FeNO和外周血EOS对支气管哮喘诊断和病情评估价值的探讨

发布时间：2018-04-08 18:26

本文选题：支气管哮喘　切入点：呼出气一氧化氮　出处：《石河子大学》2017年硕士论文

【摘要】：目的评价呼出气一氧化氮(Fractional exhaled nitric oxide,Fe NO)和外周血嗜酸性粒细胞百分比(Peripheral blood eosinophilia percentage,EOS%)对支气管哮喘诊断和病情评估的临床应用价值,并取得各自的最佳阈值。方法收集2015年12月至2016年6月因反复咳嗽、喘息、胸闷、气促等症状就诊新疆石河子大学医学院第一附属医院呼吸内科的患者222例,所有患者均行Fe NO测定、外周血检测及肺功能检查,139例患者确诊为哮喘,为哮喘组,均进行哮喘病情测试(asthma control test,ACT),83例患者为非哮喘患者,为非哮喘组,统计并分析相关数据。结果1.哮喘组和非哮喘组一般资料情况进行比较显示:哮喘组年龄18~70(43.8±1.1)岁,其中男性59例,占42.4%,女性80例,占57.6%;非哮喘组年龄18~70(46.8±1.5)岁,男性25例,占30.1%,女性58例,占69.9%。两组在性别(男/女)、平均年龄(岁)、身高(cm)、体重(kg)及BMI(kg/m2)方面比较,差异无统计学意义(P0.05)。2.(1)哮喘组Fe NO测定值(59.27±3.08ppb)明显高于非哮喘组(19.65±2.13ppb)(P0.05)。哮喘组第一秒用力呼气容积占预计值百分比(percentage of forced expiratory volumein in first second,FEVl%)(75.20±1.59%)低于非哮喘组(92.59±1.34%)(P0.05)。哮喘组EOS%(6.583±0.432%)高于非哮喘组(2.282±0.192%)(P0.05)。(2)哮喘组Fe NO与FEV1%无相关性(r=-0.037,P=0.665),与外周血EOS%存在正相关(r=0.522,P0.05)。(3)哮喘组Fe NO与ACT评分呈负相关关系(r=-0.418,P0.05),哮喘组EOS%与ACT评分呈负相关关系(r=-0.396,P0.05)。3.哮喘组Fe NO诊断哮喘的受试者工作特征(ROC)曲线下面积0.896,95%置信区间(0.853-0.940),其最佳阈值点为29.5ppb,以29.5ppb为界值诊断哮喘的敏感度78.4%,特异度91.6%。外周血EOS%辅助诊断支气管哮喘的ROC曲线下面积为0.783,95%置信区间(0.722-0.844),以3.72%为最佳临界点,其对应的敏感度为70.5%,特异度为86.7%。结论FeNO和外周血EOS%是辅助诊断哮喘的重要指标,两者联合对哮喘诊断及病情评估具有更重要的临床意义。Fe NO和外周血EOS值越高,哮喘患者病情严重程度可能性更大。
[Abstract]:Objective to evaluate the clinical application of Fractional exhaled nitric oxide-iron (no) and peripheral blood eosinophilia percentage of eosinophil (EOS) in the diagnosis and evaluation of bronchial asthma, and to obtain their optimal thresholds.Methods from December 2015 to June 2016, 222 patients with recurrent cough, wheezing, chest tightness, shortness of breath and other symptoms were collected from the Department of Respiratory Medicine, the first affiliated Hospital of the Medical College of Shihezi University of Xinjiang.The peripheral blood test and pulmonary function test showed that there were 139 cases of asthma diagnosed as asthma. All the 83 cases of asthmatic control test were non-asthmatic and non-asthmatic. The related data were statistically analyzed.Result 1.The general data of asthmatic group and non-asthmatic group were compared. The age of asthmatic group was 1870,43.8 卤1.1 years old, male 59 cases (42.4%), female 80 cases (57.6%), non-asthmatic group (1870,46.8 卤1.5) years old, male 25 cases (30.1%), female 58 cases (69.9%).The percentage of forced expiratory volume in the first second in the asthmatic group (75.20 卤1.59) was lower than that in the non-asthmatic group (92.59 卤1.34).The area under the curve of 0.896 ~ 95% confidence interval was 0.853-0.940, and the optimum threshold point was 29.5ppb.The sensitivity of 29.5ppb was 78.4 and the specificity was 91.6.The area under the ROC curve of peripheral blood EOS% adjuvant diagnosis of bronchial asthma was 0.722-0.844% confidence interval, with 3.72% as the best critical point, the sensitivity was 70.5 and the specificity was 86.7%.Conclusion FeNO and EOS% in peripheral blood are important indexes in the diagnosis of asthma. The higher the value of FeNO and EOS in peripheral blood, the more likely the severity of asthma is.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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