支气管哮喘呼出气一氧化氮与支气管激发试验的相关性研究
发布时间：2018-11-03 11:12
【摘要】：背景支气管哮喘患者存在气道慢性炎症,气道高反应性,可逆性气流受限及气道重构。临床表现为反复发作的咳嗽,胸闷,喘息,呼吸困难,需要长期规范化治疗。医生迫切需要了解哮喘患者气道炎症的情况以减少发作,目前临床上尚缺乏既简便易行又真实可靠评价气道炎症和哮喘控制状态以指导医生治疗的指标。 目的探讨分析呼出气一氧化氮(Fractional exhaled Nitric Oxide, FeNO)与乙酰甲胆碱(methacholine)支气管激发试验(bronchial provocation test, BPT)能否反应哮喘控制程度及二者的相关性分析,评估二者在支气管哮喘诊断及疗效评价方面的临床价值。 方法选取2012.1-2013.10新乡市中心医院呼吸内科门诊支气管哮喘非急性发作期患者42例参加本研究测试,并根据《全球哮喘防治创议》2009方案非急性发作期哮喘控制状态分级标准分为控制组16例,部分控制组14例,未控制组12例。设正常对照组18例。 首先进行呼出气一氧化氮测试,然后进行肺通气功能测试,最后进行乙酰甲胆碱支气管激发试验。应用FEV1(第1秒钟用力呼气容积)下降20%时乙酰甲胆碱的药物激发浓度(PC20)评价气道反应性。应用FeNO评价气道炎症。观察测试中间出现的不良反应。 结果参加测试者共60人,测试中间有7例退出。最终有哮喘控制组15例,部分控制组13例,未控制组10例,正常对照组15例完成呼出气一氧化氮、肺通气功能测试和乙酰甲胆碱支气管激发试验。 哮喘控制组,部分控制组,未控制组FeNO结果、BPT对数转换PC20(lnPC20)与正常对照组均有显著差异,有统计学意义,P0.05。哮喘控制组,部分控制组,未控制组用力肺活量结果与正常对照组无显著差异,无统计学意义,P0.05。 支气管哮喘控制组、部分控制组、未控制组FeNO进行组间比较,控制组、部分控制组分在一个子集,无显著性差异。未控制组为一个子集,与控制组、部分控制组有显著性差异。 支气管哮喘乙酰甲胆碱支气管激发试验对数转换PC20(InPC20)控制组、部分控制组、未控制组进行组间比较,分为三个独立的子集,有显著差异。 直线相关分析结果显示：控制组、部分控制组、未控制组FeNO和支气管激发试验药物激发浓度lnPC20均有直线相关性,为负相关。(分别为r=-0.971,P0.05；r=-0.948,P0.05；r=-0.969,P0.05) 结论 1.评估哮喘控制状态需综合评定,不能单纯用呼出气一氧化氮结果来评定。 2.支气管激发试验能很好的反应哮喘控制状态。 3.呼出气一氧化氮结果在35-126.9ppb之间与支气管激发试验PC20呈负相关。呼出气一氧化氮反映的气道炎症与支气管激发试验反映的气道反应性呈正相关。 4.在临床诊断及疗效评价方面,呼出气一氧化氮可部分取代支气管激发试验评价支气管哮喘患者的气道炎症及气道高反应性。
[Abstract]:Background chronic airway inflammation, airway hyperresponsiveness, reversible airflow limitation and airway remodeling are present in patients with bronchial asthma. The clinical manifestations are recurrent cough, chest tightness, wheezing, dyspnea, and require long-term standardized treatment. Doctors urgently need to understand the airway inflammation in asthmatic patients to reduce the attack. At present, there is still a lack of simple and reliable evaluation of airway inflammation and asthma control status in order to guide the treatment of doctors. Objective to investigate whether the exhaled nitric oxide (Fractional exhaled Nitric Oxide, FeNO) and methacholine (methacholine) bronchial provocation test (bronchial provocation test, BPT) can respond to asthma control and the correlation between them. To evaluate their clinical value in the diagnosis and curative effect evaluation of bronchial asthma. Methods 42 patients with non-acute attack of bronchial asthma in Department of Respiratory Medicine, Xinxiang Central Hospital, 2012.1-2013.10, were selected to participate in this study. According to the criteria of "Global Asthma Prevention and treatment Initiative" 2009, the patients were divided into control group (n = 16), partial control group (n = 14) and uncontrolled group (n = 12). 18 cases of normal control group were set up. The exhalation nitric oxide (no) test, pulmonary ventilation function test, and methacholine bronchial provocation test were carried out. Airway reactivity was evaluated by FEV1 (forced expiratory volume of 1 second) at the time of reduction of methacholine drug excitation concentration (PC20) 20. Airway inflammation was evaluated by FeNO. Adverse reactions in the middle of the test were observed. Results A total of 60 participants were involved, and 7 of them dropped out. Finally, there were 15 cases of asthma control group, 13 cases of partial control group and 10 cases of uncontrolled group, and 15 cases of normal control group completed the test of exhalation nitric oxide, pulmonary ventilation function and methacholine bronchial provocation test. The results of FeNO and BPT logarithmic conversion PC20 (lnPC20) in asthma control group, partial control group and uncontrolled group were significantly different from those in normal control group (P 0.05). The results of forced vital capacity in asthma control group, partial control group and uncontrolled group were not significantly different from those in normal control group (P 0.05). The FeNO of bronchial asthma control group, partial control group and uncontrolled group were compared among groups. There was no significant difference between control group and partial control group. The uncontrolled group was a subset, which was significantly different from the control group and partial control group. The logarithmic conversion PC20 (InPC20) control group, partial control group and uncontrolled group were divided into three independent subsets of bronchial asthma. The results of linear correlation analysis showed that there was a linear correlation between FeNO in control group, partial control group and uncontrolled group, and lnPC20 in bronchial provocation test, which was negatively correlated. Conclusion 1. Evaluation of asthma control needs comprehensive evaluation, can not only be assessed by exhalation nitric oxide results. 2. Bronchial provocation test is a good response to asthma control. 3. The results of exhalation nitric oxide were negatively correlated with PC20 of bronchial provocation test between 35-126.9ppb. Airway inflammation reflected by exhalation nitric oxide was positively correlated with airway reactivity reflected by bronchial provocation test. 4. In clinical diagnosis and efficacy evaluation, exhalation nitric oxide can partially replace bronchial provocation test to evaluate airway inflammation and airway hyperresponsiveness in patients with bronchial asthma.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R562.25
本文编号：2307617
[Abstract]:Background chronic airway inflammation, airway hyperresponsiveness, reversible airflow limitation and airway remodeling are present in patients with bronchial asthma. The clinical manifestations are recurrent cough, chest tightness, wheezing, dyspnea, and require long-term standardized treatment. Doctors urgently need to understand the airway inflammation in asthmatic patients to reduce the attack. At present, there is still a lack of simple and reliable evaluation of airway inflammation and asthma control status in order to guide the treatment of doctors. Objective to investigate whether the exhaled nitric oxide (Fractional exhaled Nitric Oxide, FeNO) and methacholine (methacholine) bronchial provocation test (bronchial provocation test, BPT) can respond to asthma control and the correlation between them. To evaluate their clinical value in the diagnosis and curative effect evaluation of bronchial asthma. Methods 42 patients with non-acute attack of bronchial asthma in Department of Respiratory Medicine, Xinxiang Central Hospital, 2012.1-2013.10, were selected to participate in this study. According to the criteria of "Global Asthma Prevention and treatment Initiative" 2009, the patients were divided into control group (n = 16), partial control group (n = 14) and uncontrolled group (n = 12). 18 cases of normal control group were set up. The exhalation nitric oxide (no) test, pulmonary ventilation function test, and methacholine bronchial provocation test were carried out. Airway reactivity was evaluated by FEV1 (forced expiratory volume of 1 second) at the time of reduction of methacholine drug excitation concentration (PC20) 20. Airway inflammation was evaluated by FeNO. Adverse reactions in the middle of the test were observed. Results A total of 60 participants were involved, and 7 of them dropped out. Finally, there were 15 cases of asthma control group, 13 cases of partial control group and 10 cases of uncontrolled group, and 15 cases of normal control group completed the test of exhalation nitric oxide, pulmonary ventilation function and methacholine bronchial provocation test. The results of FeNO and BPT logarithmic conversion PC20 (lnPC20) in asthma control group, partial control group and uncontrolled group were significantly different from those in normal control group (P 0.05). The results of forced vital capacity in asthma control group, partial control group and uncontrolled group were not significantly different from those in normal control group (P 0.05). The FeNO of bronchial asthma control group, partial control group and uncontrolled group were compared among groups. There was no significant difference between control group and partial control group. The uncontrolled group was a subset, which was significantly different from the control group and partial control group. The logarithmic conversion PC20 (InPC20) control group, partial control group and uncontrolled group were divided into three independent subsets of bronchial asthma. The results of linear correlation analysis showed that there was a linear correlation between FeNO in control group, partial control group and uncontrolled group, and lnPC20 in bronchial provocation test, which was negatively correlated. Conclusion 1. Evaluation of asthma control needs comprehensive evaluation, can not only be assessed by exhalation nitric oxide results. 2. Bronchial provocation test is a good response to asthma control. 3. The results of exhalation nitric oxide were negatively correlated with PC20 of bronchial provocation test between 35-126.9ppb. Airway inflammation reflected by exhalation nitric oxide was positively correlated with airway reactivity reflected by bronchial provocation test. 4. In clinical diagnosis and efficacy evaluation, exhalation nitric oxide can partially replace bronchial provocation test to evaluate airway inflammation and airway hyperresponsiveness in patients with bronchial asthma.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R562.25
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