呼出气一氧化氮分数（FeNO）在哮喘诊断中的作用
2012/07/06
摘要
背景：为了将呼出气一氧化氮分数作为（FeNO）作为哮喘临床检测的指标，有必要对其在哮喘诊断中的作用进行阐述。
目的：评价FeNO在儿童哮喘诊断中的作用，及寻找FeNO的决定因素。
方法：255名连续就诊的、未经激素治疗的、有哮喘可疑症状的8～16岁患者入选本研究。通过检测FeNO、问卷调查、皮肤针刺试验、肺活量检测和乙酰甲胆碱激发试验等对儿童进行评价。
结果：共有167名儿童诊断为哮喘。采用FeNO截止值为22 ppb时诊断哮喘的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为56.9%、87.2%、90.5%和48.6%。FeNO截止值为42 ppb时，特异性和PPV均达到100%，但敏感性（23.4%）和NPV（37.9%）相当低。过敏症和哮喘是与FeNO增加的两个独立危险因素。哮喘与高FeNO的相关性仅在过敏症儿童中观察到，因为不管是否患有哮喘，非过敏儿童的FeNO很低。虽然过敏性哮喘患者具有最高的FeNO，28%的这些患者FeNO低于22 ppb。
结论：较低FeNO的过敏性哮喘患者和非过敏性哮喘患者，FeNO检测可能存在假阴性，这可导致FeNO在哮喘诊断中具有较低的敏感性。FeNO在诊断哮喘中的高特异性，能在患有呼吸道症状的患者中鉴别过敏性哮喘患者。
（林江涛 审校）
Respir Med. 2012 Apr 24. [Epub ahead of print]
（林江涛 审校）
Respir Med. 2012 Apr 24. [Epub ahead of print]
Source
Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, 410 SungBong-Ro, Heungdeok-gu, 361-763 Cheongju, Republic of Korea.
Abstract
BACKGROUND: To facilitate the use of fractional exhaled nitric oxide (F(E)NO) as a clinical test, F(E)NO measurements need more clarification.
AIM: We sought to evaluate the yield of F(E)NO measurement for the diagnosis of asthma and identify the determinants of F(E)NO in children.
METHODS: Two hundred forty five consecutive steroid-naïve patients aged 8-16 years with symptoms suggestive of asthma were included. Children were evaluated using F(E)NO measurements, questionnaires, skin prick tests, spirometries, and methacholine challenge tests.
RESULTS: Asthma was diagnosed in 167 children. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of F(E)NO measurements for the diagnosis of asthma at the best cutoff value of 22 ppb were 56.9%, 87.2%, 90.5%, and 48.6%, respectively. At a cutoff value of 42 ppb, specificity and PPV were all 100% but at the cost of very low sensitivity (23.4%) and NPV (37.9%). Both atopy and asthma were identified as independent risk factors associated with high F(E)NO. The association of asthma with high F(E)NO was found only in atopic children because F(E)NO was low in non-atopic children regardless of asthma status. Although highest F(E)NO was observed in atopic asthmatic patients, 28% of these patients had F(E)NO values lower than 22 ppb.
CONCLUSION: Atopic asthmatic patients with low F(E)NO values and non-atopic asthmatic patients were responsible for false-negative cases that might contribute to low sensitivity of F(E)NO measurements in diagnosing asthma. High specificity of F(E)NO measurements may help identify patients with atopic asthma among subjects with respiratory symptoms.
Respir Med. 2012 Apr 24. [Epub ahead of print]
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低体重和肥胖儿童的哮喘严重程度、发作风险和哮喘控制治疗负担
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老年哮喘患者潮式呼吸时气流阻力感受阈值增加
