呼出气一氧化氮对嗜酸性粒细胞表型哮喘患者诊断及吸入糖皮质激素疗效评价的意义

发布时间：2018-08-11 15:39

【摘要】：背景支气管哮喘(简称哮喘)是一种呼吸道慢性炎症性疾病,临床表现为气道高反应性及气流可逆性。目前,临床上多根据肺功能、临床症状来诊断、监测哮喘和指导用药,其存在一定局限性(不能真实反映呼吸道炎症,不是每次肺功能测定均显示呼吸道的可逆性,特别是正在接受治疗的哮喘患者),远远满足不了临床需要。呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)是近年来新发现的反应呼吸道炎症的指标,有研究证实其可反应呼吸道嗜酸性粒细胞(eosinophils,EOS)炎症水平,且因其是一种无创性、操作简便、重复性好的检查而用于临床。FeNO不仅可以反应气道炎症,也能反应吸入糖皮质激素(inhaled corticosteroids,ICS)治疗的敏感性。部分学者认为FeNO水平可用来诊断哮喘及指导哮喘用药,但其目前对嗜酸性粒细胞表型哮喘诊断价值及ICS治疗疗效尚未达成共识。目的探讨FeNO检测对嗜酸性粒细胞表型哮喘的临床诊断价值及ICS疗效评价的意义。方法对2015年4月至2016年2月在新乡医学院第一附属医院呼吸内科住院的支气管哮喘患者,入选患者均为急性发作期,为哮喘组(62例),哮喘组患者根据诱导痰细胞检查分为嗜酸性粒细胞组(31例)和非嗜酸性粒细胞组(31例),其中嗜酸性粒细胞组按疾病严重程度又分为轻度哮喘组(7例)、中度哮喘组(13例)和重度哮喘组(11例);每组患者给予多索茶碱0.2g静脉输液,每天2次;西替利嗪10mg,每晚1次口服;孟鲁斯特10mg,每晚1次口服;雾化吸入布地奈德2mg和复方异丙托溴铵2.5ml雾化溶液,每天2次。常规治疗7天。出院后所有患者吸入布地奈德吸入剂4周治疗(200ug,每12小时1次)。治疗前分别检测患者的肺功能、哮喘控制测试(asthma control test,ACT)评分、FeNO水平及诱导痰嗜酸性粒细胞比例;治疗后检测患者的FeNO水平、ACT评分及肺功能。并且同时选取62例健康受试者为对照组,检测FeNO水平。结果治疗前,健康对照组FeNO水平明显低于哮喘组,差异有统计学意义(t=7.414,P=0.000);非嗜酸性粒细胞组FeNO水平明显低于嗜酸性粒细胞组,差异有统计学意义(t=6.568,P=0.000)。治疗前,哮喘组FeNO和诱导痰嗜酸性粒细胞比例呈正相关(γ=0.823,P=0.000);其中,嗜酸性粒细胞组FeNO和诱导痰嗜酸性粒细胞比例呈正相关(γ=0.770,P=0.000),非嗜酸性粒细胞组FeNO和诱导痰嗜酸性粒细胞比例无相关性(γ=0.300,P=0.101)。治疗前后FeNO水平比较,嗜酸性粒细胞组FeNO下降明显,差异有统计学意义(t=7.440,P=0.000),非嗜酸性粒细胞组下降不明显,差异无统计学意义(t=2.013,P=0.083);在嗜酸性粒细胞组中,轻、中、重度哮喘组治疗后FeNO水平低于治疗前,差异均有统计学意义(t=3.535,P=0.012;t=8.171,P=0.000;t=7.161,P=0.000)。治疗后根据ACT评分判断症状控制情况,嗜酸性粒细胞组控制率(67.7%)与非嗜酸性粒细胞组控制率(22.6%)比较差异有统计学意义(χ2=12.765,P=0.000);在嗜酸性粒细胞哮喘组中,轻度哮喘组控制率(28.6%)与中(76.9%)、重度哮喘组控制率(81.8%)比较差异有统计学意义(χ2=6.418,P=0.011;χ2=7.103,P=0.008),中度哮喘组与重度哮喘组控制率比较差异无统计学意义(χ2=0.087,P=0.769)。结论FeNO水平能反映嗜酸性粒细胞哮喘患者气道炎症程度,可用于嗜酸性粒细胞表型哮喘的诊断,对嗜酸性粒细胞哮喘患者ICS疗效评价有一定临床价值。
[Abstract]:Background Bronchial asthma (asthma) is a chronic inflammatory disease of the respiratory tract. Its clinical manifestations are airway hyperresponsiveness and airflow reversibility. Respiratory tract reversibility, especially in asthmatic patients undergoing treatment, is far from meeting clinical needs. Exhaled nitric oxide (FeNO) is a newly discovered indicator of respiratory inflammation in recent years, and has been confirmed to be responsive to eosinophils (EOS) inflammation. FeNO can not only reflect airway inflammation, but also reflect the sensitivity of inhaled corticosteroids (ICS). Some scholars believe that FeNO level can be used to diagnose asthma and guide asthma medication, but it is currently used for eosinophils. Objective To investigate the clinical value of FeNO detection in the diagnosis of eosinophilic asthma and the evaluation of ICS efficacy. Methods From April 2015 to February 2016, all the patients with bronchial asthma in the Department of Respiratory Medicine, First Affiliated Hospital of Xinxiang Medical College were enrolled. Asthma patients were divided into eosinophil group (31 cases) and non-eosinophil group (31 cases) according to the induced sputum test. The eosinophil group was divided into mild asthma group (7 cases), moderate asthma group (13 cases) and severe asthma group (11 cases) according to the severity of the disease. Sotheophylline 0.2g intravenous infusion, twice a day; cetirizine 10mg, once a night; montelukast 10mg, once a night; nebulized budesonide 2mg and compound ipratropium bromide 2.5ml aerosol solution, twice a day. Routine treatment lasted for 7 days. All patients were treated with budesonide inhalation for 4 weeks (200ug, once every 12 hours) after discharge. The pulmonary function, asthma control test (ACT), the level of FeNO and the proportion of eosinophils in induced sputum were measured. The levels of FeNO, ACT and pulmonary function were measured after treatment. 62 healthy subjects were selected as control group to detect the level of FeNO. In asthma group, the difference was statistically significant (t = 7.414, P = 0.000); the level of FeNO in non-eosinophil group was significantly lower than that in eosinophil group, the difference was statistically significant (t = 6.568, P = 0.000). Before treatment, the proportion of FeNO in asthma group was positively correlated with the proportion of eosinophils in induced sputum (gamma = 0.823, P = 0.000); among them, the level of FeNO in eosinophil group was significantly lower than that in induced sputum (t = 6.568, P The ratio of eosinophils was positively correlated (gamma = 0.770, P = 0.000). There was no correlation between the ratio of FeNO and eosinophils in induced sputum (gamma = 0.300, P = 0.101). The level of FeNO in eosinophils decreased significantly (t = 7.440, P = 0.000), but not in non-eosinophils. There was no significant difference (t = 2.013, P = 0.083); in the eosinophil group, the level of FeNO in the mild, moderate and severe asthma group after treatment was lower than that before treatment, the difference was statistically significant (t = 3.535, P = 0.012; t = 8.171, P = 0.000; t = 7.161, P = 0.000). The control rate of eosinophil group (22.6%) was significantly different (2 = 12.765, P = 0.000); the control rate of mild asthma group (28.6%) and moderate asthma group (76.9%) and severe asthma group (81.8%) were significantly different (2 = 6.418, P = 0.011; 2 = 7.103, P = 0.008), moderate asthma group and severe asthma group (2 = 6.418, P = 0.008). There was no significant difference in control rate (_2 = 0.087, P = 0.769). Conclusion FeNO level can reflect the degree of airway inflammation in patients with eosinophilic asthma, and can be used for the diagnosis of eosinophilic phenotypic asthma. It has certain clinical value in evaluating the efficacy of ICS in patients with eosinophilic asthma.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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