呼出气一氧化氮增加与气道反应性增高相关
2011/04/15
背景：气道炎症是哮喘的主要特征，多项研究表明呼出气一氧化氮浓度(Fe(NO))可作为哮喘气道炎症的一个替代指标。
目的：该研究以有职业性哮喘风险的工人（面包师、糕点师和美发学徒）为研究对象，观察他们在最初职业暴露的2年内Fe(NO)水平是否和气道高反应性（BHR）的发生相关。
方法：该研究采用标准的问卷调查进行，同时予以皮肤点刺试验和特殊的职业过敏原检测。初次检查后的6、12、15个月分别行气道反应性测定和呼出气NO检测。
结果：共441名学徒入选，其中351人完成该项研究。结果显示，在职业暴露的初期，Fe(NO)的增加与气道高反应性的发生相关（优势比 2.00 [95%可信区间 1.21-3.32]）。特异性和非特异性体质者Fe(NO)平均增加相近，且与抽烟习惯、性别及工作方式无关。面包师/糕点师的特异性体质，以及美发学徒对碱性过硫酸盐的敏感性与气道高反应性的发生呈独立相关。面包师/糕点师气道高反应性的发生较美发学徒更快，但之后发作水平下降。
结论：该研究结果表明，呼出气NO检测简单易行可重复，对于早期暴露于职业性哮喘危险因素的的学徒工而言，该检查是监测气道高反应性发生的一个有用手段。
（浙江大学附属第二医院呼吸科 王苹莉 摘译）
（Am J Respir Crit Care Med. 2010;182(6):738-44.）
Increase in exhaled nitric oxide is associated with bronchial hyperresponsiveness among apprentices.
Tossa P, Paris C, Zmirou-Navier D, Demange V, Acouetey DS, Michaely JP, Bohadana A.
Am J Respir Crit Care Med. 2010;182(6):738-44.
RATIONALE: Airway inflammation is a hallmark of asthma. Several studies have validated the use of the fractional concentration of exhaled nitric oxide (Fe(NO)) as a surrogate marker of airway inflammation in asthma.
OBJECTIVES: We examined how the change in Fe(NO) levels, since the beginning of occupational exposure, could be associated with the incidence of bronchial hyperresponsiveness (BHR) among baker, pastry maker, and hairdresser apprentices during their 2-year training.
METHODS: A standardized questionnaire was administered; skin prick tests for common and specific occupational allergens were done; methacholine challenge and measurement of Fe(NO) were performed 6, 12, and 15 months after the first examination.
MEASUREMENTS AND MAIN RESULTS: Of 441 apprentices initially included, 351 completed the study. The increase in Fe(NO), since the beginning of exposure, was associated with the incidence of BHR (odds ratio, 2.00 [95% confidence interval, 1.21-3.32] per unit increase in log parts per billion) both in atopic and nonatopic subjects. The average increase in Fe(NO) was similar in atopic and nonatopic subjects and was unrelated to past or current smoking habits, sex, or training track. Atopy in bakers/pastry makers and sensitization to alkaline persulfates in hairdressers were also independently associated with the incidence of BHR. BHR occurred sooner among bakers/pastry makers than among hairdressers, but its incidence leveled off later.
CONCLUSIONS: Our results suggest that measurement of Fe(NO), a simple and reproducible test, could be useful in the screening of BHR in workers newly exposed to agents known to cause occupational asthma.
目的：该研究以有职业性哮喘风险的工人（面包师、糕点师和美发学徒）为研究对象，观察他们在最初职业暴露的2年内Fe(NO)水平是否和气道高反应性（BHR）的发生相关。
方法：该研究采用标准的问卷调查进行，同时予以皮肤点刺试验和特殊的职业过敏原检测。初次检查后的6、12、15个月分别行气道反应性测定和呼出气NO检测。
结果：共441名学徒入选，其中351人完成该项研究。结果显示，在职业暴露的初期，Fe(NO)的增加与气道高反应性的发生相关（优势比 2.00 [95%可信区间 1.21-3.32]）。特异性和非特异性体质者Fe(NO)平均增加相近，且与抽烟习惯、性别及工作方式无关。面包师/糕点师的特异性体质，以及美发学徒对碱性过硫酸盐的敏感性与气道高反应性的发生呈独立相关。面包师/糕点师气道高反应性的发生较美发学徒更快，但之后发作水平下降。
结论：该研究结果表明，呼出气NO检测简单易行可重复，对于早期暴露于职业性哮喘危险因素的的学徒工而言，该检查是监测气道高反应性发生的一个有用手段。
（浙江大学附属第二医院呼吸科 王苹莉 摘译）
（Am J Respir Crit Care Med. 2010;182(6):738-44.）
Increase in exhaled nitric oxide is associated with bronchial hyperresponsiveness among apprentices.
Tossa P, Paris C, Zmirou-Navier D, Demange V, Acouetey DS, Michaely JP, Bohadana A.
Am J Respir Crit Care Med. 2010;182(6):738-44.
RATIONALE: Airway inflammation is a hallmark of asthma. Several studies have validated the use of the fractional concentration of exhaled nitric oxide (Fe(NO)) as a surrogate marker of airway inflammation in asthma.
OBJECTIVES: We examined how the change in Fe(NO) levels, since the beginning of occupational exposure, could be associated with the incidence of bronchial hyperresponsiveness (BHR) among baker, pastry maker, and hairdresser apprentices during their 2-year training.
METHODS: A standardized questionnaire was administered; skin prick tests for common and specific occupational allergens were done; methacholine challenge and measurement of Fe(NO) were performed 6, 12, and 15 months after the first examination.
MEASUREMENTS AND MAIN RESULTS: Of 441 apprentices initially included, 351 completed the study. The increase in Fe(NO), since the beginning of exposure, was associated with the incidence of BHR (odds ratio, 2.00 [95% confidence interval, 1.21-3.32] per unit increase in log parts per billion) both in atopic and nonatopic subjects. The average increase in Fe(NO) was similar in atopic and nonatopic subjects and was unrelated to past or current smoking habits, sex, or training track. Atopy in bakers/pastry makers and sensitization to alkaline persulfates in hairdressers were also independently associated with the incidence of BHR. BHR occurred sooner among bakers/pastry makers than among hairdressers, but its incidence leveled off later.
CONCLUSIONS: Our results suggest that measurement of Fe(NO), a simple and reproducible test, could be useful in the screening of BHR in workers newly exposed to agents known to cause occupational asthma.
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不同严重程度的远端胃食管反流哮喘患儿，其哮喘临床表现也不同
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