO) and bronchial reactivity expressed as log(PC20) (r = -0.529; 95%CI -0.616 to -0.429; p < 0.0001), but even stronger correlation was demonstrated between log(FeNO) and peripheral blood eosinophilia (r = 0.757; 95%CI 0.717 to 0.792). Receiver Operator Characteristic (ROC) curve analysis revealed that CCP can be screened for A by measuring FeNO concentration. Using 40 ppb as a cut-off value for the FeNO concentration, the specificity 82.6% and sensitivity 88.3% can be achieved.
CONCLUSION: In clinical practice, assessment of FeNO concentration can be used as a screening test for asthma in young adults who have chronic cough.
Kowal K, et al. J Asthma. 2009 Sep;46(7):692-8.
方法：该研究在540名平均年龄26.5岁（18～45岁）的非吸烟年轻CCP中开展。所有患者的静息肺活量均在正常范围内，胸片显示无明显异常。对所有患者进行了常见吸入性过敏原皮肤针刺试验、组胺支气管激发试验和FeNO检测。另入选100名健康、非吸烟、无过敏症者作为对照组（HC）。
结果：有178名CCP（32.96%）诊断为哮喘（A），其它常见诊断疾病包括鼻-鼻窦炎（R）和胃食管反流（GERD）。哮喘患者（86 ppb; 95% CI 72-94,5 ppb）的FeNO浓度中位数显著高于鼻-鼻窦炎患者（37 ppb; 95% CI 35,6-42,9 ppb; p < 0.0001）、GERD患者（14,8 ppb; 95%CI 13.3至16.2 ppb; p < 0.0001）和HC（13 ppb; 95%CI 11-15 ppb; p < 0.0001）。log(FeNO)与支气管反应性（以log(PC20)表示）显著相关（r = -0.529; 95%CI -0.616--0.429; p < 0.0001）。log(FeNO)与外周血嗜酸性粒细胞相关性更强（r = 0.757; 95%CI 0.717- 0.792）。受试者工作曲线（ROC）分析显示，CCP可通过检测FeNO来筛选哮喘患者。采用40ppb作为FeNO截断值，其特异性为82.6％，敏感性为88.3％。
结论：临床上， FeNO检测可用于在年轻成人慢性咳嗽患者中筛选哮喘患者。
（刘国梁 审校）
J Asthma. 2009 Sep;46(7):692-698.
Exhaled nitric oxide in evaluation of young adults with chronic cough.
Kowal K, Bodzenta-Lukaszyk A, Zukowski S.
BACKGROUND: Bronchial asthma (A) is frequently diagnosed in patients with chronic cough. The study was conducted to determine whether an evaluation of fractional exhaled nitric oxide (FeNO) concentration can be used as a screening test for asthma in young adults with chronic cough (CCP).
METHODS: The study was performed on 540 (mean age 26.5; range 18-45 years), nonsmoking young CCP. All patients had resting spirometry within normal limits and no abnormalities on chest radiographs. Skin prick tests with common aeroallergens, bronchial provocation challenge with histamine, and evaluation of FeNO concentration were performed in all patients. One hundred healthy, nonsmoking, nonatopic subjects were used as control subjects (HC).
RESULTS: Asthma (A) was diagnosed in 178 CCP (32.96%). Other frequent diagnoses included rhinitis/sinusitis (R) and gastroesophageal reflux (GERD). The median FeNO concentration in A (86 ppb; 95% CI 72 to 94,5 ppb) was significantly greater than in R (37 ppb; 95% CI 35,6 to 42,9 ppb; p < 0.0001), GERD (14,8 ppb; 95%CI 13.3 to 16.2 ppb; p < 0.0001), or in HC (13 ppb; 95%CI 11 to 15 ppb; p < 0.0001). Significant correlation was found between log(FeNO) and bronchial reactivity expressed as log(PC20) (r = -0.529; 95%CI -0.616 to -0.429; p < 0.0001), but even stronger correlation was demonstrated between log(FeNO) and peripheral blood eosinophilia (r = 0.757; 95%CI 0.717 to 0.792). Receiver Operator Characteristic (ROC) curve analysis revealed that CCP can be screened for A by measuring FeNO concentration. Using 40 ppb as a cut-off value for the FeNO concentration, the specificity 82.6% and sensitivity 88.3% can be achieved.
CONCLUSION: In clinical practice, assessment of FeNO concentration can be used as a screening test for asthma in young adults who have chronic cough.
Kowal K, et al. J Asthma. 2009 Sep;46(7):692-8.
