吸入皮质激素治疗的哮喘患者呼出气一氧化氮与哮喘负担的关系
2011/03/24
摘要
背景：呼出气一氧化氮水平(FENO)是气道炎症的一个标志物。目前，临床上采用FENO来评价哮喘负担，但还需更多的研究证实。
目的：探讨是否高水平的FENO与较大的哮喘负担存在相关性。
方法：本试验为多中心、横断面、回顾性研究，研究对象为采用吸入皮质激素治疗(ICS)的12至56岁的持续哮喘的患者。采用无校正的和校正后的Poisson 回归（相对风险）和负二项回归[发病率比（IRRs）]对患者的问卷调查结果和1年的用药信息进行分析，在不依赖肺活量和哮喘评分[哮喘控制测试(ACT)]）的情况下，分析FENO 水平(NIOX MINO®)与过去1年中短效b受体激动剂(SABA)及口服激素(OCS)使用之间的关系。
结果：325名入选患者中，FENO水平为7-215 ppb (中位数：28 ppb)。较高的FENO水平与过去1年更多使用SABA 和OCS 相关，且与较低的FEV1%预测值（而非ACT评分）相关。FENO 的最大四分位间距值(≥48ppb)与最小四分位间距值(≤19ppb)，分别与过去1年≥7次的SABA使用（相对风险=2.40, 95% CI=1.25-4.62）、SABA 使用总数（IRR=1.46, 95% CI=1.12-1.99）及≥1次OCS使用（相对风险=1.48, 95% CI=1.06-2.07）和OCS使用总数(IRR=1.71, 95% CI=1.09-2.66)相关。较高水平的FENO与SABA和OCS使用增加的关系，在随后的线性趋势分析中得到确认。
结论：在采用ICS治疗的持续哮喘患者中，较高水平的FENO与过去1年哮喘负担增加具有显著相关性，对指导临床哮喘治疗具有重要意义。这表明，临床实践中可将检测FENO作为辅助工具，帮助临床医生来评价哮喘患者的哮喘负担。
（苏楠 审校）
J Asthma. 2010 Dec 15. [Epub ahead of print]
Association of Exhaled Nitric Oxide to Asthma Burden in Asthmatics on Inhaled Corticosteroids.
Zeiger RS, Schatz M, Zhang F, Crawford WW, Kaplan MS, Roth RM, Chen W.
Department of Allergy, Kaiser Permanente Southern California, San Diego, Harbor City, Los Angeles and Orange County, CA, USA.
Abstract
Background. Fractional exhaled nitric oxide (FENO) is a marker of airway inflammation. Its role in assessing asthma burden in clinical practice needs more study.
Objective. To determine whether higher FENO levels are associated with greater asthma burden. Methods. This was a multicenter cross-sectional retrospective study of atopic 12- to 56-year-old persistent asthmatics on inhaled corticosteroids (ICS). Questionnaire and 1-year retrospective administrative data were used to analyze by unadjusted and adjusted robust Poisson regression (relative risks) and negative binomial regression [incidence rate ratios (IRRs)] the associations of masked FENO levels (NIOX MINO®) to short-acting beta-agonist (SABA) dispensings and oral corticosteroid (OCS) use in the past year independent of spirometry and an asthma control tool [Asthma Control Test (ACT)].
Results. FENO levels ranged from 7-215ppb (median 28ppb) in 325 patients. Higher FENO levels significantly correlated with more SABA dispensings and OCS courses in the past year, lower FEV(1)% predicted levels, but not ACT score. FENO highest (≥48ppb) versus lowest (≤19ppb) quartile values were associated independently in the past year with ≥7 SABA canisters dispensed (relative risk=2.40, 95% CI=1.25-4.62) and total number of SABA canisters dispensed (IRR=1.46, 95% CI=1.12-1.99) and with ≥1 OCS course (relative risk=1.48, 95% CI=1.06-2.07) and total number of OCS courses (IRR=1.71, 95% CI=1.09-2.66). The significant independent relationship of higher FENO levels to increasing SABA dispensings and OCS courses was confirmed by linear trend analyses.
Conclusions. Independent and clinically meaningful associations between higher FENO levels and greater asthma burden during a prior year in persistent asthmatics on ICS suggest that FENO measurement may be a complementary tool to help clinicians assess asthma burden.
J Asthma. 2010 Dec 15. [Epub ahead of print]
背景：呼出气一氧化氮水平(FENO)是气道炎症的一个标志物。目前，临床上采用FENO来评价哮喘负担，但还需更多的研究证实。
目的：探讨是否高水平的FENO与较大的哮喘负担存在相关性。
方法：本试验为多中心、横断面、回顾性研究，研究对象为采用吸入皮质激素治疗(ICS)的12至56岁的持续哮喘的患者。采用无校正的和校正后的Poisson 回归（相对风险）和负二项回归[发病率比（IRRs）]对患者的问卷调查结果和1年的用药信息进行分析，在不依赖肺活量和哮喘评分[哮喘控制测试(ACT)]）的情况下，分析FENO 水平(NIOX MINO®)与过去1年中短效b受体激动剂(SABA)及口服激素(OCS)使用之间的关系。
结果：325名入选患者中，FENO水平为7-215 ppb (中位数：28 ppb)。较高的FENO水平与过去1年更多使用SABA 和OCS 相关，且与较低的FEV1%预测值（而非ACT评分）相关。FENO 的最大四分位间距值(≥48ppb)与最小四分位间距值(≤19ppb)，分别与过去1年≥7次的SABA使用（相对风险=2.40, 95% CI=1.25-4.62）、SABA 使用总数（IRR=1.46, 95% CI=1.12-1.99）及≥1次OCS使用（相对风险=1.48, 95% CI=1.06-2.07）和OCS使用总数(IRR=1.71, 95% CI=1.09-2.66)相关。较高水平的FENO与SABA和OCS使用增加的关系，在随后的线性趋势分析中得到确认。
结论：在采用ICS治疗的持续哮喘患者中，较高水平的FENO与过去1年哮喘负担增加具有显著相关性，对指导临床哮喘治疗具有重要意义。这表明，临床实践中可将检测FENO作为辅助工具，帮助临床医生来评价哮喘患者的哮喘负担。
（苏楠 审校）
J Asthma. 2010 Dec 15. [Epub ahead of print]
Association of Exhaled Nitric Oxide to Asthma Burden in Asthmatics on Inhaled Corticosteroids.
Zeiger RS, Schatz M, Zhang F, Crawford WW, Kaplan MS, Roth RM, Chen W.
Department of Allergy, Kaiser Permanente Southern California, San Diego, Harbor City, Los Angeles and Orange County, CA, USA.
Abstract
Background. Fractional exhaled nitric oxide (FENO) is a marker of airway inflammation. Its role in assessing asthma burden in clinical practice needs more study.
Objective. To determine whether higher FENO levels are associated with greater asthma burden. Methods. This was a multicenter cross-sectional retrospective study of atopic 12- to 56-year-old persistent asthmatics on inhaled corticosteroids (ICS). Questionnaire and 1-year retrospective administrative data were used to analyze by unadjusted and adjusted robust Poisson regression (relative risks) and negative binomial regression [incidence rate ratios (IRRs)] the associations of masked FENO levels (NIOX MINO®) to short-acting beta-agonist (SABA) dispensings and oral corticosteroid (OCS) use in the past year independent of spirometry and an asthma control tool [Asthma Control Test (ACT)].
Results. FENO levels ranged from 7-215ppb (median 28ppb) in 325 patients. Higher FENO levels significantly correlated with more SABA dispensings and OCS courses in the past year, lower FEV(1)% predicted levels, but not ACT score. FENO highest (≥48ppb) versus lowest (≤19ppb) quartile values were associated independently in the past year with ≥7 SABA canisters dispensed (relative risk=2.40, 95% CI=1.25-4.62) and total number of SABA canisters dispensed (IRR=1.46, 95% CI=1.12-1.99) and with ≥1 OCS course (relative risk=1.48, 95% CI=1.06-2.07) and total number of OCS courses (IRR=1.71, 95% CI=1.09-2.66). The significant independent relationship of higher FENO levels to increasing SABA dispensings and OCS courses was confirmed by linear trend analyses.
Conclusions. Independent and clinically meaningful associations between higher FENO levels and greater asthma burden during a prior year in persistent asthmatics on ICS suggest that FENO measurement may be a complementary tool to help clinicians assess asthma burden.
J Asthma. 2010 Dec 15. [Epub ahead of print]
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研究作为哮喘潜在生物标志物的呼出气蛋白的新方法
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呼出气一氧化氮在诊断哮喘中的作用
