呼出气一氧化氮浓度测定对变应性鼻炎合并下气道高反应性或哮喘的预测及辅助诊断价值研究

发布时间：2018-03-20 04:26

本文选题：呼出气一氧化氮　切入点：变应性鼻炎　出处：《中国实用内科杂志》2014年06期 　论文类型：期刊论文

【摘要】：目的探讨呼出气一氧化氮浓度(FeNO)测定对变应性鼻炎合并无症状的下气道高反应性患者或非急性发作期(慢性持续性)哮喘患者的预测及诊断价值。方法对广州医科大学附属第一医院呼吸科收治的20例变应性鼻炎患者、15例变应性鼻炎合并无症状的下气道高反应性患者及20例变应性鼻炎合并非急性发作期(慢性持续性)哮喘患者(年龄18~50岁)进行FeNO测定、鼻腔灌洗细胞分类计数、诱导痰细胞分类计数以及乙酰甲胆碱支气管激发试验,分析各项指标的分布特点及相关性,探讨FeNO测定对变应性鼻炎患者合并无症状支气管高反应性(BHR)或非急性发作期(慢性持续性)哮喘的预测及下气道炎症的评估。结果 FeNO值的中位数和四分位间距在单纯变应性鼻炎组、变应性鼻炎合并无症状下气道反应性增高组、以及鼻炎合并哮喘组分别为24.0(15.5,35.5)pg/L、46.5(35.0,63.0)pg/L和61.5(39.0,75.0)pg/L,3组间差异具有统计学意义(P0.01)。以测定的FeNO值为标准对变应性鼻炎患者下气道高反应性进行判断,绘制ROC曲线(AUC=0.842,P=0.002),以34.0 pg/L为截断点则敏感度为75.0%,特异度为73.7%。以FeNO值对变应性鼻炎合并哮喘诊断的ROC曲线(AUC=0.887,P=0.000),FeNO值取41.0 pg/L时对变应性鼻炎合并哮喘诊断的敏感度为75.0%,特异度为83.1%。诱导痰中嗜酸性粒细胞(EOS)在单纯变应性鼻炎组、变应性鼻炎合并无症状下气道反应性增高组以及鼻炎合并哮喘组分别为(2.43±3.56)%、(7.36±4.98)%及(18.5%±11.26)%,3组间差异具有统计学意义(P0.01)。结论变应性鼻炎患者可伴有一定程度的下气道炎症,且与下气道高反应性密切相关。FeNO测定简便、稳定,对变应性鼻炎患者合并下气道高反应性或哮喘具有良好的预测和辅助诊断作用。
[Abstract]:Objective to study the predictive value and diagnostic value of nitric oxide (no) in exhaled air in patients with allergic rhinitis complicated with asymptomatic lower airway hyperreactivity or non-acute (chronic persistent) asthma. Twenty cases of allergic rhinitis with asymptomatic lower airway hyperresponsiveness and 20 cases of allergic rhinitis with non-acute attack (chronic persistent). FeNO was measured in asthmatic patients (18 to 50 years old). Nasal lavage cell classification count, induced sputum cell classification count and acetylcholine bronchial provocation test were used to analyze the distribution and correlation of the indexes. To investigate the prediction of FeNO in patients with allergic rhinitis complicated with asymptomatic bronchial hyperresponsiveness (FeNO) or nonacute (chronic persistent) asthma and the evaluation of lower airway inflammation. Results the median FeNO value and the quartile spacing were evaluated. In the simple allergic rhinitis group, In allergic rhinitis with asymptomatic increase of airway reactivity, and in rhinitis with asthma group, respectively, the difference was 24.0 15.5 / g / L 46.5g / L and 63.0g / L and 61.5 / 39.0g / L, respectively. The difference was statistically significant (P0.011.The measured FeNO value was used as the standard to judge the airway hyperresponsiveness in allergic rhinitis patients. The sensitivity and specificity of ROC curve were 75.0 and 73.7.The FeNO value was used to diagnose allergic rhinitis with asthma. The sensitivity was 75.0 when the pg/L value was 41.0 pg/L, and the specificity was 75.0 when the ROC curve for allergic rhinitis complicated with asthma was 41.0 pg/L. Inducing eosinophil eosinophils in sputum in patients with simple allergic rhinitis, In allergic rhinitis with asymptomatic increase of airway reactivity and rhinitis with asthma, 7.36 卤4.98% and 18.5% 卤11.26%, respectively, were 2.43 卤3.56% and 18.5% 卤11.26%, respectively. Conclusion the patients with allergic rhinitis may be accompanied by lower airway inflammation to a certain extent. Feno, which is closely related to the lower airway hyperresponsiveness, is simple and stable. It has a good predictive and auxiliary diagnostic effect for allergic rhinitis patients with lower airway hyperresponsiveness or asthma.
【作者单位】：呼吸疾病国家重点实验室广州医科大学附属第一医院广州呼吸疾病研究所呼吸疾病国家临床医学研究中心;
【基金】：十二五国家科技发展计划项目(2013BAI09B09,2012BAI05B01) 广州医科大学博士启动项目(2011C39)
【分类号】：R562.25;R765.21

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