呼出气一氧化氮测定在慢性阻塞性肺疾病急性发作患者中的应用研究

发布时间：2018-03-18 03:18

本文选题：呼出气一氧化氮　切入点：慢性阻塞性肺疾病急性加重　出处：《昆明医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的 (1)分析住院慢性阻塞性肺疾病急性加重(acute exacrbations of chronic obstructive pulmonary diseases, AECOPD)患者、哮喘患者及健康对照者的呼出气一氧化氮(fractional exhaled nitrie oxide, FENO)值；比较住院AECOPD患者治疗前后的FENO值及其呼出气冷凝液(exhaled breath condensate,EBC)中白细胞介素-6(interleukin-6, IL-6)白、细胞介素-5(interleukin-5, IL-5)的含量；探讨FENO在评估住院AECOPD患者气道炎症中的作用。 (2)分析住院AECOPD患者治疗前FENO值与疗效的关系,探讨FENO值测定对住院AECOPD患者治疗效果的评估意义。方法 (1)以80例住院AECOPD患者、40例住院哮喘患者和40例健康对照组为研究对象,运用呼出气一氧化氮测定仪器NIOXMINO测定FENO值；同时使用肺功能仪肺功能计量器(Ms-PFT;Jaeger:Analyzer, Unit)测定其第一秒用力呼气容积(forced expiratory volume in one second, FEV1)、第一秒用力呼气容积占预计值的百分比(forced expiratory volume in one second/predicated value, FEV1%)。 (2)住院AECOPD患者进行综合治疗后,测定其FENO值及FEV1、FEV1%,同时记录患者住院天数。 (3)随机选择住院AECOPD患者14例,健康对照11例,采用呼出气冷凝液收集仪器EcoScreen分别收集住院AECOPD患者治疗前后及健康对照的EBC,应用酶联免疫法(enzyme-linked immunosorbent assay, ELISA)检测EBC中的IL-6、IL-5含量。 (4)以治疗后FEV1增加绝对值大于等于200ml且增加百分比大于等于12%作为有治疗反应的指标,根据不同的FENO界值所对应住院AECOPD患者治疗有效的敏感度和特异度描绘的受试者工作特征(receiver operator characteristic, ROC)曲线,得出FENO值的最佳界值,将住院AECOPD患者根据最佳界值分组,分别分析两组患者中治疗前后FEV1%、FEV1及治疗天数。结果 (1) AECOPD患者及哮喘患者FENO值均高于健康对照者；哮喘患者FENO值高于AECOPD患者；AECOPD患者治疗后FENO值下降； (2) AECOPD患者EBC中IL-6、IL-5含量较正常对照者升高,治疗后二者含量均较治疗前下降； (3)住院AECOPD患者治疗后与治疗前比较,FENO值降低、FEV1、FEV1%升高；治疗前FENO值与FEV1、FEV1%无相关关系；治疗前FENO值、治疗后FENO下降值与治疗后FEV1、FEV1%改善呈正相关;治疗前FENO值与住院天数负相关。 (4)ROC曲线下面积为0.80,FENO最佳界值为25.5ppb(part per billion),以FENO25.5ppb为标准预测AECOPD患者治疗有效的敏感度为81.8%,特异度为80.9%。 (5)住院AECOPD患者25.5ppb组治疗前后FEV1、FEV1%差异无统计学意义；FENO值25.5ppb组治疗前后FEV1、FEV1%差异有统计学意义;且后者住院天数低于前者。结论 (1)呼出气一氧化氮测定方法简单易行,具有无创、可重复且质控严格的优点。AECOPD患者FENO值高于健康组,低于哮喘患者,AECOPD患者治疗后FENO值下降；提示FENO可以反应AECOPD患者气道炎症,且进一步提示了AECOPD患者和哮喘患者气道炎症的差异。 (2) AECOPD患者治疗前IL-6、IL-5均高于健康对照者,治疗后上述指标明显下降；说明EBC中IL-6、IL-5均可以反应AECOPD患者气道炎症。 (3)治疗前FENO值及治疗后其下降程度与治疗后肺功能的改善存在相关性,治疗前FENO值与住院天数亦存在相关性,说明测定FENO可能可以预测住院AECOPD患者综合治疗的反应。
[Abstract]:objective
(1) analysis of inpatients with acute exacerbation of chronic obstructive pulmonary disease (acute exacrbations of chronic obstructive pulmonary diseases, AECOPD) patients, exhaled nitric oxide in patients with asthma and healthy controls (fractional exhaled nitrie oxide, FENO); compared to live hospital before and after the treatment of patients with AECOPD and FENO value of exhaled breath condensate (exhaled breath condensate EBC), interleukin -6 (interleukin-6, IL-6), interleukin -5 (interleukin-5, IL-5) the content of FENO in hospitalized patients with airway inflammation; the role of AECOPD in the evaluation.
(2) to analyze the relationship between the FENO value and the curative effect before the treatment of the hospitalized AECOPD patients, and to discuss the significance of the evaluation of the FENO value for the treatment effect of the hospitalized AECOPD patients.
Method
(1) in 80 AECOPD patients, 40 cases of hospitalized patients with asthma and 40 healthy control group as the research object, measuring instrument NIOXMINO FENO determination using exhaled nitric oxide; at the same time, the use of spirometry and lung function measurement device (Ms-PFT; Jaeger:Analyzer, Unit) was the first second forced expiratory volume (forced expiratory volume in one second, FEV1), FEV1 percentage of predicted value (forced expiratory volume in one second/predicated value, FEV1%).
(2) after comprehensive treatment of AECOPD patients in hospital, the value of FENO and FEV1, FEV1% were measured, and the days of hospitalization were recorded at the same time.
(3) randomly selected 14 cases of hospitalized patients with AECOPD, 11 cases of healthy control, using exhaled condensate collection apparatus EcoScreen were collected from hospitalized patients and healthy controls before and after AECOPD EBC, using enzyme-linked immunosorbent assay (enzyme-linked immunosorbent, assay, ELISA) detection of EBC IL-6 in the IL-5 content.
(4) after treatment with FEV1 increased the absolute value greater than or equal to 200ml and increase the percentage of greater than or equal to 12% as a response index, according to the different FENO value corresponding subjects hospitalized AECOPD patients with effective treatment of the sensitivity and specificity of the characteristics of the work described (receiver operator characteristic, ROC) curve, obtained the best circles the FENO values, the hospitalized patients with AECOPD according to the optimalcutoff group were analyzed before and after the two FEV1% treatment group, FEV1 treatment and the number of days.
Result
(1) the FENO value of AECOPD patients and asthma patients were higher than those of healthy controls; the FENO value of the patients with asthma was higher than that of the AECOPD patients; the FENO value of the patients with AECOPD was decreased.
(2) the content of IL-6 and IL-5 in the EBC of AECOPD patients was higher than that in the normal control, and the content of the two was lower than that before the treatment.
(3) comparison of hospitalization in AECOPD patients before and after treatment, FENO decreased, FEV1 and FEV1% increased; the FENO value before treatment with FEV1, but not related to FEV1%; the FENO value before treatment and after treatment, the FEV1 value decreased after FENO treatment, FEV1% was positively related to improve; the FENO value before treatment and hospitalization days negative correlation.
(4) the area under the ROC curve is 0.80. The best value of FENO is 25.5ppb (part per billion). With FENO25.5ppb as the standard, the sensitivity of AECOPD treatment is 81.8%, and the specificity is 80.9%..
(5) there was no statistically significant difference in FEV1 and FEV1% between 25.5ppb group and AECOPD group before and after treatment. There was significant difference in FENO value between FEV1 group and FEV1% group before and after treatment, and the hospitalization days of the latter group were lower than those of the former group.
conclusion
(1) call out simple method for the determination of nitric oxide, a noninvasive, FENO advantages.AECOPD patients repeatedly and strict quality control is higher than that of healthy group is lower than that of asthma patients, patients with AECOPD FENO decreased; FENO can prompt airway inflammatory reaction in AECOPD, and further suggests that the difference between AECOPD patients and the airways of patients with asthma inflammation.
(2) before treatment, IL-6 and IL-5 in AECOPD patients were higher than those in healthy controls. After treatment, these indicators decreased significantly, indicating that IL-6 and IL-5 in EBC can reflect airway inflammation in AECOPD patients.
(3) before treatment, the FENO value and the degree of decrease after treatment were correlated with the improvement of pulmonary function after treatment. There was also a correlation between FENO value and hospitalization days before treatment. It indicated that FENO may predict the response of AECOPD patients to comprehensive treatment.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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