呼出气一氧化氮检测在慢性咳嗽中的诊断价值

发布时间：2018-04-30 15:22

本文选题：呼出气一氧化氮 + 慢性咳嗽　；参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的慢性咳嗽含义指的是患者咳嗽持续时间超过八周,而且X线检查结果表明患者不存在肺疾病证据的咳嗽。近年慢性咳嗽常被误诊为慢性支气管炎,患者长期服用抗生素和止咳药治疗效果不佳。慢性咳嗽已成为呼吸科门诊及住院的主要原因及患者主要耗资之一,我们有必要加强对这类疾病的认识。能正确分析患者的病因,有助于医生对症下药,提高治疗效果。探讨呼出气一氧化氮(FeNO)对慢性咳嗽患者气道高反应性的检测价值,观察激素治疗前后FeNO浓度的变化,为指导治疗和判断预后提供依据。方法1.通过前瞻性研究方法选取2014年3月-2015年3月在郑州大学第二附属医院及信阳市中心医院治疗的300例慢性咳嗽患者,全部研究对象先进行FeNO检测,再给予支气管激发试验,以支气管激发试验结果为金标准确定患者是否存在气道高反应性,然后与呼出气一氧化氮测定值进行比较。2.对支气管激发试验阳性患者给予糖皮质激素吸入治疗并进行随访,监测其治疗2周、治疗3月、治疗6月后FeNO浓度的变化,通过统计学方法进行比较分析。结果1.支气管激发试验结果表明192例(64.00%)患者呈现阴性,108例(36.00%)呈现阳性,分别将其作为阴性组、阳性组。阴性组FeNO值(14.24±4.87)ppb,阳性组FeNO值(49.85±31.87)ppb,两组相比较差异有统计学意义(t=9.541,P=0.006)。2.判定气道高反应性的FeNO最佳值是26.5ppb,对应的特异性以及灵敏度分别为88.74%、65.21%,阳性预测值为87.53%,阴性预测值为66.95%。3.108例支气管激发试验阳性患者在给予激素治疗2周后测得的FeNO浓度较治疗前明显下降,两组相比较差异有统计学意义(t=19.37,P0.001);激素治疗组在治疗第3个月、第6个月时期测得的FeNO浓度值基本趋于正常,与同时期阴性组相比较差异无统计学意义(t=2.373,P0.05;t=1.941,P0.05)。结论FeNO检测应用于慢性咳嗽患者的气道高反应性的检测中,能准确判定患者气道反应性程度,具有较高的特异性以及敏感性;FeNO水平有助于评估慢性咳嗽患者的激素治疗效果,对疾病的诊断和预后有着重要的指导价值。
[Abstract]:Background and objective chronic cough means that the duration of coughing for patients exceeds eight weeks, and the results of X - ray examination show that the patient has no evidence of lung disease. In recent years, chronic cough is often misdiagnosed as chronic bronchitis, and the long-term use of antibiotics and antitussive drugs is not effective. Chronic coughing has become an outpatient and living in the Department of respiration. The main reason for the hospital and one of the main cost of the patients is that it is necessary to strengthen the understanding of this kind of disease. It is helpful for the correct analysis of the cause of the patient, the medical treatment of the doctor and the improvement of the therapeutic effect. The detection value of FeNO on the airway hyperresponsiveness of the patients with chronic cough and the changes of the concentration of FeNO before and after the hormone therapy are observed. In order to provide the basis for guiding the treatment and judging the prognosis. Method 1. through prospective study, 300 patients with chronic cough were selected in the Second Affiliated Hospital of Zhengzhou University and Xinyang Central Hospital in March -2015 in March 2014. All the subjects were tested first by FeNO, and then the bronchial provocation test was given to the bronchial provocation test knot. To determine whether the patients had airway hyperresponsiveness for the gold standard, and then compared with the exhaled nitric oxide (no) determination value,.2. was given the treatment of glucocorticoid inhalation for the positive patients with bronchial provocation test and followed up for 2 weeks. The treatment for March, the changes in the concentration of FeNO after June, were compared by statistical methods. Results the results of 1. bronchial provocation test showed that 192 cases (64%) were negative, 108 cases (36%) were positive, respectively, as negative group, positive group, negative group FeNO value (14.24 + 4.87) ppb, FeNO value of positive group (49.85 + 31.87) ppb, two groups were statistically significant (t=9.541, P=0.006).2. to determine the airway hyperresponsiveness FeN The optimal value of O was 26.5ppb, the corresponding specificity and sensitivity were 88.74%, 65.21%, positive predictive value 87.53%, negative predictive value for 66.95%.3.108 cases of bronchial provocation test positive patients after 2 weeks of hormone therapy was significantly lower than before the treatment (t=19.37, P0.001); the difference was statistically significant (t=19.37, P0.001); The value of FeNO concentration measured in the treatment group for third months and sixth months tended to be normal, and there was no significant difference between the same period negative group (t=2.373, P0.05; t=1.941, P0.05). Conclusion the application of FeNO to the detection of airway hyperresponsiveness in patients with chronic cough can accurately determine the degree of airway responsiveness of the patients. High specificity and sensitivity, FeNO level can help to evaluate the effect of hormone therapy in chronic cough patients and have important guidance value for the diagnosis and prognosis of the disease.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R56

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