呼出气一氧化氮检测在支气管哮喘诊治中的作用及其与外周血嗜酸性粒细胞相关性的研究

发布时间：2018-03-09 06:17

本文选题：呼出气一氧化氮　切入点：哮喘　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价呼出气一氧化氮(Fractional exhaled Nitric Oxide,FeNO)检测在支气管哮喘诊断与治疗中的意义及其与支气管哮喘患者嗜酸性粒细胞计数的相关性。方法:1.收集2016年1月至2016年12月期间就诊新疆医科大学第一附属医院呼吸科门诊或呼吸科住院的有咳嗽、呼吸困难、胸闷气憋等临床症状的汉族患者共87例,行支气管激发/舒张试验和FeNO检测及血常规检查,依照指南诊断标准,诊断支气管哮喘组62例,非哮喘组25例(最终确诊慢性支气管炎、支气管扩张等),比较两组外周血嗜酸性粒细胞计数、Fe NO水平的差异,评价外周血嗜酸性粒细胞计数与FeNO水平的相关性,绘制ROC曲线,评价FeNO对支气管哮喘的诊断价值。支气管哮喘组依据外周血嗜酸性粒细胞计数分为高嗜酸组和低嗜酸组,比较两组FeNO水平的差异。2.哮喘组患者正规治疗3月后比较外周血嗜酸性粒细胞计数、FeNO水平与治疗前的变化,评估FeNO在评价支气管哮喘疗效中的价值。结果:哮喘组与非哮喘组FeNO值(42.66±16.13ppb比20.88±8.96ppb)差异有统计学意义(P0.05),外周血嗜酸性粒细胞计数(0.64±0.37比0.29±0.18)差异有统计学意义;支气管哮喘组外周血嗜酸性粒细胞计数与FeNO水平正相关,(r=0.62,P0.05,有统计学意义);以支气管舒张或激发试验为诊断支气管哮喘的“金标准”,评估FeNO对支气管哮喘的诊断价值,ROC曲线下面积为0.885,95%置信区间为(0.816,0.955),绘制ROC曲线,最佳阈值为28.5ppb。将FeNO28.5 ppb定义为支气管哮喘的诊断标准,敏感度为80.6%,特异度为84%;哮喘组患者3月后共有50名患者完成随访,治疗前后FENO值42.66±16.13ppb比20.84±5.69ppb,差异有统计学意义(P0.05)。结论:哮喘患者FeNO水平高于非哮喘患者;哮喘患者FeNO水平与外周血嗜酸性粒细胞正相关;FeNO对支气管哮喘有较好的特异度;FeNO水平能较好的评价哮喘的治疗效果。
[Abstract]:Objective: to evaluate the significance of exhaled Nitric Feno in the diagnosis and treatment of bronchial asthma and its correlation with eosinophil count in asthmatic patients. Methods: 1. From January 2016 to December 2016, we collected the eosinophil count in bronchial asthma patients. During the visit to the Department of Respiratory Department of the first affiliated Hospital of Xinjiang Medical University, there was a cough in the outpatient department or in the respiratory department. A total of 87 Han patients with clinical symptoms such as dyspnea, chest tightness, and so on were treated with bronchial provocation / relaxation test, FeNO test and blood routine examination. 62 cases of bronchial asthma group were diagnosed according to the diagnostic criteria. In 25 cases of non-asthmatic group (chronic bronchitis, bronchiectasis, etc.), the difference of eosinophil count and Fe no in peripheral blood was compared between the two groups, the correlation between eosinophil count and FeNO level in peripheral blood was evaluated, and the ROC curve was plotted. To evaluate the value of FeNO in the diagnosis of bronchial asthma. According to peripheral blood eosinophil count, bronchial asthma group was divided into hypereosinophilic group and low eosinophilic group. Comparison of FeNO levels between the two groups. 2. The changes of eosinophil count and Feno levels in peripheral blood after regular treatment in asthma group after March were compared with those before treatment. Results: the FeNO value of asthma group and non-asthma group was 42.66 卤16.13 ppb vs 20.88 卤8.96 ppb (P 0.05), and the eosinophil count in peripheral blood was 0.64 卤0.37 vs 0.29 卤0.18). The eosinophilic granulocyte count in peripheral blood of bronchial asthma group was positively correlated with the level of FeNO, P 0.05.The diagnostic value of FeNO for bronchial asthma was evaluated by bronchodiastolic or provocation test as the "gold standard" for the diagnosis of bronchial asthma. The area under the ROC curve is 0.885% and the confidence interval is 0.955%. The ROC curve is drawn. The optimal threshold was 28.5ppb. the FeNO28.5 ppb was defined as the diagnostic criteria for bronchial asthma, with a sensitivity of 80.6 and a specificity of 840.A total of 50 patients in the asthma group were followed up after March. The FENO value before and after treatment was 42.66 卤16.13 ppb vs 20.84 卤5.69 ppb, the difference was statistically significant (P 0.05). Conclusion: the level of FeNO in asthmatic patients is higher than that in non-asthmatic patients. The positive correlation between the level of FeNO and eosinophil in the peripheral blood of asthmatic patients showed that FeNO had a better specificity for asthma and could evaluate the therapeutic effect of asthma.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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