重度难治性哮喘的呼出气一氧化氮与呼出气冷凝液pH值
2010/12/07
背景：重度难治性哮喘不同炎症细胞表型已有报道。呼出气一氧化氮（fractional exhaled nitric oxide, FeNO）与嗜酸粒细胞炎症相关。呼出气冷凝液（exhaled breath condensate, EBC）pH值测定已视作评估哮喘患者的无创方法。我们尝试探索FENO与EBCpH值是否能确定重度难治性哮喘患者潜在细胞炎症的存在及类型。
方法：在29例重度难治性哮喘患者、27例中度哮喘患者及17例健康受试者中进行FeNO、EBCpH值测定及诱导痰细胞计数。
结果：与其他两组比较，重度难治性哮喘患者FeNO水平明显升高，而EBC pH值明显降低。在重度难治性哮喘患者中，>19 ppb的FeNO水平与痰嗜酸粒细胞增多相关（其敏感性和特异性分别为0.78和0.73），同时，不论是否存在嗜酸粒细胞，<19 ppb的FeNO水平与痰中性粒细胞增多相关（其敏感性和特异性分别为0.63和0.9）。EBC pH值不能预测重度难治性哮喘的细胞表型，但在中度哮喘患者中pH < 7.37可以预测痰嗜酸性粒细胞增多。
结论：在重度难治性哮喘患者中，不同FeNO阈值可以区分以嗜酸性粒细胞增多或以中性粒细胞增多的临床表型。不管是否同时存在嗜酸粒细胞增多，FeNO水平在嗜中性粒细胞增多的患者中降低。虽然EBC pH值不能区别重度难治性哮喘的细胞表型，但是它似乎是预测中度哮喘患者嗜酸性粒细胞增多的较好指标。
（王刚 四川大学华西医院中西医结合科 610041 摘译 ）
（Chest 2010;138(1);107-113）
Exhaled nitric oxide and exhaled breath condensate pH in severe refractory asthma
Tseliou E, Bessa V, Hillas G, Delimpoura V, Papadaki G, Roussos C, Papiris S, Bakakos P, Loukides S
Chest 2010;138(1);107-113
Background: Distinct infl ammatory cellular phenotypes of severe refractory asthma (SRA) have been reported. Fractional exhaled nitric oxide (FeNO) primarily is related to eosinophilic infl ammation.Exhaled breath condensate (EBC) pH has been suggested as a noninvasive tool in theassessment of patients with asthma. We sought to determine whether FeNO and EBC pH could identify the presence and type of the underlying cellular infl ammation in patients with SRA.
Methods: Twenty-nine patients with SRA, 27 patients with moderate asthma, and 17 healthy subjects underwent FeNO measurement, EBC collection for pH measurement, and sputum induction for cell count identifi cation.
Results: FeNO was signifi cantly higher and pH signifi cantly lower in patients with SRA than in the other groups. In SRA, FeNO levels of . 19 parts per billion were associated with a sensitivity of 0.78 and a specifi city of 0.73 for sputum eosinophilia, whereas FeNO levels of , 19 parts per billion were associated with a sensitivity of 0.63 and a specifi city of 0.9 for sputum neutrophilia irrespective of the presence of eosinophils. The pH failed to predict the cellular profi le in SRA, but a cutoff value of , 7.37 could predict sputum eosinophilia in moderate asthma.
Conclusions: In patients with SRA, different FeNO threshold values can identify those with predominant eosinophilia as well as those with neutrophilia. FeNO levels were reduced in patients with predominant neutrophilia regardless of the concomitant presence of eosinophilia. Although pH could not identify the cellular profi le in SRA, it seemed to be a better index for predicting eosinophilia in moderate asthma.
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过敏性鼻炎和/或哮喘患儿呼出气一氧化氮：与支气管高反应性的关系
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肥胖与非肥胖哮喘患者之比较：探索哮喘¬肥胖的交互关系
